Alcohol Use Biomarkers Testing
Preferred method for ruling out ethanol exposure
Identify recent ethanol exposure within 1-5 days after ingestion
Results do not accurately correlate with amount or frequency of ethanol use
May be useful in the assessment of ethanol exposure in the contexts of compliance and/or abuse
Identify recent ethanol exposure within 1-5 days after ingestion
Results do not accurately correlate with amount or frequency of ethanol use
Identify alcohol abuse or abuse relapse
Will detect chronic ethanol use (≥40 g/day for 2 weeks)
Tests for Chronic Ethanol Use or Abuse Relapse
Test for chronic ethanol use
Identify chronic heavy ethanol use for up to 28 days
Alcohol use biomarkers (eg, ethyl glucuronide, ethyl sulfate, carbohydrate deficient transferrin) can help determine acute or chronic alcohol use. Screening tests may be useful in ruling out recent alcohol use, for general screening in the assessment of ethanol exposure in the contexts of compliance and/or abuse, and as aid for monitoring alcohol abstinence.
Disease Overview
Clinical Issues
Acute ethanol intoxication beyond the first 6-8 hours is not reliably predicted by serum testing, so other biomarkers are often used to detect alcohol use.
Ethyl glucuronide (EIG) and ethyl sulfate (EIS)
- Direct metabolites of ethanol
- Detected up to 80 hours in urine after ethanol ingestion
- Good biomarkers of recent alcohol ingestion
- Useful in short-term monitoring for abstinence
Carbohydrate deficient transferrin (CDT)
- Negative charged glycoprotein proteins with incomplete glycan chain(s)
- Markedly increased by moderate to heavy alcohol use
- Most useful for long-term abstinence monitoring (up to 2 weeks)
Phosphatidylethanol (PEth)
- Phospholipid formed only in the presence of ethanol
- PEth may be a more sensitive marker of chronic use than CDT
- Identifies chronic heavy ethanol use for up to 28 days
Test Interpretation
Analytical Sensitivity
| Test | Results |
|---|---|
|
Ethyl Glucuronide Screen with Reflex to Confirmation, Urine |
Cutoff for positive screen is set at 500 ng/mL |
|
Ethyl Glucuronide and Ethyl Sulfate Confirmation, Urine |
|
|
Carbohydrate Deficient Transferrin |
Reported as percent:
|
|
Phosphatidylethanol (PEth) |
|
Limitations (by Test)
Ethyl Glucuronide and Ethyl Sulfate Confirmation, Urine
Incidental exposure from ethanol-containing products may be detected.
Ethyl Glucuronide Screen with Reflex to Confirmation, Urine
- False positive results may be caused by microbial formation or fermentation, ethanol-containing products (eg, hand sanitizer, mouthwash).
- False negative results may be caused by bacterial degradation, >4 days since ethanol ingestion.
Carbohydrate Deficient Transferrin
- Cannot be used in individuals suspected of having congenital glycosylation disorders.
- Advanced liver damage (including severe chronic viral hepatitis) and antiepileptic drug therapy can increase CDT levels.
- Interference in quantitation may be caused by:
- Severe icterus
- Genetic variants of transferrin
- Excess monoclonal or polyclonal immunoglobulins
Phosphatidylethanol (PEth)
Elevated PEth may result from incidental or unintentional ethanol exposure
- Allen J, Sillanaukee P, Strid N, Litten R. Biomarkers of Heavy Drinking. National Institute on Alcohol Abuse and Alcoholism. Bethesda, MD [Accessed: Jun 2019]
- Nanau RM, Neuman MG. Biomolecules and biomarkers used in diagnosis of alcohol drinking and in monitoring therapeutic interventions. Biomolecules. 2015; 5(3): 1339-85. PubMed
- Niemelä O. Biomarker-Based Approaches for Assessing Alcohol Use Disorders. Int J Environ Res Public Health. 2016; 13(2): 166. PubMed
Last Update: August 2019
Tests for Acute Ethanol Use