Urinary ethyl glucuronide testing detects alcohol consumption in alcoholic liver disease patients awaiting liver transplantation

Abstract

This study compared measurement of urinary ethyl glucuronide (EtG), a conjugated minor ethanol metabolite with a longer detection window than ethanol itself, with breath alcohol testing and self-report as ways to disclose recent drinking by 18 liver transplant candidates with an alcoholic liver disease diagnosis that underwent an addiction group therapy program. At each therapy session, patients were questioned about any alcohol consumption in the intervening time, and they also performed a mandatory breath alcohol test, while observed urine samples for measurement of EtG were delivered on a voluntary basis. None of the patients ever admitted to intake of alcohol, and only 1 of 127 breath alcohol tests turned out positive. However, 9 patients showed positive EtG results in 24 (49%) of 49 urine samples. The individual frequency of urine samples being positive for EtG ranged from 22% to 100% with a mean value of 57%. Because 6 patients refused to provide urine on a total of 18 occasions, alcohol use might have been even more common. These results underscore the uncertainty of self-report data and the low sensitivity of breath alcohol testing as ways to disclose recent drinking, and underline the necessity of introducing sensitive and specific objective measures of recent alcohol consumption, such as EtG, in the transplantation setting. Liver Transpl 13:757-761, 2007.

Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation

“…If these patients remain abstinent, their prognosis is superior to that of patients with liver cirrhosis of other etiologies. However, continued alcohol consumption is considered an absolute contraindication for LT. [1][2][3][4] Therefore, the high percentages of relapse cases before LT (19%-50%) 5,6 and after LT (11%-80%) [7][8][9][10][11][12][13][14][15][16][17][18][19][20] pose a serious problem. [21][22][23][24][25] To ensure abstinence by the patient, a strict and systematic investigation is required.…”

“…Recent studies using ethyl glucuronide have provided promising results. 6,26 For obvious reasons, selfreporting is not reliable because the denial of alcohol consumption is a typical symptom of addictive behavior. Because of its short half-life and increased elimination in alcoholics, ethanol is also an unreliable method of testing.…”

Molecular Species of the Alcohol Biomarker Phosphatidylethanol in Human Blood Measured by LC-MS

“…The conjugated minor ethanol metabolites ethyl glucuronide (2 ) and ethyl sulfate (3 ) and fatty acid ethyl esters (4 ) are examples of such tests. Ethyl glucuronide and ethyl sulfate are excreted in urine for a much longer time than ethanol and hence have gained popularity as diagnostically sensitive and specific tests to spot recent alcohol consumption (5)(6)(7). For detection and follow-up of long-term risky or heavy drinking, measurement of the alcohol-related change in the serum transferrin glycoform profile known as carbohydrate-deficient transferrin (CDT) 2 (8, 9 ) has become a standard method, often used in combination with liver function tests (e.g., ␥-glutamyltransferase) (1 ).…”

Liver Transplantation for Alcohol-Related Liver Disease

“…There are several studies on carbohydrate-deficient transferring (CDT) and urinary ethyl glucuronide. [42][43][44][45] Carbohydrate-deficient transferrin can be used for initial screening or to measure relapse. 39 Transferrin (glycoprotein) is secreted by liver.…”