The roles of phosphatidylethanol, ethyl glucuronide, and ethyl sulfate in identifying alcohol consumption among participants in professionals health programs

Abstract

Direct alcohol biomarkers, including urinary ethyl glucuronide (EtG), urinary ethyl sulfate (EtS), and blood phosphatidylethanol (PEth), are used to monitor alcohol abstinence in individuals who are mandated to abstain. In this consecutive case series study, we examined 1000 forensic reports of participants enrolled in a professionals health program who were contractually obligated to abstain from alcohol and who underwent recovery status evaluations. We identified 52 evaluations in which urinary EtG, EtS, and blood PEth were measured and which produced a positive result for at least one of these analytes. PEth, at a cutoff concentration of 20 ng/mL, revealed alcohol use more frequently than EtG or EtS at our laboratory's cutoff concentrations of 100 and 25 ng/mL, respectively. This was true, as well, at alternative EtG/EtS cutoff concentrations of 200/50, 300/75, and 400/100 ng/mL. PEth was more likely than EtG/EtS to be positive in participants previously diagnosed with alcohol use disorders (AUD), whereas EtG/EtS was more likely than PEth to be positive in participants without AUD. In this study, blood PEth was the most sensitive biomarker for evidencing alcohol use.

Phosphatidylethanol for Monitoring Alcohol Use in Liver Transplant Candidates: An Observational Study

“…Previous studies comparing EtG and EtS in the same population seem to have shown a good, even larger sensitivity for EtS compared to EtG [ 17 ]. That being said, there are also studies suggesting PEth could be more sensitive than EtS, although they have not been performed in liver transplant candidates [ 28 ].…”

Relationship of Phosphatidylethanol Biomarker to Self‐Reported Alcohol Drinking Patterns in Older and Middle‐Age Adults

“…Phosphatidylethanol (PEth), an ethanol (EtOH) biomarker, has been frequently used and characterized in the context of groups of individuals who consume unhealthy amounts of alcohol such as those attending alcohol treatment facilities and human immunodeficiency virus (HIV) clinics. There is increasing knowledge regarding the utility of PEth in the context of community‐dwelling adults (Helander et al, 2019; Neumann et al, 2020; Nguyen et al, 2018; Reisfield et al, 2020; Schrock et al, 2017; Ulwelling and Smith, 2018). However, less is known for older adults for whom alcohol consumption can have a different, often more detrimental, impact on health (Moos et al, 2005).…”

“…Breath testing, which is used to estimate recent alcohol consumption from the blood alcohol concentration (BAC) at the moment of sampling, or other blood‐based measures such as ethyl glucuronide and ethyl sulfate can detect very recent alcohol ingestion (Halter et al, 2008; Mastrovito and Strathmann, 2020; Neumann et al, 2020; Reisfield et al, 2020). Other common blood‐ and urine‐based measures used in a clinical setting include carbohydrate‐deficient transferrin (CDT) and serum γ‐glutamyltransferase (GGT; Litten et al, 2010; Mastrovito and Strathmann, 2020; Neumann et al, 2020; Reisfield et al, 2020). However, CDT and GGT may be influenced by other factors besides alcohol intake, including smoking, gender, age, and various diseases (Andresen‐Streichert et al, 2018; Conigrave et al, 2003; Neumann et al, 2020).…”

“…Recognizing individual variation in PEth clearance, in general, PEth may be detected in blood for up to 10 days after a single episode of alcohol consumption and can be detected up to 3 weeks after repeated consumption and may be stable in preserved samples for years (Helander et al, 2019; Hill‐Kapturczak et al, 2018; Javors et al, 2016; Lakso et al, 2019; Lopez‐Cruzan et al, 2018; Schröck et al, 2017). Because PEth accumulates in the body after repeated drinking and because the elimination period varies from days to weeks according to amount and frequency ingested, it can be useful for providing information on alcohol consumption particularly when combined with additional biomarkers (Gnann et al, 2012; Neumann et al, 2020; Reisfield et al, 2020; Ulwelling and Smith, 2018). PEth is better than traditional biomarkers as it appears to be uninfluenced by liver disease (Andresen‐Streichert et al, 2018; Stenton et al, 2019; Ulwelling and Smith, 2018), although more research in this area is needed (Hakim et al, 2019; Nguyen et al, 2018).…”

“…Most recently, dermal monitors have complimented self‐report to characterize synthesis and elimination of PEth to experimentally determined volumes of alcohol (Hill‐Kapturczak et al, 2018). The association of PEth with low or minimal alcohol consumption may be weaker or more variable (Helander et al, 2019; Helander et al, 2012; Kechagias et al, 2015; Neumann et al, 2020; Reisfield et al, 2020).…”