Comparison of Ethyl Glucuronide and Carbohydrate-Deficient Transferrin in Different Body Fluids for Post-mortem Identification of Alcohol Use

Aims: Alcohol abuse is a major risk factor for premature death. Confirming the role of alcohol consumption in cause-of-death investigations has, however, remained difficult, due to lack of reliable biomarkers. Methods: We compared ethyl glucuronide (EtG) and carbohydrate-deficient transferrin (CDT) assays from serum, urine, cerebrospinal fluid and vitreous humor in a forensic autopsy population with either a positive (n = 38) or negative (n = 22) history of alcohol abuse based on detailed medical and police records and forensic toxicological investigations. Results: A positive blood alcohol concentration (median 1.15%, range 0-3.3%) was found in 26/38 (68%) of the cases with a documented history of alcohol abuse. EtG concentrations (mean +/- SD) in urine (339 +/- 389 mg/l, P < 0.001), vitreous humor (4.2 +/- 4.8 mg/l, P < 0.001), serum (6.9 +/- 8.9 mg/l, P < 0.01) and cerebrospinal fluid (1.7 +/- 2.7 mg/l, P < 0.01) were significantly higher among the cases with a positive history of alcohol use than those in the alcohol-history negative group, whereas in corresponding comparisons CDT was significantly different only in cerebrospinal fluid (4.3 +/- 2.1 vs. 2.3 +/- 0.6%, P < 0.05). The highest sensitivities (92%) in detecting ante-mortem alcohol use were obtained for urine and vitreous humor EtG assays. Conclusion: Our data indicate that measurements of EtG in urine or vitreous humor show the highest diagnostic accuracies in postmortem investigations of excessive alcohol consumption and can be recommended for routine applications.