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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/122551
Ethylglucuronide replacing ethanol in the routine screening of alcohol dependent outpatients: clinical implications
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[eng] BACKGROUND:
The development of an alcohol biomarker is a long process where different stages take place over time. From discovery to full clinical use and implementation, each accomplished stage increases the confidence in and the relevance of such biomarkers. In recent years, new biomarkers have been discovered, with outstanding improvements in the sensibility and specificity for the detection of recent drinking. However, the clinical, therapeutic and economical consequences of such biochemical improvements remain to be determined. With the present thesis we expect to investigate the clinical implications of such new biomarkers, with a special focus on urine ethyl glucuronide (EtG), in order to fully establish its contribution to the field of alcohol use disorders. It comprises three articles: the first (Study 1) compares the screening performance of ethyl glucuronide versus ethanol, clinical judgment and self report, under routine, real circumstances in alcohol dependent outpatients. The second one (Study 2) investigates the differential, one-year clinical evolution of patients screening positive and negative in Study 1, taking into account both clinical and economic consequences. Finally, Study 3 evaluates patients’ knowledge and attitudes towards regular alcohol urine screening.
METHODS:
Study 1 consisted of a cross-sectional comparison aiming at clinically validating EtG under real, routinely clinical conditions. For that purpose, 613 consecutive urinary samples, provided by 188 outpatients with alcohol dependence were analyzed for ethanol and EtG. Study 2 retrospectively assessed the clinical evolution of patients participating in Study 1. A survival analysis was conducted in order to compare the rate of relapse between EtG positive and negative patients. Regression models were performed to compare the mean number of days hospitalized between groups, the risk of being lost to follow-up and treatment expenses. In Study 3 a cross-sectional survey among alcohol dependent outpatients was conducted. In consonance with the principles of patient centered care, it aimed at investigating patients’ attitudes and beliefs towards regular alcohol urine screening. For attitudes’ assessment, we adapted the Drug Attitude Inventory (DAI-10) to the field of alcohol urine screening. Internal consistency, test-retest reliability and concurrent validity were evaluated for the adapted questionnaire.
RESULTS:
Study 1 showed an overriding superiority of EtG over ethanol, clinical judgment and self report, detecting a significant greater number of positive samples in routine, real circumstances. Study 2 revealed a clearly different clinical evolution between EtG positive and negative patients during the following 12 months, with EtG positive patients being at greater risk of relapse, hospitalization and incurring in more treatment expenses. Study 3 suggested that regular alcohol screening is highly valued by alcohol outpatients. It also showed that besides relapse prevention, other functions related to therapeutic alliance building, social desirability and impression management play a key role as well.
CONCLUSIONS:
Regular alcohol urine screening with ethyl glucuronide seems to have an impact on the clinical management of alcohol dependent outpatients, offering a better detection of recent drinking and the possibility of an improved relapse prevention strategy.
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BARRIO GIMÉNEZ, Pablo. Ethylglucuronide replacing ethanol in the routine screening of alcohol dependent outpatients: clinical implications. [consulta: 9 de desembre de 2025]. [Disponible a: https://hdl.handle.net/2445/122551]