Haddadin Rakahn, Molina Steven, Trad George, Ryan John, Gish Robert
Department of Internal Medicine, HCA Healthcare; MountainView Hospital, Las Vegas, NV, USA.
University of California Riverside, School of Medicine, Riverside, CA, USA.
Gastroenterology Res. 2024 Dec;17(5-6):205-211. doi: 10.14740/gr1790. Epub 2024 Dec 28.
Alcohol dependence remains a significant global health issue, exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. Phosphatidylethanol (PEth), a direct biomarker of recent alcohol consumption, offers improved specificity, sensitivity, and a longer detection window of 2 - 4 weeks compared to traditional biomarkers. This study evaluates the association between PEth testing and hospital outcomes in hospitalized patients by comparing outcomes among patients with positive PEth and negative PEth test results.
This retrospective cohort study used data from the TriNetX database, comprising de- identified medical records from 66 US healthcare organizations from 2015 to 2024. The study population included patients with documented PEth test results. Patients were divided into two groups: positive PEth test results (≥ 20 ng/mL) and negative PEth test results (≤ 19 ng/mL). Propensity score matching was performed to minimize bias, balancing for age, sex, race, ethnicity, and comorbidities such as cirrhosis, diabetes mellitus, hypertension, coronary artery disease, and chronic obstructive pulmonary disease (COPD). Key hospital outcomes assessed included mortality, delirium tremens, endoscopy/colonoscopy, liver transplant status, liver transplant rejection, liver transplant complications, hepatorenal syndrome, intensive care unit (ICU) admission, hepatic encephalopathy, and sarcopenia. These outcomes were chosen based on their prevalence in patients with alcohol use.
Patients with positive PEth results demonstrated significantly worse outcomes compared to patients in the negative PEth group. Positive PEth results were associated with higher mortality (odds ratio, 10.037; P < 0.001), ICU admissions, and rates of complications such as hepatorenal syndrome, hepatic encephalopathy, and sarcopenia. Postoperative liver transplant complications and rejection were also more frequent in the positive cohort.
This study highlights the association between recent alcohol use, as identified by PEth testing, and severe hospital outcomes. While PEth testing provides an objective measure of recent alcohol consumption, further research is needed to explore its role in improving clinical outcomes and guiding interventions for patients with alcohol use.
酒精依赖仍然是一个重大的全球健康问题，2019年冠状病毒病（COVID-19）大流行使其更加恶化。磷脂酰乙醇（PEth）是近期酒精摄入的直接生物标志物，与传统生物标志物相比，具有更高的特异性、敏感性，以及2至4周的更长检测窗口期。本研究通过比较PEth检测呈阳性和阴性的患者的结局，评估住院患者中PEth检测与医院结局之间的关联。
这项回顾性队列研究使用了TriNetX数据库的数据，该数据库包含2015年至2024年来自美国66家医疗保健机构的去识别化医疗记录。研究人群包括有记录的PEth检测结果的患者。患者分为两组：PEth检测结果呈阳性（≥20 ng/mL）和PEth检测结果呈阴性（≤19 ng/mL）。进行倾向得分匹配以尽量减少偏差，平衡年龄、性别、种族、民族以及肝硬化、糖尿病、高血压、冠状动脉疾病和慢性阻塞性肺疾病（COPD）等合并症。评估的关键医院结局包括死亡率、震颤谵妄、内镜检查/结肠镜检查、肝移植状态、肝移植排斥反应、肝移植并发症、肝肾综合征、重症监护病房（ICU）入院、肝性脑病和肌肉减少症。这些结局是根据它们在酒精使用患者中的患病率选择的。
与PEth阴性组的患者相比，PEth结果呈阳性的患者结局明显更差。PEth结果呈阳性与更高的死亡率（比值比，10.037；P < 0.001）、ICU入院率以及肝肾综合征、肝性脑病和肌肉减少症等并发症发生率相关。阳性队列中术后肝移植并发症和排斥反应也更频繁。
本研究强调了通过PEth检测确定的近期酒精使用与严重医院结局之间的关联。虽然PEth检测提供了近期酒精摄入的客观测量方法，但仍需要进一步研究以探索其在改善临床结局和指导酒精使用患者干预措施方面的作用。
