(177) Utilization of phosphatidylethanol (PEth) levels in those seeking inpatient alcohol withdrawal management

Abstract: Background/Significance: Phosphatidylethanol (PEth) has emerged as an important direct alcohol biomarker to assess recent heavy drinking as levels correlate with self-reported drinking in the past 2-4 weeks. However, research is lacking to evaluate if PEth levels correlate with the severity of alcohol withdrawal, which could assist hospital clinicians to identify patients who may be at greater risk of experiencing severe alcohol withdrawal.

Methods: A prospective study enrolled individuals undergoing alcohol withdrawal treatment at a ASAM level 4 inpatient withdrawal management unit (i.e. “detox”). The primary aim was to assess the correlation of serum PEth levels with CIWA scores and total medication requirements. Secondary aims correlated PEth levels with drinking history, AUDIT, and PAWSS score. The study was approved by the Institutional Review Board, and participants were compensated.

Results: A total of 30 individuals were enrolled who were on average 48.7 years of age (SD 11.7), mostly white (67.7%), and reported drinking on average 27.5 drinks per day (SD 29.8, range 8-40). Admission PEth levels (mean: 934.9ng/ml, SD: 546.6, range: 42 – >2,000ng/ml) were not significantly correlated with total medication requirements in diazepam equivalents (r=0.05, p=0.78) or CIWA scores (r=0.09 to -0.14, p >0.05). Analyses showed no significant correlations between PEth levels and drinks per drinking days (r=0.16, p = 0.38), total AUDIT scores (r=0.17, p=0.35) or PAWSS scores (r=0.13, p=0.50).

Discussion: PEth levels may be a useful measure to confirm the degree of recent drinking, but these results may suggest that PEth levels may have no predictive value for alcohol consumption or withdrawal severity when the amount of alcohol consumed is very high (i.e. > 20 drinks per day). Further research is warranted to better understand the utility of PEth testing among those at risk for alcohol withdrawal.

Conclusion/Implications: PEth may not be a reliable biomarker for predicting alcohol withdrawal severity among heavy drinkers. Further studies are needed to better characterize the role of PEth in clinical settings.

References:
1. Isaksson, A., Walther, L., Hansson, T., Andersson, A. & Alling, C. Phosphatidylethanol in blood (B-PEth): a marker for alcohol use and abuse. Drug Test. Anal. 3, 195–200 (2011). 2. Cherrier, M. M. et al. Relationship of Phosphatidylethanol Biomarker to Self-Reported Alcohol Drinking Patterns in Older and Middle-Age Adults. Alcohol. Clin. Exp. Res. 44, 2449–2456 (2020). 3. Kummer, N. et al. Quantification of phosphatidylethanol 16:0/18:1, 18:1/18:1, and 16:0/16:0 in venous blood and venous and capillary dried blood spots from patients in alcohol withdrawal and control volunteers. Anal. Bioanal. Chem. 408, 825–838 (2016).
4. Sonmez, M. B., Cinar, R. K., Gorgulu, Y., Kilic, E. K. & Unal, A. Evaluation of phosphatidylethanol by ELISA for detection of excessive alcohol use compared with traditional biomarkers: a case-control study. Psychiatry Clin. Psychopharmacol. 27, 41–46 (2017).

Presentation Eligibility: I am planning to work on submitting the manuscript for publication eventually but it will not be published before November 2024.

Diversity, Equity, and Inclusion: Managing alcohol use disorder and acute withdrawal poses significant challenges. Health disparities related to alcohol use disproportionately affect Native American, Hispanic, and Black populations. Identifying a reliable biomarker that correlates with alcohol consumption and the severity of withdrawal symptoms is crucial for effective clinical management. This approach could also substantially benefit patients from minority backgrounds.