Urine test improves detection of alcohol use in liver transplant patients

By Sharon Nirenberg MD

NEW YORK (Reuters Health) - When used together, urinary ethyl glucuronide (uEtG) and the Alcohol Use Disorders Identification Test for alcohol consumption (AUDIT-c) improve the detection of alcohol consumption in liver transplant candidates and recipients, according to a recent study.

The study, published online May 7 in Liver Transplantation, confirms the results of previous studies which found uEtG was the most sensitive and accurate marker of alcohol consumption when compared to others, including carbohydrate deficient transferrin, urinary ethanol (uETOH), and serum ethanol (sETOH).

Previous studies have also shown that uEtG can detect low levels of alcohol (approximately 10 g) up to 80 hours after alcohol was last consumed.

Liver transplant patients who abstain from alcohol for a period of time prior to transplantation are less likely to relapse post transplant, experts believe. Furthermore, alcohol use after transplant is associated with increased morbidity and mortality due to graft loss and noncompliance with immunosuppressive therapy.

"It is crucial to assess alcohol consumption both in liver transplant candidates and in liver transplant recipients," senior author Dr. Paolo Angeli of the University of Padova, Italy, told Reuters Health via email. This study, he added, shows that routine use of the AUDIT-c and uEtG, which are simple and reliable tools, may help physicians detect alcohol consumption in these patient populations.

Dr. Angeli and colleagues assessed the sensitivity, specificity, and accuracy of various serum and urine markers in determining alcohol consumption in 121 liver transplant candidates and recipients. Additionally, a hepatologist administered the AUDIT-c at each outpatient visit.

Alcohol consumption was detected in 32.7% of the liver transplant candidates (32/98) and 21.7% of the recipients (5/23). Twenty patients with a positive biomarker denied alcohol consumption on the AUDIT-c assessment.

uEtG was the most sensitive (89.2%) and accurate (95.9%) marker for detecting alcohol consumption. Additionally, compared to carbohydrate deficient transferrin (CDT), uEtG was more strongly correlated with the amount of alcohol patients reported consuming. Together, uEtG and AUDIT-c demonstrated a higher accuracy in detecting alcohol consumption than CDT and AUDIT-c (AUROC=0.98 vs 0.80; p<0.001).

"We know that patients do not always tell us when they are drinking, but it is important to find out in order to get them back into treatment to improve posttransplant outcomes, " Dr. Patricia A. Sheiner, a liver transplant surgeon at Hartford Hospital in Connecticut, told Reuters Health via email.

Dr. Sheiner, who was not involved in the study, added, "The use of the uEtG test, if inexpensive and easy to get, will gain more traction, especially since it can detect lower levels of alcohol used in the past 80 hours which is an improvement over testing used today."

SOURCE: http://bit.ly/1qVVG4Q

Liver Transpl 2014.