Blood phosphatidyl ethanol levels as a tool to detect alcohol misuse in trauma patients

Abstract

Introduction

There is a strong need for a reliable marker of harmful alcohol consumption to identify injured patients that can benefit from alcohol interventions, and blood phosphatidyl ethanol (PEth) has not previously been tested on this population. This study aims to compare the performance of blood PEth concentration, blood alcohol concentration (BAC) and the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) for the screening of alcohol misuse in trauma patients.

Methods

Prospective cross-sectional study of 238 adult patients presenting in the emergency department with any type of trauma. PEth concentration was determined in whole blood by high-performance liquid chromatography with tandem mass spectrometry. Consent, AUDIT-C score and demographic data were obtained.

Results

The sample consisted of majority male (67.6%), single (46.2%) and employed (66%) patients. The most common type of trauma was traffic collision (63.9%). The mean age was 41.7 years. We found a significant correlation between PEth levels with AUDIT-C score (Spearman’s r = 0.654; p < .0001). PEth had an area under the ROC curve of 0.885 to detect hazardous alcohol consumption (AUDIT-C score ≥ 6) and PEth ≥23.9 ng/mL cutoff point provided 91.2% of sensitivity and 78.4% of specificity. Twelve patients reported alcohol abstinence, but had quantifiable levels of PEth.

Conclusions

PEth levels and AUDIT-C score had a moderate correlation in our population. PEth was useful to identify 12 cases of underreporting of alcohol consumption habits. PEth shows promising results, but more research is needed to identify the best screening tool for alcohol misuse in trauma patients.

Keywords:

• Trauma
• ethanol
• phosphatidylethanol
• emergency medicine
• secondary prevention

Acknowledgments

V.V Muller, F. E. Gerbase, and Tegner M are recipients of CAPES (Ministry of Education, Brazil) scholarships. R. Linden is recipient of a research scholarship from the National Council for Scientific and Technological Development in Brazil (CNPQ) and Maria Eduarda Krutzmann from CNPQ.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was financial supported by the National Institute of Science and Technology in Forensic Sciences [MCTI/CNPQ/CAPES/FAPS 16/2014 – INCT program, CNPQ 465450/2014-8] and CNPq (process 432940/2018-9).