The urinary ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid in surgical patients with chronic alcohol misuse

The urinary ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid w as reported to be elevated for a period of up to 22 h following acute alcoh ol ingestion. Therefore, the ratio could detect continuous alcohol consumpt ion, in what was considered to be a high-risk surgical group, on the evenin g prior to surgery. The aim of this study was to determine the preoperative ratio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid in patients with continuous preoperative alcohol misuse. Forty-two patients participate d in this institutionally approved study, once their written informed conse nt had been obtained. Chronic alcoholics were defined by meeting the criter ia of the Diagnostic and Statistical Manual of Mental Disorders criteria an d an ethanol consumption greater than or equal to 60 g/day. The urine sampl es were taken preoperatively and determined by means of gas chromatography- mass spectrometry and high performance liquid chromatography. The urinary r atio of 5-hydroxytryptophol to 5-hydroxyindole-3-acetic acid was significan tly increased in chronic alcoholics. The ICU stay of these patients was sig nificantly prolonged due to an increased incidence of pneumonia and sepsis. Five chronic alcoholics died, whereas no deaths occurred in the nonalcohol ic group (p = 0.05). As the measurement of the urinary ratio of 5-hydroxytr yptophol to 5-hydroxyindole-3-acetic acid could detect alcohol consumption immediately prior to operation, this marker could assist the carbohydrate-d eficient transferrin in screening for patients with high-level dependency; these patients were considered to be at a high risk of developing intercurr ent complications. (C) 1998 Elsevier Science Inc.