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Validation of Blood Phosphatidylethanol as an Alcohol Consumption Biomarker in Patients with Chronic Liver Disease
Author(s) -
Stewart Scott H.,
Koch David G.,
Willner Ira R.,
Anton Raymond F.,
Reuben Adrian
Publication year - 2014
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.12442
Subject(s) - phosphatidylethanol , medicine , abstinence , confidence interval , biomarker , alcoholic liver disease , alcohol , liver disease , alcohol consumption , chronic liver disease , gastroenterology , cutoff , heavy drinking , cirrhosis , chemistry , psychiatry , biochemistry , phospholipid , physics , quantum mechanics , membrane , phosphatidylcholine
Background Blood phosphatidylethanol ( PE th) is a promising biomarker of alcohol consumption. This study was conducted to evaluate its performance in patients with liver disease. Methods This study included 222 patients with liver disease. Patient‐reported alcohol use was obtained as a reference standard, and PE th was measured by tandem mass spectrometry. Receiver operating characteristic ( ROC ) and contingency table analyses were used to assess the performance of PE th in detecting any drinking and averaging 4 or more drinks daily in the past 30 days. Results At the limit of quantitation (20 ng/ml), PE th was 73% sensitive (95% confidence interval [ CI ] 65 to 80) and 96% specific (95% CI 92 to 100) for any drinking in the past month. Subjects who drank but had a negative PE th result were mainly light drinkers. Subjects who reported 30‐day abstinence but with quantifiable PE th either reported heavy drinking within the past 6 weeks or had data that suggested underreported drinking. At the optimal cutoff concentration of 80 ng/ml, PE th was 91% sensitive (95% CI 82 to 100) and 77% specific (95% CI 70 to 83) for averaging at least 4 drinks daily. Conclusions PE th is a useful test for detecting alcohol use in patients with liver disease, but cutoff concentrations for heavy drinking will result in misclassification of some moderate to heavy drinkers.