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Markers accurately measured alcohol consumption in LT recipients, candidates

Urinary ethyl glucuronide and the Alcohol Use Disorders Identification Test were accurate when measuring alcohol consumption among liver transplant candidates and recipients, according to data from a recent study.

Researchers assessed 98 liver transplant candidates (LTC) with alcoholic cirrhosis (mean age, 55.7 years; 77.6% men) and 23 liver transplant recipients (LTR) with pretransplant alcoholic cirrhosis (mean age, 60 years; 78.2% men) from the management program at the University of Padua, Italy, between January 2011 and December 2012.

Follow-up for LTCs and LTRs differed depending on the incidence of ensuing complications. All patients underwent an alcohol use disorders identification test (AUDIT-c) to identify alcohol consumption based on answers to three questions: overall frequency of drinking, usual quantity of drinks consumed and frequency of consuming five or more drinks. Other evaluated direct markers were urinary ethyl glucuronide (uEtG), carbohydrate-deficit transferrin, urinary ethanol and serum ethanol.

Alcohol consumption was found in 30.6% of all patients, including 21.7% of LTRs and 32.7% of LTCs. Fourteen percent of patients admitted alcohol consumption at the time of AUDIT-c, whereas 16.5% of patients denied alcohol intake, but were found to be positive for alcohol consumption. Of the 20 patients who denied drinking alcohol, 19 were positive for uEtG.

Researchers said uEtG was the strongest alcoholic marker (P<.0001), displaying the highest sensitivity (89.2%; 95% CI, 79.2-99.2%) and accuracy (95.9%; 95% CI, 92.2-99.5%) rates. Multivariate analysis revealed AUDIT-c (OR=274.245; 95% CI, 7.145->999.999) and uEtG (OR=493.809; 95% CI, 51.292->999.99) to be independent predictors of alcohol consumption and the most accurate combination of all markers examined.

“The association of AUDIT-c and uEtG substantially improves the detection of alcohol consumption in these patients,” the researchers wrote. “We suggest using uEtG and AUDIT-c at each visit in LTCs and randomly in LTRs. However, uEtG and AUDIT-c should be used at each visit even in LTRs whenever a clinical suspicion or risk factors for relapse to drinking occur.”

Disclosure: The researchers report no relevant financial disclosures.