BETA-CARBOLINES IN CHRONIC-ALCOHOLICS UNDERGOING ELECTIVE TUMOR RESECTION

The prevalence of chronic alcoholism in patients with carcinomas of th e upper digestive tract exceeds 60%. The patient's history and laborat ory markers, preoperatively, are often not sensitive or specific enoug h to detect alcohol-dependent patients, preoperatively, who are at ris k of developing alcohol withdrawal syndrome (AWS) during their postope rative intensive care unit (ICU) stay. Previously, it was found that p lasma norharman was elevated in chronic alcoholics, suggesting marker characteristics for chronic ethanol misuse and possibly alcohol depend ence. We investigated whether beta-carbolines (i.e., harman and norhar man) were different between chronic alcoholics and nonalcoholics with carcinoma, and how the levels change in alcohol-dependent patients dur ing their hospital stay. Ninety-seven patients with oral, pharyngeal, laryngeal, or esophageal carcinomas were evaluated regarding their dri nking habits. Sixty patients were transferred to the ICU following tum or resection. Chronic alcoholics met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The dail y ethanol intake in chronic alcoholics was greater than or equal to 60 g. Blood samples were collected on admission to the hospital, preoper atively, on admission to the ICU and on days 2, 4, and 7 in the ICU. H arman and norharman were determined by HPLC. Elevated norharman was fo und in chronic alcoholics on admission to the hospital, whereas harman did not differ between groups. On admission, the area under the recei ver operating characteristics curve was significantly larger for carbo hydrate-deficient transferrin and preoperatively for norharman. The pr eoperative norharman levels were significantly correlated with the per iod of mechanical ventilation and the length of ICU stay. Postoperativ ely, norharman decreased in all patients, except a group of 11 alcohol -dependent patients who developed AWS during their ICU stay. The findi ng that elevated norharman levels were found in chronic alcoholics on admission to the hospital and preoperatively supports the view of a sp ecific marker for alcoholism. Preoperative norharman was superior to c arbohydrate-deficient transferrin and was associated with a prolonged ICU stay and a prolonged period of mechanical ventilation. Further stu dies are required to determine whether norharman aids in the preoperat ive diagnosis of chronic alcohol misuse with respect to the prevention of postoperative complications.