Clinicians rely on ethanol biomarkers to avoid the potential negative effects that ethanol consumption can have on medical treatments. Often, these tests are used to verify patient-reported ethanol use, but can place the laboratory and provider in an adversarial relationship with patients.
In yesterday’s session, “Biomarkers of Ethanol Consumption: Clinical Utility and Ethical Considerations for Testing,” Stephen Roper, PhD, and Melissa Budelier, PhD, discussed the advantages and limitations of currently available tests and the ethical principles that inform ordering practices and guide difficult decisions that keep patients’ best interests in mind.
As laboratorians, Budelier, director of clinical chemistry and toxicology at TriCore Reference Laboratories in New Mexico, and Roper, assistant director of pediatric laboratory services, St. Louis Children’s Hospital, “noticed an increase in test volume for many ethanol biomarkers, and wanted to better understand the patient population these tests were being ordered for.” Their research focused on ordering practices, how the results were being interpreted, consensus guidelines, and ethical principles as they relate to laboratory medicine. “We realized that others, too, may benefit from learning more about the utility of various ethanol biomarkers,” Budelier said.
Like many laboratory assays, ethanol biomarkers are potentially subject to false positive and false negative results, and the subsequent assay performance is dependent on the test ordered, the method used, and the purpose of testing. Considering the potential medical decisions based on ethanol consumption, it is important for laboratorians and providers to understand these assays’ utility and limitations. As Budelier noted, “there is little education available to laboratorians on applying ethical principles to everyday practice.” This session highlighted the unique opportunity laboratorians have to provide insight on both test utility and ethical principles.
There is tremendous demand for accurate determination of a patient’s ethanol use. Roper reviewed the current biomarkers of both acute and chronic ethanol consumption and the clinical utility of each assay. He highlighted the importance of the clinical context for testing, and remarked how context can have ramifications if misinterpreted. “No cutoff is going to be perfect for everybody,” Roper said, and this can be highlighted in the example of a heavy drinker whose PEth is decreasing after alcohol cessation. A single test result above cutoff would not provide the clinician a complete picture of the individual’s actual drinking status or elimination kinetics for the biomarker. In this context, the clinician and patient would be best served with trending their lab results.
Given the medical treatment decisions based on ethanol consumption, and the potential adversarial position in which it places clinicians, it is critical that laboratorians support clinicians with measured, accurate guidance on the use of ethanol biomarkers and their limitations.
This relationship between the entire treatment team is essential to navigating the ethical use of these results, while maximizing patient safety and outcomes.