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Hair follicles indicate excessive alcohol use in alcoholic cirrhosis

Hair ethyl glucuronide levels accurately estimated chronic excessive alcohol use in patients with alcoholic cirrhosis, according to recently published data.

“The exclusion of chronic excessive alcohol use based on the [hair ethyl glucuronide] level corresponded in all patients with the absence of histological hallmarks of ongoing excessive alcohol use, except in one abstinent patient with nonalcoholic steatohepatitis,” Jef Verbeek, MD, PhD, from the University Hospitals KU Leuven, Belgium, and colleagues wrote.

The study comprised 58 patients with alcoholic cirrhosis and 43 patients with alcoholic cirrhosis who denied chronic excessive alcohol use during the previous 3 months. Researchers collected proximal 3-cm scalp hair strands, blood samples and responses to a detailed questionnaire from all patients, and liver biopsies from 13 patients in the first group and 16 patients in the second group.

Characteristics including age, sex, BMI, liver tests, renal function, MELD scores and use of hair cosmetics did not differ between the groups. Additionally, total bilirubin, international normalized ratio, MELD scores and creatinine levels did not differ between the 67 patients with hair ethyl glucuronide less than 50 pg/mg and the 34 patients with hair ethyl glucuronide of 50 pg/mg or higher.

Patients with cirrhosis and hair ethyl glucuronide levels below 50 pg/mg did not show histological signs of ongoing excessive alcohol use, except one patient who had a hair ethyl glucuronide level less than 0.7 pg/mg and a history of bariatric surgery.

Fifteen of the 43 patients with alcoholic cirrhosis who denied recent chronic excessive alcohol had hair ethyl glucuronide levels of 50 pg/mg or higher, indicating chronic excessive alcohol use in the previous 3 months.

“We advocate to interpret [hair ethyl glucuronide] levels below 50 pg/mg with caution. This [hair ethyl glucuronide] range excludes chronic excessive alcohol use, but does not allow distinction between abstinence or ongoing moderate alcohol use in patients with alcoholic cirrhosis,” the researchers wrote. “Possibly, these issues can be redressed by serial or segmental hair analyses and the additional testing of urinary [ethyl glucuronide].” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.