Hair ethyl glucuronide detects excessive alcohol use in cirrhosis

BOSTON — Hair ethyl glucuronide was accurate in detecting excessive alcohol use up to 3 months in patients with cirrhosis, suggesting it may be a useful biomarker, according to data presented by Jef Verbeek, MD, PhD, and colleagues at The Liver Meeting.

“Current biomarkers of alcohol use have little value due to short half life or limited diagnostic accuracy. At the moment, there is no golden standard to prove chronic alcohol abuse in patients with cirrhosis. The aim of the study was to explore the diagnostic potential of hair analysis measurements of ethyl glucuronide to demonstrate ongoing alcohol misuse or use in patients with alcoholic cirrhosis,” said Frederik Nevens, MD, PhD, from the department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Belgium.

Jef Verbeek

In the trial, 101 patients with alcoholic cirrhosis were enrolled and divided among a validation cohort (n = 58) and a clinical application cohort (n = 43). In the validation cohort, 43 healthy volunteers were also used. During the study, patients completed a questionnaire and submitted to blood and a 3-cm scalp hair strand collection to properly measure hair ethyl glucuronide and other biomarkers. The researchers measured patients’ alcohol use as abstinent (0 g/day), moderate (0 to 60 g/day) or excessive (more than 60 g/day) for the previous 3 months.

Among patients with cirrhosis, hair ethyl glucuronide showed high diagnostic accuracy for excessive alcohol use with 100% sensitivity, 95% specificity, 95% positive predictive value and 100% negative predictive value. Hair ethyl glucuronide also showed 100% specificity for moderate alcohol use in healthy volunteers; however, hair ethyl glucuronide did not provide a reliable discrimination between moderate alcohol users and those who were abstinent, according to Nevens.

Frederik Nevens

The hair ethyl glucuronide correlated well with alcohol use in the previous 3 months in healthy volunteers (P = .0004) and patients with cirrhosis (P = .00097). The hair ethyl glucuronide was not affected by kidney or liver impairment, compared with the use of Carbohydrate Deficient Transferrin, which was unmeasurable in 35% of patients due to the presence of cirrhosis.

“Based on the refined cut-off levels derived from our validation group, self-declared abstinence or moderate alcohol use was refuted in 35% of patients referred for liver transplantation,” Verbeek told Healio.com/Hepatology.

Verbeek and Nevens concluded: “In patients with alcoholic cirrhosis, hair ethyl glucuronide is an accurate biomarker of chronic excessive alcohol use in the previous 3 months. The values correlate quite well with the amount of consumed alcohol and are not influenced by degree of liver failure. Therefore, hEtG offers the clinician an objective proof of alcohol abuse during the preceding 3 months.” – by Melinda Stevens

Reference:

Verbeek J, et al. Abstract 95. Presented at: The Liver Meeting; Nov. 11-15, 2016; Boston.

Disclosures: Nevens reports consulting for AbbVie, Bristol-Myers Squibb, CFA, Durect, Gore, Intercept Pharmaceuticals, Janssen-Cilag, MSD, Novartis, Ono Pharma and Promethera Biosciences; and receiving grant/research support from AbbVie, Astellas, Ferring, Janssen-Cilag, Novartis and Roche.