BETA-CARBOLINES IN CHRONIC-ALCOHOLICS FOLLOWING TRAUMA

In our society every second polytraumatized patient is a chronic alcoh olic. A patient's alcohol-related history is often unavailable and lab oratory markers are not sensitive or specific enough to detect alcohol -dependent patients who are at risk of developing alcohol withdrawal s yndrome (AWS) during their post-traumatic intensive care unit (ICU) st ay. Previously, it has been found that plasma levels of norharman are elevated in chronic alcoholics. We investigated whether beta-carboline s, i.e, harman and norharman levels, could identify chronic alcoholics following trauma and whether possible changes during ICU stay could s erve as a predictor of deterioration of clinical status. Sixty polytra umatized patients were transferred to the ICU following admission to t he emergency room and subsequent surgery. Chronic alcoholics were incl uded only if they met the DSM-III-R and ICD-10 criteria for alcohol de pendence or chronic alcohol abuse/harmful use and their daily ethanol intake was greater than or equal to 60 g. Harman and norharman levels were assayed on admission and on days 2, 4, 7 and 14 in the ICU. Harma n and norharman levels were determined by high pressure liquid chromat ography. Elevated norharman levels were found in chronic alcoholics (n = 35) on admission to the hospital and remained significantly elevate d during their ICU stay. The area under the curves (AUG) showed that n orharman was comparable to carbohydrate-deficient transferrin (CDT) an d superior to conventional laboratory markers in detecting chronic alc oholics. Seventeen chronic alcoholics developed AWS; 16 of these patie nts experienced hallucinations or delirium. Norharman levels were sign ificantly increased on days 2 and 4 in the ICU in patients who develop ed AWS compared with those who did not. An increase in norharman level s preceded hallucinations or delirium with a median period of approxim ately 3 days. The findings that elevated norharman levels are Sound in chronic alcoholics, that the AUC was in the range of CDT on admission and that norharman levels remained elevated during the ICU stay, supp ort the view that norharman is a specific marker for alcoholism in tra umatized patients. Since norharman levels increased prior to the onset of hallucinations and delirium it seems reasonable to investigate fur ther the potential role of norharman as a possible substance which tri ggers AWS.