Biomarkers of chronic alcohol misuse

Current Biomarker Findings Dovepress open access to scientific and medical research Review Open Access Full Text Article Current Biomarker Findings downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Biomarkers of chronic alcohol misuse This article was published in the following Dove Press journal: Current Biomarker Findings 17 January 2014 Number of times this article has been viewed Philippe Gonzalo 1 Sylvie Radenne 2 Sylvie Gonzalo 3 Laboratoire de Biochimie, Centre Hospitalier Universitaire de SaintEtienne, Saint-Etienne, France; 2Service d’Hépatologie-Gastroentérologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France; 3 Laboratoire Biomnis, Lyon, France 1 Introduction Correspondence: Philippe Gonzalo Laboratoire de Biochimie, Plateau de Bio-Pathologie, Centre Hospitalier Universitaire de Saint-Etienne, 42055 Saint-Etienne Cedex 02, France Tel +33 4 77 12 75 53 Fax +33 4 77 82 84 63 Email Alcohol abuse and dependence are defined as psychiatric disorders according to the criteria described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).1 Alcohol abuse and alcohol dependence, although somewhat overlapping, are defined as follows: Alcohol abuses are characterized by the recurring use of alcoholic beverages despite alcohol’s negative consequences on various aspects of life, including professional, social, family, economic, legal, and health problems. Alcohol dependence is marked by the need for significantly increased amounts of alcohol, the characteristic withdrawal syndrome, and unsuccessful efforts to cut down drinking. This division into dependence and abuse has not been retained in the DSM-V revision, and abuse and dependence criteria have been combined into a single substance use disorder, with craving being regarded as an additional criterion.2 Chronic alcohol abuse is usually referred to by the generic term “alcoholism,” although several chronic alcohol misuses exist, including binge drinking (heavy episodic drinking during a short period of time), a new drinking behavior arising predominantly in adolescents and young adults. All these behaviors result in severe long-term health effects.3 As stated by Allen in 2003, biomarkers of heavy drinking are not intended to replace the psychometric measures of alcohol misuse that generally aim to assess drinking behavior and alcohol dependence.4 Instead, they are complementary to selfreporting questionnaires and clinical investigations, and the two approaches should 9 submit your manuscript | www.dovepress.com Current Biomarker Findings 2014:4 9–22 Dovepress © 2014 Gonzalo et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/CBF.S37239 Powered by TCPDF (www.tcpdf.org) Abstract: Biological markers of chronic alcoholism can be divided into two groups: direct and indirect markers. Direct markers (mainly blood or serum and urine ethanol, ethylglucuronide, ethyl sulfate, and phosphatidylethanol) directly track the intake of alcohol and vary in their sensitivity and kinetics of appearance and clearance. Indirect markers (mean corpuscular volume, γ-glutamyl transferase, alanine aminotransferase and aspartate aminotransferase, and carbohydrate-deficient transferrin) are biological parameters that are influenced by a steady and significant alcohol intake. We discuss the values of these tests and the relevance of their prescriptions for the clinical evaluation of heavy drinking. We indicate, when known, the pathophysiological mechanism of their elevations. We also discuss the amount and time of alcohol consumption required to give a positive result and the duration of abstinence required for the return to normal values. The forensic use of these biomarkers will not be considered in this review. Keywords: alcoholism, biomarker, CDT, relapse, alcohol-induced liver disease Dovepress Current Biomarker Findings downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Gonzalo et al be used in conjunction. Indeed, in contrast to self-reporting, biomarkers do not suffer from inaccurate reports of drinking behaviors. In this way, they can provide clinicians with an additional source of objective information on patients. However, they have their own limitations, depending on patient conditions and being subject to analytical caveats. This is obvious when comparison of specificities and sensitivities for the same biomarker are performed between several studies. The implementation of standardization is constantly ongoing to reduce analytical discrepancies between laboratories. However, test results are still not all correctly standardized, and thus the results are not interpretable using the same reference values in each laboratory, a property called commutability. In addition, methods have significantly changed over time, particularly in enzymology, and as a consequence, it is now difficult to compare and interpret results obtained 20 or 30 years ago. Another difficulty when comparing studies arises from the characteristics of the population, including the reference population. Indeed, detecting heavy drinking in the general population for driving license restitution is much easier than detecting it among cirrhotic patients. Frequency of alcohol addiction in the general population is also a common caveat. Sensitivity refers to the ability to identify a specific trait (in this case, heavy drinking), but it is much easier to detect the trait with a low rate of false-positive results when the trait is common compared with when it is rare. This can also account for the observed conflicting performances reported for identical alcohol biomarkers. For all these reasons, it is necessary to note that although they are apparently fully objective, biomarker results should be interpreted in context. Another difficulty with alcohol biomarkers, beyond the fact that they are reported to rise when alcohol is consumed, is correctly interpreting this elevation. Indeed, the use of traditional biomarkers is well-established, but their alleged performances have evolved, and therefore, it is difficult to interpret them reliably. New biomarkers are generally less available, and their performances are somewhat poorly assessed. This, of course, depends both on the marker and on the circumstances in which it is prescribed. For example (...truncated)