Thursday, November 9, 2017

Simple Blood Test Identifies Critically Ill Patients Who Misuse Alcohol, Study Finds

MAYWOOD, IL –  A simple blood test for a compound called PEth can accurately identify critically ill hospital patients who misuse alcohol, a study has found.

The finding is important because patients who misuse alcohol tend to have worse outcomes. If validated in further studies, the PEth test could help doctors anticipate and perhaps ward off alcohol-related complications such as organ failure and impaired healing of wounds and bones.

The study, published in Alcoholism: Clinical & Experimental Research, included researchers from Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center and the University of Colorado and was led by Loyola Medicine pulmonologist Majid Afshar, MD.

Patients who misuse alcohol and subsequently arrive at the hospital in critical condition develop more complications, have longer recovery times, develop organ dysfunction more frequently and are at greater risk of dying, according to earlier studies by Dr. Afshar and other researchers. Alcohol misuse is defined as heavy drinking (one or more drinks per day for women and two or more drinks per day for men) and/or binge drinking (four or more drinks per occasion for women and five or more drinks for men).

Current methods to identify alcohol misuse are problematic. For example, many critically ill patients in intensive care lack the capacity to answer questions about alcohol use. And testing blood alcohol concentration does not distinguish among different types of alcohol use, such as heavy daily use or occasional binge drinking.

An alternative test measures phosphatidylethanol (PEth), a compound in the blood that is a biomarker of alcohol use. With a half-life of four to 12 days, PEth lasts much longer in the body than blood alcohol concentration. (Half-life is the time it takes for PEth to fall to half its original level.) PEth remains detectable for up to three weeks.

The study enrolled 122 adults at Loyola University Medical Center and the University of Colorado Denver: 33 were critically ill patients treated in intensive care and burn units; 51 were treated in an alcohol detoxification unit; and 38 served as healthy controls. Alcohol misuse was determined by giving participants the Alcohol Use Disorders Identification Test, which asks questions such as how often a participant binge drinks, is unable to stop drinking or feels remorseful about drinking.

The study found that a PEth level of at least 250 nanograms per milliliter (ng/ml) was 88.7 percent accurate in identifying participants who display alcohol misuse and a level higher than 400 ng/ml was 83 percent accurate in identifying those who showed severe alcohol misuse.

The study is the first to examine the role PEth could play in critically ill patients. The findings "demonstrate good diagnostic accuracy for PEth in discriminating alcohol misuse, with useful cut-points to risk-stratify patients," Dr. Afshar and colleagues concluded. "Further validation in a more representative sample of critically ill patients is needed prior to clinical and research application."

The study was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the National Institute of General Medical Sciences.

In addition to Dr. Afshar, other co-authors include Cara Joyce, PhD; Meagan Yong; Richard Cooper, MD; and Erin Lowery, MD, of Loyola; Ellen Burnham, MD; Brendan Clark, MD; Jeannette Gaydos; and Elizabeth Kovacs, PhD, of the University of Colorado; and Gordon Smith, MPH, of the University of Maryland.

The study is titled, "Cut-point levels of phosphatidylethanol to identify alcohol misuse in a mixed cohort including critically ill patients."

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH) on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, and Loyola Outpatient Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 247-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

About Trinity Health

Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 93 hospitals, as well as 122 continuing care programs that include PACE, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $23.4 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 131,000 colleagues, including 7,500 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services — ranked by number of visits — in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org. You can also follow @TrinityHealthMI on Twitter.