Ethyl glucuronide in hair. A sensitive and specific
marker of chronic heavy drinking
Luca Morini1, Lucia Politi2 & Aldo Polettini3
Department of Legal Medicine and Public Health, University of Pavia, Pavia, Italy,1 Department of Anatomy, Histology, and Legal Medicine, University of Florence,
Florence, Italy2 and Department of Medicine and Public Health, University of Verona,Verona, Italy3
Aims This study aims to define a cut-off concentration for ethyl glucuronide in hair to determine if therewas a history
of heavy drinking. Settings Pavia, Italy. Participants We analysed hair samples from 98 volunteers among
teetotallers, social drinkers and heavy drinkers, whose ethanol daily intake (EDI) was estimated by means of a
written questionnaire. Measurements Ethyl glucuronide hair concentration (HEtG) was measured by liquid
chromatography-tandem mass spectrometry (lower limit of quantification: 3 pg/mg) using a fully validated method.
Findings The HEtG level providing the best compromise between sensitivity (0.92) and specificity (0.96) at detecting
an EDI of 60 g or higher during the last 3 months was 27 pg/mg. None of the factors examined among those known
to affect ethanol metabolism and/or the diagnostic power of other markers of ethanol use or hair analyses, including
age, gender, bodymass index, tobacco smoke, prevalent beverage, hair colour, cosmetic treatments and hygienic habits
was found to influencemarker performance significantly. However, the slight differences in HEtG performance observed
for some factors (e.g. body mass index, smoke and hair treatments) require further studies on larger groups of indi-
viduals in order to assess their influence more precisely. Conclusions Our results confirm further that HEtG is a
sensitive and specific marker of chronic heavy drinking.
Keywords Alcohol, alcoholism, hair ethyl glucuronide, sensitivity and specificity.
Correspondence to: Luca Morini, Department of Legal Medicine and Public Health, Via Forlanini, 12 I-27100 Pavia, Italy. E-mail: luca.morini@unipv