The ethanol conjugate ethyl glucuronide is a useful marker of recent alcohol consumption

Background: Current biological state markers remain suboptimal with regard to sensitivity and specificity for monitoring alcohol consumption. The currently used state markers can be influenced by age, sex, and a variety of substances and non-alcohol-associated diseases and do not fully cover the time axis for alcohol intake. Ethyl glucuronide (EtG) is a promising, nonvolatile, water-soluble marker of recent alcohol consumption that is stable during storage and can be detected for an extended time period (up to 80 hr) after alcohol is completely eliminated from the body. Patients and Methods: In the WHO/ISBRA Study of State and Trait Markers of Alcohol Use and Dependence, EtG was determined in urine samples from 304 patients with an liquid chromotography, electrospray ionization double mass spectrometry (ESI-LC/MS-MS) method. Deuterium labeled EtG was used as internal standard. Determination limit was 0.1 mg/liter. All measurements were performed in duplicate. A calibration solution was measured after each 10 samples. Results: The following significant correlations were found for the Spearman rank correlation for the total sample between EtG and other variables: sobriety in days (r = -0.6), 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid (HTOL/HLAA) ratio (r = 0.58), ethanol level (r = 0.433), methanol level (r = 0.198), carbohydrate-deficient transferrin (r = 0.458), gamma-glutamyltransferase (r = 0.428), aspartate aminotransferase (r = 0.260), age (r = 0.264), and total grams of ethanol consumed in the previous month (r = 0.467). In a subsample of 277 subjects in whom no ethanol was detectable in urine, the following correlations with EtG levels were found: sobriety (days; r = -0.597), HTOL/HIAA ratio (r = 0.478) gamma-glutamyltransferase (r = 0.422), total grams of ethanol consumed last month (r = 0.395), and carbohydrate-deficient transferrin (r = 0.366; all significant at p < 0.05). When we compared results between EtG levels and the HTOL/HIAA ratio, 68.8% (n = 119) of those positive for EtG did not have elevated values for the HTOL/HLAA ratio. Thirty-one percent (31.2%) of these 119 subjects were positive for both parameters, but of those negative for EtG, only 4.4% had an elevated HTOL/HIAA ratio. Conclusions: EtG is a good candidate for a sensitive, specific, and reliable marker of recent alcohol intake. The complementary use of this marker with other biological state markers should significantly improve treatment outcome and therapy effectiveness and reduce costs.