Background 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. Methods 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. Results 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. Conclusions 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.

Phosphatidylethanol is a direct alcohol biomarker for identifying alcohol misuse. It carries several advantages over other alcohol biomarkers including a detection half-life of several weeks and little confounding by patient characteristics or organ dysfunction. The aim of this study is to derive an optimal phosphatidylethanol cutpoint to identify organ donors with alcohol misuse, and to assess the impact of alcohol misuse on organ allocation. Discrimination of phosphatidylethanol was evaluated using the area under the ROC curve from a mixed effects logistic regression model. Phosphatidylethanol had an area under the ROC curve of 0.89 (95% CI 0.80–0.98). A phosphatidylethanol cutpoint of ≥84 ng/mL provided optimal discrimination for the identification of alcohol misuse with a sensitivity of 75% (95% CI 52.9%–89.4%) and a specificity of 97% (95% CI 91%–99%), a positive predictive value of 82% (95% CI 59%–94%), and a negative predictive value of 95% (95% CI 89%–98%). In critically ill deceased organ donors phosphatidylethanol had good test characteristics to discriminate alcohol misuse. Other alcohol biomarkers performed poorly in deceased organ donors. Liver allocation was decreased in donors with alcohol misuse by proxy history, but not in those with phosphatidylethanol >84 ng/ml, revealing possible information bias in liver allocation.

Little is known about the alcohol habits of people with advanced lung disease. Following lung transplantation, patients are asked to abstain from or minimize alcohol use. The aim of this investigation was to assess alcohol use in a cohort of patients with advanced lung disease undergoing evaluation for lung transplant. This is a prospective observational investigation comparing patient self-report of alcohol use with their responses on the Alcohol Use Disorders Identification Test (AUDIT), and alcohol biomarkers collected at the time of transplant. There were 86 included in the cohort, 34% currently using alcohol, 13% had AUDIT scores >3, and 10% had positive results for alcohol biomarkers at the time of transplantation. Patients with evidence of recent alcohol use prior to lung transplant surgery had a 1.5-fold increase in hospital length of stay following lung transplant (P = .028), spent 3 times as long on mechanical ventilation after transplant, and required intensive care unit monitoring nearly 3 times longer than those without recent alcohol use (P = .008). There were no differences in primary graft dysfunction, although several patients with recent alcohol use had post-transplant atrial arrhythmias, acute kidney injury, and acute cellular rejection. Abstaining from alcohol use may optimize outcomes following lung transplant.

RATIONALE: Walnut is a relevant allergenic food in paediatric population. An accurate diagnosis is essential. The aim of this study was to assess the diagnostic capacity of natural and three commercial walnut extracts to perform skin prick tests (SPT). METHODS: Fifty-one atopic children were included in the study; 39 with a clinical history of walnut allergy and positive specific IgE values to walnut (> _ 0.35 KU/L) and 12 atopic controls tolerating walnut. SPT whit three commercial walnut extracts (ALKÒ, LetiÒ, RoxallÒ) as well as prick-prick test (PPT) with natural walnut were performed. Wheals > _3 mm were considered positive. The sensitivity and specificity for SPTs with commercial extracts and natural walnut, as well as wheal sizes (WS), were analyzed. RESULTS: SPTs with ALKÒ, RoxallÒ and LetiÒ walnut extracts as well as natural walnut, showed high sensitivity (100; 100; 97.44; 100) but moderate to low specificity (75; 41.66; 41.66; 58,33) values with no differences between them. In walnut allergic patients, the median WS with Roxall'sÒ walnut extract (9.5mm) was significantly larger than Leti'sÒ (7.5mm; p <0.001) and ALK'sÒ (7.5mm; p <0.001) but similar to those of the PPT (9.5mm; p 5 0.566), while ALK'sÒ and Leti'sÒ WSs were significantly smaller compared to those of the PPT (p5 0,003; p<0,001). CONCLUSIONS: Commercial walnut extracts from ALKÒ, RoxallÒ and LetiÒ have a similar diagnostic accuracy. However, in walnut allergic patients, the WS of the SPT with Roxall's walnut extract is significantly larger than those performed with ALK's and Leti's extracts and similar to the PPT.

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