Biomolecules and Biomarkers Used in Diagnosis of Alcohol Drinking and in Monitoring Therapeutic Interventions

Nanau, Radu M.; Neuman, Manuela G. · 2015 · OpenAlex-citations

DOI: 10.3390/biom5031339

archive: archived pipeline: cataloged verified

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Summary

This systematic review addresses the critical need for accurate, quantitative methods to detect alcohol consumption and monitor therapeutic interventions in populations where self-reporting is unreliable, such as transplant candidates, HIV patients, and occupational hazard offenders. The authors highlight that while alcohol misuse causes significant global morbidity, many individuals deny drinking, necessitating biochemical verification. The study aims to evaluate current biomarkers, assess their detection windows and sensitivities, and identify the need for assay standardization to ensure their utility as routine clinical tools. The authors conducted a systematic review of literature published between 2010 and 2015 using PubMed and Google Scholar databases. They analyzed studies correlating social instruments with biochemical tests for various markers, including breath alcohol concentration (BrAC), blood alcohol concentration (BAC), ethyl glucuronide (EtG), ethyl sulfate (EtS), phosphatidylethanol (PEth), fatty acid ethyl esters (FAEE), and carbohydrate-deficient transferrin (CDT). The review synthesizes data on the pharmacokinetics, detection limits, and diagnostic performance of these biomarkers across different populations, including healthy volunteers, drivers, and patients undergoing alcohol withdrawal treatment. The findings indicate that breath tests provide rapid results but have a short detection window of hours and suffer from significant variability due to physiological factors like breathing patterns, lung capacity, and food intake. Consequently, BrAC is often a poor estimator of actual BAC in real-world scenarios, with commercial devices showing inconsistent sensitivity. Direct metabolites in urine, specifically EtG and EtS, offer extended detection windows of up to 80 hours and five days, respectively, after alcohol elimination. EtG demonstrates high sensitivity and specificity for detecting recent consumption, with studies showing it identifies relapse cases missed by breath tests and self-reports. For instance, in one study, 93.2% of relapse cases were identified solely by EtG. However, EtG sensitivity decreases after 24 hours for light drinking. Indirect markers like CDT and gamma-glutamyl transpeptidase reflect longer-term, heavy consumption but require correlation with direct markers for comprehensive monitoring. The significance of this review lies in its demonstration that no single biomarker is sufficient for all clinical and forensic contexts. The authors conclude that a combination of methods is necessary to cover immediate, short-term, and long-term consumption windows. Specifically, EtG and EtS are superior for verifying abstinence and detecting relapse in treatment settings, while breath tests remain useful for immediate impairment assessment despite their limitations. The review underscores the urgent need for standardized assays and cut-off values to ensure these biochemical tests are reliably integrated into routine medical and legal practice, thereby improving the monitoring of alcohol misuse and therapeutic adherence.

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• alcohol