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|Title:||Assessment of alcohol consumption in liver transplant candidates and recipients: the best combination of the tools available||Authors:||Piano, Salvatore
Chiara Frigo, Anna
|Keywords Plus:||CARBOHYDRATE-DEFICIENT TRANSFERRIN;URINARY ETHYL GLUCURONIDE;LONG-TERM SURVIVAL;PRIMARY-CARE;PROBLEM DRINKING;DISEASE PATIENTS;SCREENING TOOL;CIRRHOSIS;RECIDIVISM;IMMUNOASSAY||Mesh headings:||Alcohol Drinking;End Stage Liver Disease;Liver Transplantation||Secondary Mesh headings:||Aged;Alcoholism;Biomarkers;Ethanol;Female;Glucuronates;Humans;Male;Middle Aged;Odds Ratio;Prospective Studies;ROC Curve;Recurrence;Transferrin||Issue Date:||Jul-2014||Publisher:||WILEY-BLACKWELL||Journal:||Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society||Abstract:||
The detection of alcohol consumption in liver transplant candidates (LTCs) and liver transplant recipients (LTRs) is required to enable a proper assessment of transplant eligibility and early management of alcohol relapse, respectively. In this clinical setting, urinary ethyl glucuronide (uEtG), the Alcohol Use Disorders Identification Test for Alcohol Consumption (AUDIT-c), serum ethanol, urinary ethanol, carbohydrate-deficient transferrin (CDT), and other indirect markers of alcohol consumption were evaluated and compared prospectively in 121 LTCs and LTRs. Alcohol consumption was diagnosed when AUDIT-c results were positive or it was confirmed by a patient's history in response to abnormal results. Alcohol consumption was found in 30.6% of the patients. uEtG was found to be the strongest marker of alcohol consumption (odds ratio = 414.5, P < 0.001) and provided a more accurate prediction rate of alcohol consumption [area under receiving operating characteristic (ROC) curve = 0.94] than CDT (area under ROC curve = 0.63, P < 0.001) and AUDIT-c (area under ROC curve = 0.73, P < 0.001). The combination of uEtG and AUDIT-c showed higher accuracy in detecting alcohol consumption in comparison with the combination of CDT and AUDIT-c (area under ROC curve = 0.98 versus 0.80, P < 0.001). Furthermore, uEtG was the most useful marker for detecting alcohol consumption in patients with negative AUDIT-c results. In conclusion, the combination of AUDIT-c and uEtG improves the detection of alcohol consumption in LTCs and LTRs. Therefore, they should be used routinely for these patients.
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