International Journal of Legal Medicine

, Volume 126, Issue 2, pp 243–250 | Cite as

Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers

  • Hicham Kharbouche
  • Mohamed Faouzi
  • Nathalie Sanchez
  • Jean Bernard Daeppen
  • Marc Augsburger
  • Patrice Mangin
  • Christian Staub
  • Frank SporkertEmail author
Original Article



Ethyl glucuronide (EtG) in hair has emerged as a useful biomarker for detecting alcohol abuse and monitoring abstinence. However, there is a need to establish a reliable cutoff value for the detection of chronic and excessive alcohol consumption.


One hundred and twenty-five subjects were classified as teetotalers, low-risk drinkers, at-risk drinkers, or heavy drinkers. The gold standard for subjects' classifications was based on a prospective daily alcohol self-monitoring log. Subjects were followed for a 3-month period. The EtG diagnostic performance was evaluated and compared with carbohydrate-deficient transferring (CDT) and the activities of aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl-transferase (γGT).


A cutoff of >9 pg/mg EtG in hair, suggesting an alcohol consumption of >20/30 g (at-risk drinkers), and a cutoff of >25 pg/mg, suggesting a consumption of >60 g (heavy drinkers), were determined by receiver operating characteristic analysis. The EtG diagnostic performance was significantly better (P < 0.05) than any of the traditional biomarkers alone. EtG, as a single biomarker, yielded a stronger or similar diagnostic performance in detecting at-risk or heavy drinkers, respectively, than the best combination of traditional biomarkers (CDT and γGT). The combination of EtG with traditional biomarkers did not improve the diagnostic performance of EtG alone. EtG demonstrated a strong potential to identify heavy alcohol consumption, whereas the traditional biomarkers failed to do so. EtG was not significantly influenced by gender, body mass index, or age.


Hair EtG definitively provides an accurate and reliable diagnostic test for detecting chronic and excessive alcohol consumption. The proposed cutoff values can serve as reference for future cutoff recommendations for clinical and forensic use.


Alcohol consumption Cutoff Diagnostic performance Ethyl glucuronide Alcohol biomarkers 



Aspartate aminotransferase


Alanine aminotransferase




Carbohydrate-deficient transferring


Ethyl glucuronide

DASM log

Daily Alcohol Self-monitoring log


Gas chromatography-tandem mass spectrometry


Limit of quantification


Receiver operating characteristic


Area under the ROC curve


Body mass index


Odds ratio


Confidence interval



This study was generously supported by a grant from the Swiss Foundation for Alcohol Research. The authors would like to thank Sara Petter for her assistance as well as Annette Jordan and Magali Dovat-Sabatella for their support in sample analysis.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hicham Kharbouche
    • 1
  • Mohamed Faouzi
    • 2
  • Nathalie Sanchez
    • 2
  • Jean Bernard Daeppen
    • 2
  • Marc Augsburger
    • 1
  • Patrice Mangin
    • 1
  • Christian Staub
    • 1
  • Frank Sporkert
    • 1
    Email author
  1. 1.University Center of Legal Medicine, Lausanne–GenevaLausanneSwitzerland
  2. 2.Alcohol Treatment CenterLausanne University Hospital CHUVLausanneSwitzerland

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