White Daniel, Salman Sam, Joyce David A
PathWest Laboratory Medicine, Department of Clinical Pharmacology and Toxicology, Perth, Australia.
School of Medicine and School of Biomedical Sciences, University of Western Australia, Perth, Australia.
Drug Alcohol Rev. 2025 Jan;44(1):80-89. doi: 10.1111/dar.13947. Epub 2024 Sep 16.
Phosphatidylethanol (PEth) is a specific and persisting marker of ethanol (alcohol) consumption. Early success of medically necessary abstinence can be assessed by monitoring PEth disappearance at a biologically plausible rate. This requires an understanding of PEth elimination, its variability and its determinants. To achieve this, we characterised PEth elimination in drinkers who voluntarily abstained. We aimed to derive a nomogram from the data to assist practitioners in recognising abstinence.
Twenty-nine usual drinkers who were prepared to abstain from alcohol consumption for 4 weeks were recruited. Erythrocyte PEth was measured weekly. A population pharmacokinetic model for PEth was developed, describing the time-course of PEth elimination. Estimates were derived for population average, inter-individual variability in PEth half-life and any covariate influences. These estimates informed a nomogram of PEth elimination that incorporated a boundary separating continued abstinence from resumed drinking. The nomogram was tested to identify drinking events among participants.
The model estimated a population average elimination rate constant (k) of 0.088 day, corresponding to a half-life of 7.9 days with a residual coefficient of variation of 8.5%. Elimination was first order and no covariate influences were identified. The nomogram was internally assessed as predictively accurate for 21 successfully abstinent participants and in detecting alcohol consumption in 2 further participants, using a 99.9% prediction interval.
The value of PEth in distinguishing alcohol abstinence from consumption is enhanced by using a nomogram to confirm abstinence within weeks of its medically necessary imposition. Further work will establish the value of this approach in clinical practice.
磷脂酰乙醇（PEth）是乙醇（酒精）摄入的一种特异性且持久的标志物。通过监测PEth以生物学上合理的速率消失情况，可以评估医学必需戒酒的早期成效。这需要了解PEth的消除过程、其变异性及其决定因素。为实现这一目标，我们对自愿戒酒者的PEth消除情况进行了特征描述。我们旨在从数据中得出一个列线图，以协助从业者识别戒酒情况。
招募了29名准备戒酒4周的常饮酒者。每周测量红细胞PEth。建立了PEth的群体药代动力学模型，描述PEth消除的时间进程。得出了群体平均值、PEth半衰期的个体间变异性以及任何协变量影响的估计值。这些估计值为PEth消除列线图提供了依据，该列线图纳入了区分持续戒酒和恢复饮酒的界限。对该列线图进行了测试，以识别参与者中的饮酒事件。
该模型估计群体平均消除速率常数（k）为0.088天，对应半衰期为7.9天，残余变异系数为8.5%。消除过程为一级，未发现协变量影响。使用99.9%的预测区间，对21名成功戒酒的参与者进行内部评估时，该列线图预测准确，且在另外2名参与者中检测到了饮酒情况。
通过使用列线图在医学必需戒酒几周内确认戒酒情况，PEth在区分戒酒和饮酒方面的价值得到了提升。进一步的工作将确定这种方法在临床实践中的价值。
