PEth 16:0/18:1 and 16:0/18:2 after consumption of low doses of alcohol—A contribution to cutoff discussion

Abstract

Phosphatidylethanol in blood has gained recognition as a direct alcohol biomarker. Although different cutoffs have been suggested, there is no consensus for differentiating abstinence from alcohol consumption. In this study, 75 participants (72% female) consumed 20 g of ethanol on three consecutive evenings. Blood was sampled on each following day and PEth 16:0/18:1 and 16:0/18:2 were determined. PEth 16:0/18:1 ranged from 8.9–21.5, 8.7–19.3, and 8.8–42.3 ng/ml and PEth 16:0/18:2 from 8.7–31.7, 9.0–39.3, and 9.4–43.0 ng/ml after the respective days of ethanol consumption. PEth 16:0/18:1 yielded a sensitivity of 25%, 45%, and 49% and PEth 16:0/18:2 of 40%, 61%, and 68% for the consumption days, respectively (cutoff 10 ng/ml). PEth 16:0/18:1 reached >20 ng/ml in five samples overall. Sensitivity of PEth 16:0/18:2 > 20 ng/ml was better with 35% after the three drinking days. Overall, PEth 16:0/18:1 was >35 ng/ml in one sample and PEth 16:0/18:2 in three samples. Significantly, more women had PEth 16:0/18:1 > 10 ng/ml after the third day of consuming 20 g of alcohol (p = 0.02) and PEth 16:0/18:2 > 10 ng/ml after the second (p = 0.023) and the third (p = 0.002) consumption, which can be led back to the higher blood alcohol concentration women reach after consuming the same alcohol amount as men. Although the response rates of PEth to alcohol uptake are subject to strong interindividual differences, results suggest that PEth cutoff should be lowered for better detection of consumption of low to medium amounts of alcohol. Furthermore, it is advantageous to analyze both PEth 16:0/18:2 and 16:0/18:1.

Increase of PEth after Single Consumption of Alcohol and Evaluation of a Volumetric DBS Filter Paper Device

“…The ability to estimate by how much PEth concentrations increase ater single consumption o alcohol is particularly important or abstinence control, especially with regard to cut-o concentrations (1,18). A prerequisite or participation in the presented study was at least occasional alcohol consumption.…”

“…The authors do not report in detail the increase in PEth concentrations. Other studies on alcohol consumption ocused on higher doses o alcohol consumed on one or consecutive days or on exceeding a cut-o concentration ater prolonged abstinence or on the infuence o repeated consumption o small amounts o alcohol (18,19,21,22). Regioisomerically pure PEth reerence material was not used in all these studies.…”

“But I didn’t drink!”: What to do with discordant phosphatidylethanol results

“…For example, patients fully intending to abstain from alcohol may take early meaningful steps toward change by switching to “nonalcoholic” beer brands measuring 0.5% alcohol by volume (~1.5 g of ethanol in a 12-ounce container) as compared with other true 0.0% beverages. While “alcohol-free” beer and wine have not been found to increase PEth, 32 ethanol from any source in high enough amounts can cause positive PEth. We have treated patients found to be regularly consuming large amounts of “nonalcoholic” 0.5% beer exhibiting low-positive PEth (our experience is the level does not exceed 40 ng/mL).…”

“…As clinicians working with medically and surgically ill patients, we seek the detection of any alcohol consumption and often use uEtG and PEth together, particularly in the context of zero-sum liver allocation. At 20 ng/mL, PEth sensitivity is highest for the detection of ≥4 drinks per day in liver disease, 17 meaning patients with lower alcohol exposure may have undetectable PEth 32 but still could exhibit positive uEtG (>500 ng/mL). uEtG and PEth used together in LT patients detected 21 (75%) of 28 patients with recent alcohol exposure 7 .…”

Monitoring of phosphatidylethanol in dried blood spots and of ethyl glucuronide in hair over 6 months of alcohol consumption

“…Lowering the cutoff of PEth 16:0/18:1 has been discussed in recently published articles. 15 Regarding Participant 4, five out of eight of his PEth analyses could be assigned as negative (<20 ng/mL) according to the current German guidelines. 6 If a cutoff of 10 ng/mL for PEth 16:0/18:1 will be used instead, only one PEth analysis will produce a negative result for recent ethanol consumption.…”