PEth and AUDIT flagged different patients, so use them together

Design

Retrospective cohort using linked primary care records and registries, Sweden

Population

3,679 patients with PEth and AUDIT; 8,934 with PEth and reported weekly drinks

Primary outcome

Concordance between PEth, AUDIT and reported weekly drinks for hazardous alcohol use

Effect

Hazardous use 26.5% (AUDIT), 14.6% to 18.3% (PEth), 8.5% (10 or more drinks a week)

In this retrospective Swedish cohort, primary care records were linked to national registries. One sample comprised 3,679 patients with a phosphatidylethanol (PEth) result and an AUDIT score within 90 days of each other, and another 8,934 patients with PEth and a documented weekly alcohol intake. Hazardous use was defined as PEth above 210 ng/mL, AUDIT of 8 or more, or 10 or more drinks a week.

The prevalence varied by method: 26.5% by AUDIT, 14.6% to 18.3% by PEth and 8.5% by reported drinks. Each method found patients that the others missed. PEth correlated moderately with both AUDIT and reported drinking, and nonlinearly. At similar PEth levels, men and people with higher education or income reported more drinks, while younger patients had higher AUDIT scores.

The authors conclude PEth should be read alongside self-report. In practice, a negative questionnaire does not exclude hazardous drinking, and a raised PEth is best used to open a conversation rather than to confront. PEth testing may not be widely available or affordable in Indian primary care, and the source does not address that.

• AUDIT of 8 or more flagged 26.5%; PEth above 210 ng/mL flagged 14.6% to 18.3%; 10 or more drinks a week flagged 8.5%.
• Each method identified patients the others did not.
• PEth correlated only moderately with AUDIT and reported drinking.
• Consider using PEth alongside AUDIT and a drinks history, not instead of them.
• Use a raised result to start a non-judgemental conversation.

Why it matters

A single negative screen gives false reassurance and a single biomarker misses some drinkers.

Don't overread it

The patients had PEth tested for clinical reasons, so the sample is not representative of all primary care attenders.

The statistics, in plain English

Because there is no gold standard for hazardous drinking, this study could only compare the methods with one another. Differences in prevalence reflect what each measures: AUDIT captures patterns and consequences, reported drinks capture volume, and PEth reflects intake over the previous weeks.

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