Abstract
In both clinical and forensic settings, hair analysis for ethyl glucuronide (HEtG) has been increasingly employed for diagnosing chronic excessive drinking and, more recently, for monitoring abstinence. This paper aims at meta-analysing published data on HEtG concentrations in teetotallers, social drinkers and heavy drinkers in order to evaluate the use of this marker in hair for identifying chronic excessive drinking and for monitoring abstinence. In May 2012, a systematic multi-database search retrieved 366 records related to HEtG and further screened for relevant publications in the field. Fifteen (4.1 %) records matched the selection criteria and were included in the meta-analysis. The mean and 95 % confidence intervals (CI) of HEtG concentrations in social drinkers (mean 7.5 pg/mg; 95 % CI 4.7–10.2 pg/mg; p < 0.001), heavy drinkers (mean 142.7 pg/mg; 95 % CI 99.9–185.5 pg/mg; p < 0.001) and deceased subjects with a known history of chronic excessive drinking (mean 586.1 pg/mg; 95 % CI 177.2–995.0 pg/mg; p < 0.01) were calculated. The ranges of mean values and 95 % confidence intervals for single studies involving teetotallers/social or social/heavy drinkers showed a partial overlap with a down-trespassing of both the 7 and 30 pg/mg thresholds for social and heavy drinkers, respectively. Although larger and well-designed population studies are required to draw any definitive conclusion, our data show that the cut-off of 30 pg/mg limits the false-negative effect in differentiating heavy from social drinkers, whereas the recently proposed 7 pg/mg cut-off value might only be used for suspecting an active alcohol use, and not for proving complete abstinence.
Similar content being viewed by others
References
Ferrara SD, Bajanowski T, Cecchi R, Boscolo-Berto R, Viel G (2011) Bio-medicolegal scientific research in Europe: a comprehensive bibliometric overview. Int J Legal Med 125:393–402
Ferrara SD, Bajanowski T, Cecchi R, Snenghi R, Case C, Viel G (2010) Bio-medicolegal guidelines and protocols: survey and future perspectives in Europe. Int J Legal Med 124:345–350
Nalesso A, Viel G, Cecchetto G, Mioni D, Pessa G, Favretto D, Ferrara SD (2011) Quantitative profiling of phosphatidylethanol molecular species in human blood by liquid chromatography high resolution mass spectrometry. J Chromatogr A 1218:8423–8431
Pragst F, Rothe M, Moench B, Hastedt M, Herre S, Simmert D (2010) Combined use of fatty acid ethyl esters and ethyl glucuronide in hair for diagnosis of alcohol abuse: interpretation and advantages. Forensic Sci Int 196:101–110
Boscolo-Berto R, Viel G, Cecchi R, Terranova C, Vogliardi S, Bajanowski T, Ferrara SD (2012) Journals publishing bio-medicolegal research in Europe. Int J Legal Med 126:129–137
Favretto D, Nalesso A, Frison G, Viel G, Traldi P, Ferrara SD (2010) A novel and an effective analytical approach for the LC-MS determination of ethyl glucuronide and ethyl sulfate in urine. Int J Legal Med 124:161–164
Viel G, Boscolo-Berto R, Cecchi R, Bajanowski T, Vieira ND, Ferrara SD (2011) Bio-medicolegal scientific research in Europe. A country-based analysis. Int J Legal Med 125:717–725
Schrader J, Rothe M, Pragst F (2012) Ethyl glucuronide concentrations in beard hair after a single alcohol dose: evidence for incorporation in hair root. Int J Legal Med 126:791–799
Alt A, Janda I, Seidl S, Wurst FM (2000) Determination of ethyl glucuronide in hair samples. Alcohol Alcohol 35:313–314
Appenzeller BM, Agirman R, Neuberg P, Yegles M, Wennig R (2007) Segmental determination of ethyl glucuronide in hair: a pilot study. Forensic Sci Int 173:87–92
Janda I, Weinmann W, Kuehnle T, Lahode M, Alt A (2002) Determination of ethyl glucuronide in human hair by SPE and LC-MS/MS. Forensic Sci Int 128:59–65
Kharbouche H, Sporkert F, Troxler S, Augsburger M, Mangin P, Staub C (2009) Development and validation of a gas chromatography-negative chemical ionization tandem mass spectrometry method for the determination of ethyl glucuronide in hair and its application to forensic toxicology. J Chromatogr B Anal Technol Biomed Life Sci 877:2337–2343
Kharbouche H, Steiner N, Morelato M, Staub C, Boutrel B, Mangin P, Sporkert F, Augsburger M (2010) Influence of ethanol dose and pigmentation on the incorporation of ethyl glucuronide into rat hair. Alcohol 44:507–514
Tagliaro F, Bortolotti F, Viel G, Ferrara SD (2011) Caveats against an improper use of hair testing to support the diagnosis of chronic excessive alcohol consumption, following the “Consensus” of the Society of Hair Testing 2009 [Forensic Science International 196 (2010) 2]. Forensic Sci Int 207:e69–e70
Morini L, Zucchella A, Polettini A, Politi L, Groppi A (2010) Effect of bleaching on ethyl glucuronide in hair: an in vitro experiment. Forensic Sci Int 198:23–27
Kintz P (2012) Consensus of the Society of Hair Testing on hair testing for chronic excessive alcohol consumption 2011. Forensic Sci Int 218:2
Agius R, Nadulski T, Kahl HG, Dufaux B (2012) Significantly increased detection rate of drugs of abuse in urine following the introduction of new German driving licence re-granting guidelines. Forensic Sci Int 215:32–37
Albermann ME, Musshoff F, Madea B (2011) Comparison of ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) concentrations in hair for testing abstinence. Anal Bioanal Chem 400:175–181
Boscolo-Berto R, Viel G, Montagnese S, Raduazzo DI, Ferrara SD, Dauvilliers Y (2012) Narcolepsy and effectiveness of gamma-hydroxybutyrate (GHB): a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 16:431–443
Boscolo-Berto R (2009) Clinical testing and evidence-based medicine: when the absence of evidence doesn’t mean evidence of absence. G Ital Nefrol 26:417
Viel G, Boscolo-Berto R, Cecchetto G, Fais P, Nalesso A, Ferrara SD (2012) Phosphatidylethanol in blood as a marker of chronic alcohol use: a systematic review and meta-analysis. Int J Mol Sci 13:14788–14812
Kerekes I, Yegles M, Grimm U, Wennig R (2009) Ethyl glucuronide determination: head hair versus non-head hair. Alcohol Alcohol 44:62–66
Kharbouche H, Faouzi M, Sanchez N, Daeppen JB, Augsburger M, Mangin P, Staub C, Sporkert F (2012) Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers. Int J Legal Med 126:243–250
Kintz P, Villain M, Vallet E, Etter M, Salquebre G, Cirimele V (2008) Ethyl glucuronide: unusual distribution between head hair and pubic hair. Forensic Sci Int 176:87–90
Kronstrand R, Brinkhagen L, Nystrom FH (2012) Ethyl glucuronide in human hair after daily consumption of 16 or 32 g of ethanol for 3 months. Forensic Sci Int 215:51–55
Lamoureux F, Gaulier JM, Sauvage FL, Mercerolle M, Vallejo C, Lachatre G (2009) Determination of ethyl-glucuronide in hair for heavy drinking detection using liquid chromatography-tandem mass spectrometry following solid-phase extraction. Anal Bioanal Chem 394:1895–1901
Morini L, Politi L, Polettini A (2009) Ethyl glucuronide in hair. A sensitive and specific marker of chronic heavy drinking. Addiction 104:915–920
Morini L, Politi L, Acito S, Groppi A, Polettini A (2009) Comparison of ethyl glucuronide in hair with carbohydrate-deficient transferrin in serum as markers of chronic high levels of alcohol consumption. Forensic Sci Int 188:140–143
Pirro V, Valente V, Oliveri P, De Bernardis A, Salomone A, Vincenti M (2011) Chemometric evaluation of nine alcohol biomarkers in a large population of clinically-classified subjects: pre-eminence of ethyl glucuronide concentration in hair for confirmatory classification. Anal Bioanal Chem 401:2153–2164
Pirro V, Di Corcia D, Pellegrino S, Vincenti M, Sciutteri B, Salomone A (2011) A study of distribution of ethyl glucuronide in different keratin matrices. Forensic Sci Int 210:271–277
Politi L, Morini L, Leone F, Polettini A (2006) Ethyl glucuronide in hair: is it a reliable marker of chronic high levels of alcohol consumption? Addiction 101:1408–1412
Shi Y, Shen B, Xiang P, Yan H, Shen M (2010) Determination of ethyl glucuronide in hair samples of Chinese people by protein precipitation (PPT) and large volume injection-gas chromatography-tandem mass spectrometry (LVI-GC/MS/MS). J Chromatogr B Anal Technol Biomed Life Sci 878:3161–3166
Yegles M, Labarthe A, Auwärter V, Hartwig S, Vater H, Wennig R, Pragst F (2004) Comparison of ethyl glucuronide and fatty acid ethyl ester concentrations in hair of alcoholics, social drinkers and teetotallers. Forensic Sci Int 145:167–173
Offidani C, Strano Rossi S, Chiarotti M (1993) Drug distribution in the head, axillary and pubic hair of chronic addicts. Forensic Sci Int 63:105–108
Author information
Authors and Affiliations
Corresponding author
Additional information
Rafael Boscolo-Berto and Guido Viel have equally contributed to the paper and should be considered co-first authors.
Rights and permissions
About this article
Cite this article
Boscolo-Berto, R., Viel, G., Montisci, M. et al. Ethyl glucuronide concentration in hair for detecting heavy drinking and/or abstinence: a meta-analysis. Int J Legal Med 127, 611–619 (2013). https://doi.org/10.1007/s00414-012-0809-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-012-0809-0