Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients

被引:45
作者
Afshar, Majid [1 ,2 ,3 ]
Burnham, Ellen L. [4 ]
Joyce, Cara [3 ]
Clark, Brendan J. [4 ]
Yong, Meagan [1 ,2 ]
Gaydos, Jeannette [4 ]
Cooper, Richard S. [3 ]
Smith, Gordon S. [5 ]
Kovacs, Elizabeth J. [6 ]
Lowery, Erin M. [1 ,2 ]
机构
[1] Loyola Univ, Stritch Sch Med, Hlth Sci Campus, Maywood, IL 60153 USA
[2] Loyola Univ, Stritch Sch Med, Alcohol Res Program, Hlth Sci Campus, Maywood, IL 60153 USA
[3] Loyola Univ Chicago, Stritch Sch Med, Dept Publ Hlth Sci, Hlth Sci Campus, Maywood, IL USA
[4] Univ Colorado, Dept Med, Div Pulm Sci & Crit Care Med, Sch Med, Aurora, CO USA
[5] Univ Maryland, Dept Surg, Shock Trauma & Anesthesiol Res STAR Organized Res, Baltimore, MD 21201 USA
[6] Univ Colorado, Dept Surg, Sch Med, Aurora, CO USA
关键词
Phosphatidylethanol; Biomarker; Alcohol Misuse; Critical Illness; DISORDERS IDENTIFICATION TEST; CARBOHYDRATE-DEFICIENT TRANSFERRIN; RESPIRATORY-DISTRESS-SYNDROME; DRIED BLOOD SPOTS; ETHANOL METABOLITES; HOSPITAL MORTALITY; TRAUMA PATIENTS; LIVER-DISEASE; PRIMARY-CARE; TEST AUDIT;
D O I
10.1111/acer.13471
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
BackgroundAlthough alcohol misuse is associated with deleterious outcomes in critically ill patients, its detection by either self-report or examination of biomarkers is difficult to obtain consistently. Phosphatidylethanol (PEth) is a direct alcohol biomarker that can characterize alcohol consumption patterns; however, its diagnostic accuracy in identifying misuse in critically ill patients is unknown. MethodsPEth values were obtained in a mixed cohort comprising 122 individuals from medical and burn intensive care units (n=33), alcohol detoxification unit (n=51), and healthy volunteers (n=38). Any alcohol misuse and severe misuse were referenced by Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C scores separately. Mixed-effects logistic regression analysis was performed, and the discrimination of PEth was evaluated using the area under the receiver-operating characteristic (ROC) curve. ResultsThe area under the ROC curve for PEth was 0.927 (95% CI: 0.877, 0.977) for any misuse and 0.906 (95% CI: 0.850, 0.962) for severe misuse defined by AUDIT. By AUDIT-C, the area under the ROC curves was 0.948 (95% CI: 0.910, 0.956) for any misuse and 0.913 (95% CI: 0.856, 0.971) for severe misuse. The PEth cut-points of 250 and 400ng/ml provided optimal discrimination for any misuse and severe misuse, respectively. The positive predictive value for 250ng/ml was 88.7% (95% CI: 77.5, 95.0), and the negative predictive value was 86.7% (95% CI: 74.9, 93.7). PEth400ng/ml achieved similar values, and similar results were shown for AUDIT-C. In a subgroup analysis of critically ill patients only, test characteristics were similar to the mixed cohort. ConclusionsPEth is a strong predictor and has good discrimination for any and severe alcohol misuse in a mixed cohort that includes critically ill patients. Cut-points at 250ng/ml for any, and 400ng/ml for severe, are favorable. External validation will be required to establish these cut-points in critically ill patients.
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页码:1745 / 1753
页数:9
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