How Low Should You Go? Determining the Optimal Cutoff for Exhaled Carbon Monoxide to Confirm Smoking Abstinence When Using Cotinine as Reference
How Low Should You Go? Determining the Optimal Cutoff for Exhaled Carbon Monoxide to Confirm Smoking Abstinence When Using Cotinine as Reference
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DOI：
10.1093/ntr/ntu085
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发表时间：
2014-10-01
影响因子：
4.7
通讯作者：
Hendricks, Peter S.
中科院分区：
文献类型：
--
作者：
Cropsey, Karen L.;Trent, Lindsay R.;Hendricks, Peter S.
引言：在戒烟临床试验中强调戒烟对于确定治疗有效性至关重要。有几种生物学方法可以验证禁欲（e。例如，在一个实施例中，呼出的一氧化碳[CO]，可替宁），虽然可替宁提供了更长的检测窗口，但它不容易用于涉及尼古丁替代疗法的试验。尼古丁和烟草研究学会的生化验证小组委员会引用8-10 ppm的CO作为确定戒烟的可行截止值;然而，最近的文献表明这个截止值可能太高，可能高估了治疗的疗效。方法：本研究在662名参与戒烟临床试验的个体中检查了CO和可替宁之间的关系。计算受试者工作特征曲线，以确定使用可替宁确认戒断时，在给定CO水平下的假阳性和假阴性百分比。跨种族和gender.Results的差异也进行了检查：一氧化碳截止值为3 ppm（97.1%正确分类）最准确区分吸烟者和非吸烟者。同样的截止值对于种族和性别群体都是准确的。8 ppm的标准截止值（14.0%的吸烟者被误分类为戒烟者）和10 ppm（20.6%的吸烟者被错误分类为戒烟者）产生了非常高的假阴性率，并且当样本中的大部分人的可替宁测试发现他们仍在吸烟时，错误地将他们识别为戒烟者。结论：建议研究人员和临床医生在完全戒烟为目标时采用更严格的CO截止值，范围为3-4 ppm。
Introduction: Confirming abstinence during smoking cessation clinical trials is critical for determining treatment effectiveness. Several biological methods exist for verifying abstinence (e. g., exhaled carbon monoxide [CO], cotinine), and while cotinine provides a longer window of detection, it is not easily used in trials involving nicotine replacement therapy. The Society for Research on Nicotine and Tobacco's Subcommittee on Biochemical Verification cite 8-10 parts per million (ppm) for CO as a viable cutoff to determine abstinence; however, recent literature suggests this cutoff is likely too high and may overestimate the efficacy of treatment.Methods: This study examined the relationship between CO and cotinine in a sample of 662 individuals participating in a smoking cessation clinical trial. A receiver operating characteristics curve was calculated to determine the percentage of false positives and false negatives at given CO levels when using cotinine as confirmation of abstinence. Differences were also examined across race and gender.Results: A CO cutoff of 3 ppm (97.1% correct classification) most accurately distinguished smokers from nonsmokers. This same cutoff was accurate for both racial and gender groups. The standard cutoffs of 8 ppm (14.0% misclassification of smokers as abstainers) and 10 ppm (20.6% misclassification of smokers as abstainers) produced very high false-negative rates and inaccurately identified a large part of the sample as being abstinent when their cotinine test identified them as still smoking.Conclusions: It is recommended that researchers and clinicians adopt a more stringent CO cutoff in the range of 3-4 ppm when complete abstinence from smoking is the goal.