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Alcohol Biomarkers in Clinical and Forensic Contexts
Hilke Andresen-Streichert1, Alexander Müller, Alexander Glahn
1These authors share the position of the first/last author; Institute of Legal Medicine, Department of Toxicology and Alcohology, Faculty of Medicine, University of Cologne, Germany; Institute of Legal Medicine, Department of Toxicology and Alcohology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany; Forensisch Toxikologisches Centrum München GmbH, Munich, Germany; Hepatobiliary Surgery and Transplantation Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Background:
Biomarkers of alcohol consumption are important not only in forensic contexts, e.g., in child custody proceedings or as documentation of alcohol abstinence after temporary confiscation of a driver's license. They are increasingly being used in clinical medicine as well for verification of abstinence or to rule out the harmful use of alcohol.
Methods:
This review is based on pertinent publications that were retrieved by a selective literature search in PubMed concerning the direct and indirect alcohol markers discussed here, as well as on the authors' experience in laboratory analysis and clinical medicine.
Results:
Alongside the direct demonstration of ethanol, the available markers of alcohol consumption include the classic indirect markers carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and mean corpuscular volume (MCV) as well as direct alcohol markers such as ethyl glucuronide (EtG) and ethyl sulfate (EtS) in serum and urine and EtG and fatty acid ethyl esters (FAEE) in hair. Phosphatidylethanol (PEth) is a promising parameter that com - plements the existing spectrum of tests with high specificity (48-89%) and sensi - tivity (88-100%). In routine clinical practice, the demonstration of positive alcohol markers often leads patients to admit previously denied alcohol use. This makes it possible to motivate the patient to undergo treatment for alcoholism.
Conclusion:
The available alcohol biomarkers vary in sensitivity and specificity with respect to the time period over which they indicate alcohol use and the minimum extent of alcohol use that they can detect. The appropriate marker or combination of markers should be chosen in each case according to the particular question that is to be answered by laboratory analysis.
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