Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 26;24(5):761-767.
doi: 10.1093/ntr/ntab224.

Optimal Cutoff Concentration of Urinary Cyanoethyl Mercapturic Acid for Differentiating Cigarette Smokers From Nonsmokers

Deepak Bhandari  1 , Luyu Zhang  1 , Wanzhe Zhu  1 , Víctor R De Jesús  1 , Benjamin C Blount  1
Affiliations

Optimal Cutoff Concentration of Urinary Cyanoethyl Mercapturic Acid for Differentiating Cigarette Smokers From Nonsmokers

Deepak Bhandari et al. Nicotine Tob Res. .

Abstract

Introduction: Cotinine is a widely used biomarker for classifying cigarette smoking status. However, cotinine does not differentiate between the use of combustible and noncombustible tobacco products. The increasing use of noncombustible tobacco drives the need for a complementary biomarker for distinguishing cigarette smokers from users of noncombustible tobacco products.

Aims and methods: We evaluated the urinary acrylonitrile metabolite, 2CyEMA, as a biomarker of exposure to cigarette smoke in the US population-representative data from the National Health and Nutritional Examination Survey (NHANES). Smoking status was categorized based on the recent tobacco use questionnaire. The receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff concentrations by maximizing Youden's J index. The area under the curve (AUC) was used to compare 2CyEMA effectiveness with respect to serum cotinine.

Results: The overall cutoff concentration for the classification of cigarette smokers from nonsmokers was 7.32 ng/ml with high sensitivity and specificity (≥0.925). When stratified by demographic variables, the cutoff concentrations varied among subgroups based on age, sex, and race/Hispanic origin. Non-Hispanic Blacks had the highest cutoff concentration (15.3 ng/ml), and Hispanics had the lowest (4.63 ng/ml). Females had higher cutoff concentrations (8.80 ng/ml) compared to males (6.10 ng/ml). Among different age groups, the cutoff concentrations varied between 4.63 ng/ml (21-39 years old) and 10.6 ng/ml (for ≥60 years old). We also explored the creatinine adjusted cutoff values.

Conclusions: 2CyEMA is an effective biomarker for distinguishing cigarette smokers from nonsmokers (users of noncombustible tobacco products or nonusers).

Implications: Distinguishes smokers from noncombustible tobacco product users.

PubMed Disclaimer

Conflict of interest statement

Declaration of Interests

The authors declare no competing financial interest.

Figures

Figure 1.
Figure 1.
Weighted ROC curves of urinary 2CyEMA (ng/mL) and serum cotinine (left), and 2CyEMA (μg/g creatinine) and serum cotinine (right) for exclusive cigarette smoker versus tobacco nonusers group. The 2CyEMA cutoff levels were 7.32 ng/mL (sensitivity 0.933; specificity 0.925) and 11.4 μg/g creatinine (sensitivity 0.924; specificity 0.946)
Figure 2.
Figure 2.
Distributions (weighted) of urinary 2CyEMA (left) and serum cotinine (right) among exclusive smokers, tobacco nonusers, and users of exclusive noncombustible tobacco products in adult U.S. population, based on NHANES 2011–2016.
See this image and copyright information in PMC

References

    1. The Health Consequences of Smoking - 50 Years of Progress: A Report of the Surgeon General. In: U.S. Department of Health and Human Services CfDCaP, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health, ed. Atlanta, GA: 2014.
    1. Tevis DS, Flores SR, Kenwood BM, et al. Harmonization of Acronyms for Volatile Organic Compound Metabolites Using a Standardized Naming System. Int J Hyg Environ Health. 2021; 235: 113749. - PMC - PubMed
    1. U.S. EPA. IRIS Toxicological Review of Acrylonitrile (Interagency Science Consultation Draft). Washington, DC: Environmental Protection Agency; 2011.
    1. Rothman KJ. Cancer occurrence among workers exposed to acrylonitrile. Scand J Work, Environ Health. 1994;20(5):313–321. - PubMed
    1. Sakurai H Carcinogenicity and other health effects of acrylonitrile with reference to occupational exposure limit. Industrial Health. 2000;38(2):165–180. - PubMed