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Fipps DC, Meyer R, Woods J, Watt K, Schneekloth T, Gifford J, Kolla BP. Clinical Utility and Impact of Phosphatidylethanol Testing in Liver Transplantation Evaluations. J Acad Consult Liaison Psychiatry 2024; 65:157-166. [PMID: 38042370 DOI: 10.1016/j.jaclp.2023.11.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/21/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Phosphatidylethanol (PEth) is a serum biomarker that can detect alcohol use within the last 28 days with excellent sensitivity and specificity. Urinary ethyl glucuronide (uEtG) is commonly used in transplant settings to screen for alcohol use; however, it has several limitations relevant to liver transplantation. Transplant centers are beginning to regularly utilize PEth as part of the screening process for high-risk liver transplantation candidates although the clinical utility of uniform pre-transplant PEth testing is unclear. METHODS This was a retrospective chart review of all patients evaluated for liver transplantation from December 1, 2019, through May 31, 2022, at a large academic tertiary referral center utilizing uniform serum PEth and uEtG screening. Information regarding the patients' transplantation status, age, sex, race, Model for End-Stage Liver Disease score, and PEth levels was obtained. In those with a positive PEth, we examined if the result would have been detected with uEtG, identified a discrepancy from the documented patient report of last use, led to a change in the Psychosocial Assessment of Candidate for Transplantation score, or influenced the transplant selection committee's decision. RESULTS Our sample included 865 individuals (mean age = 55.20, 61.27% male and 82.54% white) with calculated Model for End-Stage Liver Disease-Sodium scores ranging from 6.43 to 50.65 (mean: 18.09; median: 16.46). Forty-eight patients were found to have a positive PEth (PEth range 20-1833); 75% of the sample had alcohol-associated liver disease. In 23 of 48 (47.91%) cases, the positive PEth identified alcohol use missed by a concomitant uEtG screen. A positive PEth test identified a discrepancy from patients' self-report in 29 (60.42%) cases and influenced the selection committee's decision in 28 cases (58.33%). CONCLUSION Uniform pretransplant PEth screening of liver transplant candidates at the time of initial evaluation identified alcohol use that would have been missed by uEtG testing, identified discrepancies from the patient's self-report, and influenced clinical decision-making in a significant number of cases. These findings support the use of uniform PEth screening in liver transplantation evaluations.
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Affiliation(s)
- David C Fipps
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Rachel Meyer
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Kymberly Watt
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN
| | | | - Jennifer Gifford
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Winder GS, Clifton EG, Denysenko L, DiChiara AM, Hathaway D, Perumalswami PV, Shenoy A, Suzuki J, Tareen K, Mellinger JL, Fernandez AC. "But I didn't drink!": What to do with discordant phosphatidylethanol results. Liver Transpl 2024; 30:213-222. [PMID: 37486958 DOI: 10.1097/lvt.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
Liver transplantation (LT) teams must be adept at detecting, evaluating, and treating patients' alcohol use, given its prominence among psychological and behavioral phenomena which cause and contribute to liver diseases. Phosphatidylethanol (PEth) is a highly useful alcohol biomarker increasingly recommended for routine use in hepatology and LT. PEth is unique among alcohol biomarkers because of its wide detection window, high sensitivity and specificity, and the correlation of its numerical value with different patterns of alcohol use. Alongside myriad clinical opportunities in hepatology and LT, PEth also confers numerous challenges: little guidance exists about its clinical use; fearing loss of LT access and the reactions of their clinicians and families, candidates and recipients are incentivized to conceal their alcohol use; and liver clinicians report lack of expertise diagnosing and treating substance-related challenges. Discordance between patient self-reported alcohol use and toxicology is yet another common and particularly difficult circumstance. This article discusses the general toxicological properties of PEth; explores possible scenarios of concordance and discordance among PEth results, patient history, and self-reported drinking; and provides detailed clinical communication strategies to explore discordance with liver patients, a key aspect of its use.
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Affiliation(s)
- Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin G Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lex Denysenko
- Department of Psychiatry, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alex M DiChiara
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - David Hathaway
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ponni V Perumalswami
- Department of Internal Medicine, Gastroenterology Section, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University, New York City, New York, USA
| | - Joji Suzuki
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kinza Tareen
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jessica L Mellinger
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Jophlin LL, Singal AK, Bataller R, Wong RJ, Sauer BG, Terrault NA, Shah VH. ACG Clinical Guideline: Alcohol-Associated Liver Disease. Am J Gastroenterol 2024; 119:30-54. [PMID: 38174913 PMCID: PMC11040545 DOI: 10.14309/ajg.0000000000002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/04/2023] [Indexed: 01/05/2024]
Abstract
ABSTRACT Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%-50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%-60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.
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Affiliation(s)
- Loretta L Jophlin
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville Health, Louisville, Kentucky, USA
| | - Ashwani K Singal
- Division of Gastroenterology and Hepatology, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Ramon Bataller
- Liver Unit, Department of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Norah A Terrault
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Segal A, Pearl E, Fatabhoy M, Zohr SJ, Bryce K, Gonzalez HC, Miller-Matero LR. Factors associated with a positive phosphatidylethanol test during liver transplantation evaluation. Clin Transplant 2023; 37:e15100. [PMID: 37577900 DOI: 10.1111/ctr.15100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/14/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Early identification of alcohol use is crucial for informing recommendations of appropriate follow-up treatment pre-liver transplant and optimizing post-liver transplant outcomes. The purpose of the study was to investigate whether there are psychosocial factors associated with a positive PEth test. METHODS All patients who underwent a routine pre-surgical psychological evaluation for liver transplant listing (all etiologies, including acute liver failure, dual organ, and re-transplantation) at a single health care system in 2020 were included in a retrospective chart review. Data extraction included results from PEth testing and information from the psychological evaluation (i.e., demographic, psychiatric symptoms, and cognitive functioning). RESULTS There were 158 patients (73.8%) who had a PEth test, of whom 21.5% had a positive result (n = 34). Younger age was associated with a positive PEth (p < .001). ALD status and type of ALD (hepatitis vs. cirrhosis) were also associated with a positive PEth test. Other demographic characteristics and psychiatric symptoms were not associated with a positive PEth result (p > .05). CONCLUSION Younger age was the only significant demographic variable associated with a positive PEth test. Given the difficulty of predicting who may be using alcohol, it may be useful to use PEth testing for all patients during the pre-liver transplant evaluation and while patients are listed for liver transplant. Early identification of alcohol use through routine PEth testing will help identify patients who are using alcohol and need further treatment for alcohol use to optimize health and post-transplant outcomes.
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Affiliation(s)
- Antú Segal
- Behavioral Health Department, Henry Ford Health, Detroit, Michigan, USA
- Transplant Institute, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University, School of Medicine, Detroit, Michigan, USA
| | - Elise Pearl
- Behavioral Health Department, Henry Ford Health, Detroit, Michigan, USA
| | - Megha Fatabhoy
- Behavioral Health Department, Henry Ford Health, Detroit, Michigan, USA
| | - Samantha J Zohr
- Behavioral Health Department, Henry Ford Health, Detroit, Michigan, USA
| | - Kelly Bryce
- Behavioral Health Department, Henry Ford Health, Detroit, Michigan, USA
- Transplant Institute, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University, School of Medicine, Detroit, Michigan, USA
| | - Humberto C Gonzalez
- Transplant Institute, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University, School of Medicine, Detroit, Michigan, USA
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Lisa R Miller-Matero
- Behavioral Health Department, Henry Ford Health, Detroit, Michigan, USA
- Wayne State University, School of Medicine, Detroit, Michigan, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
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Lim N, Leventhal TM, Thomson MJ, Hassan M, Thompson J, Adams A, Chinnakotla S, Humphreville V, Kandaswamy R, Kirchner V, Pruett TL, Schuller L, McCarty M, Lake J. Protocolized screening and detection of occult alcohol use before and after liver transplant: Lessons learned from a quality improvement initiative. Clin Transplant 2023; 37:e15036. [PMID: 37218656 DOI: 10.1111/ctr.15036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Detection of alcohol (ETOH) use with biomarkers provides an opportunity to intervene and treat patients with alcohol use disorder before and after liver transplant (LT). We describe our center's experience using urine ethyl glucuronide (EtG) and serum phosphatidylethanol (PEth) in alcohol screening protocols. METHODS Single-center, retrospective review of patients presenting for LT evaluation, patients waitlisted for LT for alcohol-associated liver disease (ALD), and patients who received a LT for ALD over a 12-month period, from October 1, 2019 through September 30, 2020. Patients were followed from waitlisting to LT, or for up to 12 months post-LT. We monitored protocol adherence to screening for ETOH use- defined as completion of all possible tests over the follow-up period- at the initial LT visit, while on the LT waitlist and after LT. RESULTS During the study period, 227 patients were evaluated for LT (median age 57 years, 58% male, 78% white, 54.2% ALD). Thirty-one patients with ALD were placed on the waitlist, and 38 patients underwent LT for ALD during this time period. Protocolized adherence to screening for alcohol use was higher for PEth for all LT evaluation patients (191 [84.1%] vs. 146 [67%] eligible patients, p < .001), in patients with ALD waitlisted for LT (22 [71%] vs. 14 (48%] eligible patients, p = .04) and after LT for ALD, 20 (33 [86.8%] vs. 20 [52.6%] eligible patients, p < .01). Few patients with a positive test in any group completed chemical dependency treatment. CONCLUSIONS When screening for ETOH use in pre- and post-LT patients, protocol adherence is higher using PEth compared to EtG. While protocolized biomarker screening can detect recurrent ETOH use in this population, engagement of patients into chemical dependency treatment remains challenging.
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Affiliation(s)
- N Lim
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - T M Leventhal
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - M J Thomson
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - M Hassan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - J Thompson
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - A Adams
- Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - S Chinnakotla
- Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - V Humphreville
- Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - R Kandaswamy
- Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - V Kirchner
- Division of Abdominal Transplantation, Stanford University, Palo Alto, California, USA
| | - T L Pruett
- Division of Transplant Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - L Schuller
- University of Minnesota Physicians, Minneapolis, Minnesota, USA
| | - M McCarty
- Complex Care Analytics, Fairview Health Services, Minneapolis, Minnesota, USA
| | - J Lake
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
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Shetty A, De La Torre S, Ibrahim B, Hong A, Meza J, Saab S. Role of Biomarkers to Assess the Use of Alcohol. J Clin Gastroenterol 2023; 57:537-545. [PMID: 37039472 DOI: 10.1097/mcg.0000000000001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Alcohol-associated liver disease has seen a significant rise in the last 2 decades, with an associated rise in the need for accurate alcohol use assessment. Alcohol use has been associated with poor outcomes in both the pre-liver transplant and post-liver transplant patients. Patients with alcohol use disorder often under-report their alcohol consumption because of varying factors, highlighting the need for objective assessment of alcohol use. Aside from the available self-report questionnaires, multiple serologic biomarkers are currently available to assist clinicians to assess recent alcohol consumption among patients with chronic liver disease, liver transplant candidates, and recipients. In this review, we will assess some of these alcohol biomarkers, discuss their strengths and weakness, and review-available data to discuss their role in pre-liver transplant and post-liver transplant population.
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Affiliation(s)
| | | | | | | | - Julio Meza
- Family Medicine, University of California at Los Angeles, Los Angeles, CA
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Iruzubieta P, Bataller R, Arias-Loste MT, Arrese M, Calleja JL, Castro-Narro G, Cusi K, Dillon JF, Martínez-Chantar ML, Mateo M, Pérez A, Rinella ME, Romero-Gómez M, Schattenberg JM, Zelber-Sagi S, Crespo J, Lazarus JV. Research Priorities for Precision Medicine in NAFLD. Clin Liver Dis 2023; 27:535-551. [PMID: 37024222 DOI: 10.1016/j.cld.2023.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
NAFLD is a multisystem condition and the leading cause of chronic liver disease globally. There are no approved NAFLD-specific dugs. To advance in the prevention and treatment of NAFLD, there is a clear need to better understand the pathophysiology and genetic and environmental risk factors, identify subphenotypes, and develop personalized and precision medicine. In this review, we discuss the main NAFLD research priorities, with a particular focus on socioeconomic factors, interindividual variations, limitations of current NAFLD clinical trials, multidisciplinary models of care, and novel approaches in the management of patients with NAFLD.
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Affiliation(s)
- Paula Iruzubieta
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Avenida Valdecilla 25, 39008, Santander, Spain
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, University of Pittsburgh Medical Center, PA, USA
| | - María Teresa Arias-Loste
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Avenida Valdecilla 25, 39008, Santander, Spain
| | - Marco Arrese
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, 8331150, Santiago, Chile
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Puerta de Hierro University Hospital, Puerta de Hierro Health Research Institute (IDIPHIM), CIBERehd, Universidad Autonoma de Madrid, Calle Joaquín Rodrigo 1, 28222, Majadahonda, Spain
| | - Graciela Castro-Narro
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Hepatology and Transplant, Hospital Médica Sur, Asociación Latinoamericana para el Estudio del Hígado (ALEH), Mexico City, Mexico
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - John F Dillon
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - María Luz Martínez-Chantar
- Liver Disease Laboratory, Center for Cooperative Research in Biosciences (CIC BioGUNE), Basque Research and Technology Alliance (BRTA), Centro de Investigación Biomedica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Derio, Bizkaia, Spain
| | - Miguel Mateo
- Pharmacy Organisation and Inspection, Government of Cantabria, Santander, Spain
| | - Antonio Pérez
- Endocrinology and Nutrition Department, Santa Creu I Sant Pau Hospital, Universitat Autónoma de Barcelona, IIB-Sant Pau and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Mary E Rinella
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Manuel Romero-Gómez
- UCM Digestive Diseases and CIBERehd, Virgen Del Rocío University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Shira Zelber-Sagi
- University of Haifa, School of Public Health, Mount Carmel, Haifa, Israel; Department of Gastroenterology, Tel- Aviv Medical Centre, Tel- Aviv, Israel
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Avenida Valdecilla 25, 39008, Santander, Spain.
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellón 171, ENT-2, Barcelona ES-08036, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA.
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Segal A, Adkins E, Fatabhoy M, Bryce K, Gonzalez HC, Miller-Matero LR. Utility of phosphatidylethanol testing in liver transplant evaluation: examining concordance to self-reported alcohol use. Liver Transpl 2023; 29:456-458. [PMID: 36799451 DOI: 10.1097/lvt.0000000000000097] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/23/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Antú Segal
- Behavioral Health Department, Detroit, Michigan, USA
- Transplant Institute, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elise Adkins
- Behavioral Health Department, Detroit, Michigan, USA
| | | | - Kelly Bryce
- Behavioral Health Department, Detroit, Michigan, USA
- Transplant Institute, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Humberto C Gonzalez
- Transplant Institute, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Gastroenterology and Hepatology, Detroit, Michigan, USA
| | - Lisa R Miller-Matero
- Behavioral Health Department, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
- Center for Health Policy and Health Services Research, Detroit, Michigan, USA
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LIU Z, DONG J, LI H, YANG R, SHAO Z, WANG S. [Determination of phosphatidylethanol in whole-blood by liquid chromatography-tandem mass spectrometry based on intelligent scheduled time-zone acquisition technology and the application to population level survey]. Se Pu 2023; 41:131-141. [PMID: 36725709 PMCID: PMC9892970 DOI: 10.3724/sp.j.1123.2022.06025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Alcohol intake is an important risk factor for cardiovascular disease, liver disease, and diabetes. The accurate and objective evaluation of alcohol intake is important for disease prevention and intervention, as well as alcohol intake monitoring. Phosphatidylethanol (PEth) is a potential clinical biomarker of alcohol consumption. Monitoring PEth levels can provide an objective and quantitative basis for alcohol intake studies. Unlike other current alcohol biomarkers, PEth can only be produced in the presence of alcohol. Therefore, PEth is highly specific for alcohol intake and not affected by confounding factors, such as age, gender, hypertension, kidney disease, liver disease, and other comorbidities. Because of its long half-life and high specificity for alcohol intake, PEth may be used as a tool for monitoring drinking behavior in the clinical, transportation, and other fields. Given rapid developments in mass spectrometry technology over the past decade, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has become the preferred method for PEth detection. However, most current LC-MS/MS methods focus on the determination of one or several PEth homologs, and the number of PEth homologs that can be determined simultaneously is relatively limited. Moreover, the detection capacity of the available methods remains insufficient, and their analytical sensitivity for some PEth homologs must be further improved. In this study, a novel LC-MS/MS method based on an intelligent scheduled time-zone negative multiple reaction monitoring acquisition technology (Scheduled-MRM) was developed. The technology monitors two ion channels in each PEth to ensure reliable results and can quantify 18 PEth homologs in human whole blood simultaneously. Methanol-methyl tert-butyl ether-water was used as the extraction system. An XBridge C18 column (100 mm×2.1 mm, 3.5 μm) was selected for gradient elution with 2.5 mmol/L ammonium acetate isopropanol solution and 2.5 mmol/L ammonium acetate aqueous solution-acetonitrile (50∶50, v/v) as the mobile phases. Negative electronic spray ionization in scheduled-MRM mode was applied for MS/MS detection. The method was validated to have a linear range of 10-2500 ng/mL with correlation coefficients greater than 0.9999. The limits of detection and quantification were 0.7-2.8 and 2.2-9.4 ng/mL, respectively, and the spiked recoveries ranged from 91.0% to 102.2%. The method was confirmed to be simple, rapid, and precise, and subsequently validated for the measurement of 18 PEth homologs in human blood. Scheduled-MRM can assign a suitable scan time to each ion channel and effectively reduce the number of concurrent ion pairs monitored per unit time. This technology overcomes the problem of insufficient dwell time caused by an excessive number of ion channels, thereby avoiding the redundant monitoring of non-retention times. Scheduled-MRM significantly improved the detection sensitivity, data acquisition quality, and signal response of the proposed method. Whole blood samples from 359 volunteers with regular drinking habits were analyzed using this method. The total PEth concentrations ranged from 51.13 ng/mL to 2.89 μg/mL, with a mean of 363.16 ng/mL. PEth 16∶0/18∶1 and 16∶0/18∶2 were the two most abundant homologs, with mean concentrations of 74.21 and 48.75 ng/mL, accounting for approximately 20.43% and 13.42%, respectively, of the total PEth. Spearman correlation analyses showed that the PEth homologs correlated well with each other, γ-glutamyltransferase, a clinically available biological marker of alcohol, and other clinical biochemical parameters related to liver and kidney function. Overall, the method was demonstrated to be sensitive, precise, and accurate; thus, it may be an effective tool for monitoring alcohol intake in the clinical and other fields.
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