Phosphatidylethanol vs Transdermal Alcohol Monitoring for Detecting Alcohol Consumption Among Adults.
Phosphatidylethanol vs Transdermal Alcohol Monitoring for Detecting Alcohol Consumption Among Adults.
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DOI：
10.1001/jamanetworkopen.2023.33182
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发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Marcus, Gregory M.
中科院分区：
文献类型：
--
作者：
Hahn, Judith A.;Fatch, Robin;Barnett, Nancy P.;Marcus, Gregory M.
磷脂酰乙醇 (PEth)（一种血液生物标记物）的最佳截止值是多少，以客观地检测前一个月的酗酒情况？在这项对 64 名患有阵发性心房颤动的中年人和老年人进行的诊断研究中，与连续脚踝监测检测汗液中酒精排泄的读数相比，PEth 对前 4 周内大量饮酒具有高度敏感性 (84%) 和特异性 (73%)。重度饮酒的最佳临界值是 18.5 ng/mL。这些发现表明，具有该临界值的 PEth（或针对普通人群中大量饮酒的建议临界值 20 ng/mL）可用于准确捕获临床护理中中老年男性的重度饮酒情况。这项诊断研究评估了一项针对中老年人的研究中大量饮酒时磷脂酰乙醇的最佳临界值。酒精生物标志物可以改善临床护理中重度饮酒的检测，但血液生物标志物磷脂酰乙醇 (PEth) 的临界值尚未确定。在一项针对中老年人的研究中确定重度饮酒的最佳 PEth 截止值。这是一项为期 4 周的诊断研究，对象是患有阵发性心房颤动 (AF) 且当前饮酒的成人，招募自 2014 年 9 月至 2019 年 9 月从普通心脏病学和心脏电生理学门诊诊所招募的患者。数据分析时间为 2021 年 10 月至 2022 年 3 月。主要目的是确定重度饮酒的最佳 PEth 截止值，使用安全连续远程酒精监测仪 (SCRAM) 测量 透皮酒精。 PEth 检测到的曲线下面积 (AUC) 与过去 4 周内任何一周 SCRAM 检测到的重度饮酒（即≥3 次[女性]和≥4 次[男性]发作）或任何一周内任何估计的呼吸酒精含量为 0.08% 或更高相比，PEth 截止值是使用 Youden J 统计数据计算的。通过按下事件监视器、通过酒精使用障碍识别测试-消费 (AUDIT-C) 进行回顾性自我报告以及使用 2 周回顾，对 PEth 与个人饮酒进行了类似的分析。在这项诊断研究中，64 名患者在 4 周内同时进行了 PEth 和 SCRAM 测量（54 名 [84.4%] 男性；平均年龄，65.5 [95% CI，62.6-68.5] 岁；51 名 [79.7%] 白人），其中 31 名 (48.4%) 在 4 周内有任何 SCRAM 检测到的重度饮酒，4 周时 PEth 中位数 (IQR) 为 23 ng/mL（<限制 定量至 60 ng/mL)。 PEth 与任何 SCRAM 检测到的重度饮酒的 AUC 为 0.83（95% CI，0.72-0.93）。最佳 PEth 截止值为 18.5 ng/mL（AUC，0.83；95% CI，0.72-0.93），敏感性为 83.9%（95% CI，66.3%-94.5%），特异性为 72.7%（95% CI，54.5%-86.7%）。通过使用事件监视器和 AUDIT-C 进行的个人饮酒报告以及通过这些措施和通过每隔 2 周收集的 SCRAM 得出的 PEth 测试特征与 4 周 SCRAM 相比相似。在以中年和老年白人男性为主的人群中，PEth 与 SCRAM 相比效果更好。 18.5 ng/mL 的 PEth 临界值（或四舍五入为 20 ng/mL，建议大量饮酒的 PEth 临界值）可用于临床护理，以检测中年和老年男性的大量饮酒。
What is the best cutoff for phosphatidylethanol (PEth), a blood biomarker, to objectively detect prior month heavy alcohol use? In this diagnostic study of 64 persons of middle age and older with paroxysmal atrial fibrillation, PEth was highly sensitive (84%) and specific (73%) for heavy alcohol use in the prior 4 weeks compared with readings from a continuous ankle monitoring to detect alcohol excreted in sweat. The optimal cutoff for heavy alcohol consumption was 18.5 ng/mL. These findings suggest that PEth with this cutoff value (or rounded to the recommended cutoff of 20 ng/mL for significant alcohol consumption in the general population) could be used to accurately capture heavy alcohol use in middle-age and older men in clinical care. This diagnostic study evaluates the optimal cutoff for phosphatidylethanol for heavy alcohol consumption in a study of middle-age and older adults. Alcohol biomarkers can improve detection of heavy alcohol use in clinical care, yet cutoffs for phosphatidylethanol (PEth), a blood biomarker, have not been established. To determine the optimal cutoff for PEth for heavy alcohol consumption in a study of middle-age and older adults. This was a 4-week diagnostic study of adults with paroxysmal atrial fibrillation (AF) and current alcohol consumption, recruited from general cardiology and cardiac electrophysiology outpatient clinics from September 2014 to September 2019. Data were analyzed from October 2021 to March 2022. The main aim was to determine the optimal PEth cutoff for heavy alcohol consumption, using the Secure Continuous Remote Alcohol Monitor (SCRAM) to measure transdermal alcohol. Area under the curve (AUC) for PEth-detected compared with SCRAM-detected heavy alcohol consumption in any week over the prior 4 weeks (ie, ≥3 [women] and ≥4 [men] episodes) or any estimated breath alcohol of 0.08% or greater in any week, and the PEth cutoff was calculated using the Youden J statistic. Similar analyses were conducted comparing PEth with individual drinks reported by pressing an event monitor, retrospective self-report via the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C), and using 2-week look-backs. In this diagnostic study of 64 patients with both PEth and SCRAM measures over 4 weeks (54 [84.4%] men; mean age, 65.5 [95% CI, 62.6-68.5] years; 51 [79.7%] White), 31 (48.4%) had any SCRAM-detected heavy alcohol consumption over the 4 weeks, and the median (IQR) PEth at 4 weeks was 23 ng/mL (<limit of quantification to 60 ng/mL). The AUC for PEth vs any SCRAM-detected heavy alcohol consumption was 0.83 (95% CI, 0.72-0.93). The optimal PEth cutoff was 18.5 ng/mL (AUC, 0.83; 95% CI, 0.72-0.93), with sensitivity of 83.9% (95% CI, 66.3%-94.5%) and specificity of 72.7% (95% CI, 54.5%-86.7%). The PEth test characteristics by individual drink reporting using the event monitors and by the AUDIT-C, and by these measures and by SCRAM collected for 2-week intervals, were similar to those compared with the 4-week SCRAM. In a predominately middle-age and older White male population, PEth compared well with SCRAM. A PEth cutoff of 18.5 ng/mL (or rounded to 20 ng/mL, a recommended PEth cutoff for significant alcohol consumption) can be used in clinical care to detect heavy alcohol consumption in middle-age and older men.
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DOI：
10.1111/acer.12442
发表时间：
2014-06
期刊：
Alcoholism, clinical and experimental research
影响因子：
--
作者：
Stewart SH;Koch DG;Willner IR;Anton RF;Reuben A
通讯作者：
Reuben A
DOI：
10.1111/j.1530-0277.2009.01113.x
发表时间：
2010-03-01
期刊：
Alcoholism, clinical and experimental research
影响因子：
--
作者：
Stewart SH;Law TL;Randall PK;Newman R
通讯作者：
Newman R
DOI：
10.15585/mmwr.mm6939a6
发表时间：
2020-10-02
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Esser MB;Sherk A;Liu Y;Naimi TS;Stockwell T;Stahre M;Kanny D;Landen M;Saitz R;Brewer RD
通讯作者：
Brewer RD
影响因子：
2.8
作者：
Miller, PM;Thomas, SE;Mallin, R
通讯作者：
Mallin, R
DOI：
10.1111/j.1530-0277.2012.01768.x
发表时间：
2012-09-01
影响因子：
3.2
作者：
Gnann, Heike;Weinmann, Wolfgang;Thierauf, Annette
通讯作者：
Thierauf, Annette