The present paper aims at a systematic review of the current knowledge on phosphatidylethanol (PEth) in blood as a direct marker of chronic alcohol use and abuse. In March 2012, the search through “MeSH” and “free-text” protocols in the databases Medline/PubMed, SCOPUS, Web of Science, and Ovid/Embase, combining the terms phosphatidylethanol and alcohol, provided 444 records, 58 of which fulfilled the inclusion criteria and were used to summarize the current evidence on the formation, distribution and degradation of PEth in human blood: (1), the presence and distribution of different PEth molecular species (2), the most diffused analytical methods devoted to PEth identification and quantization (3), the clinical efficiency of total PEth quantification as a marker of chronic excessive drinking (4), and the potential utility of this marker for identifying binge drinking behaviors (5). Twelve papers were included in the meta-analysis and the mean (M) and 95% confidence interval (CI) of total PEth concentrations in social drinkers (DAI ≤ 60 g/die; M = 0.288 µM; CI 0.208–0.367 µM) and heavy drinkers (DAI > 60 g/die; M = 3.897 µM; CI 2.404–5.391 µM) were calculated. The present analysis demonstrates a good clinical efficiency of PEth for detecting chronic heavy drinking.

The Alcohol Use Disorders Identification Test (AUDIT) and its short form, the AUDIT-C, the main clinical instruments used to identify unhealthy drinking behaviors, are influenced by memory bias and under-reporting. In recent years, phosphatidylethanol (PEth) in blood has emerged as a marker of unhealthy alcohol use. This systematic review aims to investigate the molecular characteristics of PEth and summarize the last ten years of published literature and its use compared to structured questionnaires. A systematic search was performed, adhering to PRISMA guidelines, through “MeSH” and “free-text” protocols in the databases PubMed, SCOPUS, and Web of Science. The inclusion criteria were as follows: PEth was used for detecting unhealthy alcohol consumption in the general population and quantified in blood through liquid chromatography coupled to mass spectrometry, with full texts in the English language. Quality assessment was performed using the JBI critical appraisal checklist. Twelve papers were included (0.79% of total retrieved records), comprising nine cross-sectional studies and three cohort studies. All studies stratified alcohol exposure and quantified PEth 16:0/18:1 through liquid chromatography coupled to mass spectrometry (LC-MS) in liquid blood or dried blood spots (DBS) with lower limits of quantitation (LLOQ) ranging from 1.7 ng/mL to 20 ng/mL. A correlation between blood PEth level and the amount of alcohol ingested in the previous two weeks was generally observed. PEth interpretative cut-offs varied greatly among the included records, ranging from 4.2 ng/mL to 250 ng/mL, with sensitivity and specificity in the ranges of 58–100% and 64–100%, respectively. Although the biomarker seems promising, further research elucidating the variability in PEth formation and degradation, as well as the molecular mechanisms behind that variability, are necessary.

Postmortem interval (PMI) estimation is a challenge of utmost importance in forensic daily practice. Traditional methods face limitations in accuracy and reliability, particularly for advanced decomposition stages. Recent advances in “omics” sciences, providing a holistic view of postmortem biochemical changes, offer promising avenues for overcoming these challenges. This systematic review aims at investigating the role of mass-spectrometry-based “omics” approaches in PMI estimation to elucidate molecular mechanisms underlying predictable time-dependent biochemical alterations occurring after death. A systematic search was performed, adhering to PRISMA guidelines, through “free-text” protocols in the databases PubMed, SCOPUS and Web of Science. The inclusion criteria were as follows: experimental studies analyzing, as investigated samples, animal or human corpses in toto or in parts and estimating PMI through MS-based untargeted omics approaches, with full texts in the English language. Quality assessment was performed using STROBE and ARRIVE critical appraisal checklists. A total of 1152 papers were screened and 26 included. Seventeen papers adopted a proteomic approach (65.4%), nine focused on metabolomics (34.6%) and two on lipidomics (7.7%). Most papers (57.7%) focused on short PMIs (120 days) (15.4%). Muscle tissue was the most frequently analyzed substrate (34.6% of papers), followed by liver (19.2%), bones (15.4%), cardiac blood and leaking fluids (11.5%), lung, kidney and serum (7.7%), and spleen, vitreous humor and heart (3.8%). Predictable time-dependent degradation patterns of macromolecules in different biological substrates have been discussed, with special attention to molecular insights into postmortem biochemical changes.