Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients.
Cut-Point Levels of Phosphatidylethanol to Identify Alcohol Misuse in a Mixed Cohort Including Critically Ill Patients.
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DOI：
10.1111/acer.13471
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发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Lowery EM
中科院分区：
文献类型：
--
作者：
Afshar M;Burnham EL;Joyce C;Clark BJ;Yong M;Gaydos J;Cooper RS;Smith GS;Kovacs EJ;Lowery EM
尽管酒精滥用与危重患者的有害结果相关，但通过自我报告或生物标志物检查难以一致地检测到酒精滥用。磷脂酰乙醇（PEth）是一种直接的酒精生物标志物，可以表征酒精消费模式;然而，其在识别危重患者误用方面的诊断准确性尚不清楚。PEth值是在一个混合队列中获得的，该队列包括来自医疗和烧伤重症监护病房（n=33）、酒精解毒病房（n=51）和健康志愿者（n=38）的122名个体。任何酒精滥用和严重滥用分别参考AUDIT和AUDIT-C评分。进行混合效应logistic回归分析，并使用受试者工作特征（ROC）曲线下面积评价PEth的区分度。对于AUDIT定义的任何误用，PEth的ROC曲线下面积为0.927（95% CI：0.877，0.977），对于重度误用，为0.906（95% CI：0.850，0.962）。根据AUDIT-C，任何误用的ROC曲线下面积为0.948（95% CI：0.910，0.956），严重误用的ROC曲线下面积为0.913（95% CI：0.856，0.971）。PEth临界点≥ 250 ng/mL和≥ 400 ng/mL分别为任何误用和重度误用提供了最佳区分。≥ 250 ng/mL的阳性预测值为88.7%（95% CI：77.5%，95.0%），阴性预测值为86.7%（95% CI：74.9%，93.7%）。PEth ≥ 400 ng/mL获得相似的值，AUDIT-C显示相似的结果。仅在危重患者的亚组分析中，检测特征与混合队列相似。PEth是一个强有力的预测因子，在包括危重患者的混合队列中，对任何和严重的酒精滥用具有良好的区分力。任何情况下的临界点为250 ng/mL，重度情况下的临界点为400 ng/mL，这是有利的。需要外部验证来确定危重患者的这些临界点。
Although alcohol misuse is associated with deleterious outcomes in critically ill patients, its detection by either self-report or examination of biomarkers is difficult to obtain consistently. Phosphatidylethanol (PEth) is a direct alcohol biomarker that can characterize alcohol consumption patterns; however, its diagnostic accuracy in identifying misuse in critically ill patients is unknown. PEth values were obtained in a mixed cohort comprised of 122 individuals from medical and burn intensive care units (n=33), alcohol detoxification unit (n=51), and healthy volunteers (n=38). Any alcohol misuse and severe misuse were referenced by AUDIT and AUDIT-C scores separately. Mixed effects logistic regression analysis was performed and the discrimination of PEth was evaluated using the area under the receiver operating characteristic (ROC) curve. The area under the ROC curve for PEth was 0.927 (95% CI: 0.877, 0.977) for any misuse and 0.906 (95% CI: 0.850, 0.962) for severe misuse defined by AUDIT. By AUDIT-C, the area under the ROC curves were 0.948 (95% CI: 0.910, 0.956) for any misuse and 0.913 (95% CI: 0.856, 0.971) for severe misuse. The PEth cut-points of ≥ 250 ng/mL and ≥ 400 ng/mL provided optimal discrimination for any misuse and severe misuse, respectively. The positive predictive value for ≥ 250 ng/mL was 88.7% (95% CI: 77.5%, 95.0%) and negative predictive value was 86.7% (95% CI: 74.9%, 93.7%). PEth ≥ 400 ng/mL achieved similar values and similar results were shown for AUDIT-C. In a subgroup analysis of critically ill patients only, test characteristics were similar to the mixed cohort. PEth is a strong predictor and has good discrimination for any and severe alcohol misuse in a mixed cohort that includes critically ill patients. Cut-points at 250 ng/mL for any, and 400 ng/mL for severe, are favorable. External validation will be required to establish these cut-points in critically ill patients.
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影响因子：
5.5
作者：
Bouchery, Ellen E.;Harwood, Henrick J.;Brewer, Robert D.
通讯作者：
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影响因子：
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作者：
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DOI：
10.1111/j.1530-0277.2012.01768.x
发表时间：
2012-09-01
影响因子：
3.2
作者：
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2
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8.8
作者：
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