Barrio Pablo, Teixidor Lidia, Rico Naira, Bruguera Pol, Ortega Lluisa, Bedini José Luis, Gual Antoni
Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Barcelona, Spain.
Eur Addict Res. 2016;22(5):243-8. doi: 10.1159/000445741. Epub 2016 May 26.
To test the screening performance of urinary ethyl glucuronide (EtG) under routine clinical conditions in a sample of alcohol-dependent outpatients, comparing it against urinary ethanol, self reports and clinical judgment.
A cross-sectional study under routine conditions was conducted in February 2015, where 613 consecutive urinary samples, provided by 188 outpatients with alcohol use disorders, were analyzed for ethanol and EtG (cut-off level = 500 ng/ml). Clinical variables such as the presence of aversive medication, comorbidities and clinician judgment were also collected. The discrepancy between the number of alcohol and EtG positives was recorded. A logistic regression analysis including clinical variables was conducted to assess for predictors of EtG positivity.
Urinary alcohol yielded 9 positives (1.5% of all urine samples) belonging to 8 patients. EtG yielded 136 positives (22% of all urine samples) belonging to 74 patients. Of these, 93.4% (127 of 136) were negative for alcohol. All urinary alcohol positives resulted in EtG positives. The clinician judged 48 samples from 26 patients as belonging to not abstinent patients and 550 samples from 178 patients as belonging to abstinent patients. She was unsure in 15 samples from 15 patients. When comparing it against EtG as the gold standard, the area under the curve was 0.592. Self reports were extremely unreliable in this study, with only 5 patients reporting drinking in a total of 6 urine samples. In the logistic regression model, only aversive medications (OR 2.1, 95% CI 1.3-3.3) and clinician judgment (OR 2, 95% CI 1.4-2.9) resulted in significant effects.
EtG performed largely better than ethanol for urine screening in alcohol outpatients, detecting an extra 20.4% (125 out of 613) of positives. It means that for each alcohol-positive sample, there were 15 EtG-positive samples. Although better than ethanol, clinician judgment was also not performed efficiently. If routinely implemented in the screening of alcohol outpatients, EtG might bring relevant changes that merit further research.
在酒精依赖门诊患者样本的常规临床条件下，测试尿中乙基葡萄糖醛酸苷（EtG）的筛查性能，并将其与尿乙醇、自我报告和临床判断进行比较。
于2015年2月在常规条件下进行了一项横断面研究，对188例酒精使用障碍门诊患者提供的613份连续尿样进行乙醇和EtG分析（临界值 = 500 ng/ml）。还收集了诸如厌恶药物的使用情况、合并症和临床医生判断等临床变量。记录酒精阳性和EtG阳性数量之间的差异。进行了包括临床变量的逻辑回归分析，以评估EtG阳性的预测因素。
尿乙醇检测出9例阳性（占所有尿样的1.5%），属于8名患者。EtG检测出136例阳性（占所有尿样的22%），属于74名患者。其中，93.4%（136例中的127例）乙醇检测为阴性。所有尿乙醇阳性结果EtG均为阳性。临床医生将26例患者的48份样本判断为非戒酒患者，178例患者的550份样本判断为戒酒患者。她对15例患者的15份样本不确定。以EtG作为金标准进行比较时，曲线下面积为0.592。在本研究中自我报告极不可靠，总共6份尿样中只有5例患者报告饮酒。在逻辑回归模型中，只有厌恶药物（比值比2.1，95%置信区间1.3 - 3.3）和临床医生判断（比值比2，95%置信区间1.4 -
2.9）有显著影响。
在酒精门诊患者的尿液筛查中，EtG的表现总体上比乙醇好得多，多检测出20.4%（613例中的125例）阳性。这意味着每有1例酒精阳性样本，就有15例EtG阳性样本。虽然比乙醇好，但临床医生的判断效率也不高。如果在酒精门诊患者筛查中常规实施，EtG可能会带来值得进一步研究的相关变化。
