Integrated biomarker analysis of multi-organ effects following MDMA and alcohol co-consumption in Pakistan: A pilot...

3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy") is a widely abused recreational drug associated with multi-organ toxicity. Objective was to compare hepatic, renal, and systemic biochemical abnormalities after acute MDMA exposure alone and with alcohol. This cross-sectional pilot study was conducted at Sheikh Zayed bin Al Nahyan and Shalamar Medical and Dental Colleges, Pakistan. The study included 24 exposed participants (ecstasy-only n = 10; ecstasy and alcohol n = 14) and 20 controls. Blood samples were analyzed for AST (<37 U/L), ALT (<63 U/L), ALP (46-116 U/L), GGT (<55 U/L), LDH (81-234 U/L), Urea (10-50 mg/dl), Creatinine (0.7-1.4 mg/dL), Uric Acid (3.5-7.2 mg/dl), and CK (39-232 U/L). Marked hepatorenal biochemical injury was predefined as ALP > 3 times the laboratory specific upper limit of normal or serum urea > 150 mg/dl. Group comparison, age and sex adjusted multivariable linear regression and ROC analyses were performed. The study group exhibited significantly elevated hepatorenal biomarkers vs. controls. Median AST, ALT and ALP were117.0, 117.5 and 439.0 U/L, equivalent to 3.16, 1.86 and 3.78 x ULN, respectively. Median urea and creatinine levels were 172.5 mg/dL and 1.42 mg/dL respectively. No significant difference was found between ecstasy-only and ecstasy and alcohol after correction. Adjusted models showed significantly higher ALP, urea, and creatinine in both study groups versus controls. RSI and STI showed high apparent discrimination (AUC 1.000 and 0.890, respectively). Acute MDMA exposure was associated with marked hepatic and renal biochemical abnormalities. Alcohol co-consumption did not independently exacerbate organ damage. The RSI and STI are novel, cost-effective, and highly accurate tools for emergency triage using routine laboratory parameters.