Ethyl Glucuronide in Hair Compared With Traditional Alcohol Biomarkers—A Pilot Study of Heavy Drinkers Referred to an Alcohol Detoxification Unit


Reprint requests: Gudrun Høiseth, MD, Norwegian Institute of Public Health, Division of Forensic Toxicology and Drug Abuse, Pb 4404 Nydalen, N-0403 Oslo, Norway; Fax: +47-22-38-32-33; E-mail:


Background:  Traditional biomarkers for heavy alcohol use include serum carbohydrate-deficient transferrin (CDT), the enzymes aspartate aminotranserase (AST), and alanine aminotransferase (ALT) as well as gamma-glutamyl transferase (GGT). Measurement of the nonoxidative ethanol metabolite, ethyl glucuronide (EtG) in hair, has been proposed as a new marker with superior qualities. The aim of this study was to investigate the sensitivity of EtG in hair to detect heavy alcohol use compared with CDT, AST, ALT, and GGT. We also wanted to study the quantitative relation between alcohol intake and the different biomarkers.

Methods:  Sixteen patients with a history of heavy alcohol use over the previous 3 months were recruited directly after admission to a withdrawal clinic. They were thoroughly interviewed about their drinking pattern as well as relevant diseases and use of medicines or drugs. Serum was sampled and analyzed for %CDT, AST, ALT, and GGT. Hair samples were collected and analyzed for EtG.

Results:  The mean estimated daily intake (EDI) over the previous 3 months was 206 ± 136 g pure alcohol. All patients fulfilled the criteria for heavy alcohol use. The sensitivity to detect heavy alcohol use was 64% for %CDT, 67% for AST, 67% for ALT, 93% for GGT, and 94% for EtG. There was no correlation between the quantitative values of EDI and %CDT, AST, ALT, and GGT. There was a positive, statistically significant correlation between EDI and the level of EtG in hair.

Conclusions:  In this study, EtG in hair and GGT showed the best sensitivity to detect heavy alcohol use and there was a positive correlation between EDI and the concentrations of EtG in hair. Before giving recommendations for clinical practice, further studies should be carried out on larger materials and populations with a wider range of alcohol intake.