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Observational Study
. 2023 Oct;19(4):362-367.
doi: 10.1007/s13181-023-00967-x. Epub 2023 Sep 11.

Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection

Ari B Filip  1 , Christopher W Farnsworth  2 , Michael E Mullins  3 , Bridgit O Crews  2 , Jeffrey A Kraut  4
Affiliations
Observational Study

Accuracy of a Glycerol Dehydrogenase Assay for Ethylene Glycol Detection

Ari B Filip et al. J Med Toxicol. 2023 Oct.

Abstract

Introduction: Ethylene glycol (EG) is a frequently considered toxicant in poisoned patients. Definitive diagnosis relies on gas chromatography (GC), but this is unavailable at most hospitals. A glycerol dehydrogenase (GDH)-based assay rapidly detects EG. A rapid turnaround time and wide availability of necessary instrumentation suggest this method could facilitate the rapid detection of EG.

Methods: This is a prospective, observational analysis of banked, remnant serum samples submitted to the laboratory of a large, multi-hospital healthcare system. Samples were submitted over a 12-month period for the explicit purpose of testing for suspected EG ingestion. All samples underwent GC and the GDH-based assay.

Results: Of the 118 analyzed samples, 88 had no EG detected by GC, and 30 were "positive." At the manufacturer's threshold of 6 mg/dL EG, there was 100% (95%CI; 88.7-100) positive percent agreement (PPA) and 98% (92.1-99.6) negative percent agreement (NPA). Adjusted to a threshold of 9 mg/dL, both the PPA and NPA were 100%. Deming regression of the observed concentrations revealed a slope of 1.16 (1.01 to 1.32) and intercept of -5.3 (-8.9 to -1.7).

Conclusions: The GDH assay provides a sensitive and specific method for the detection and quantification of EG that is comparable to a GC-based method. More widespread use of this rapid, inexpensive assay could improve the care of patients with suspected toxic alcohol exposure. Further study is needed to evaluate the test performance in real-time patient treatment decisions.

Keywords: Ethylene glycol; Gas chromatography; Glycerol dehydrogenase; Screening; Toxic alcohols.

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Conflict of interest statement

David Templeton, MS, and Catachem Inc. (Oxford, CT) provided the glycerol dehydrogenase reagents. Neither Mr. Templeton nor any other agents or employees of Catachem Inc. had any role in the study design or the data analysis.

Figures

Fig. 1
Fig. 1
Ethylene glycol undergoes endogenous metabolism to glycolaldehyde by alcohol dehydrogenase (ADH). Glycerol dehydrogenase (GDH) similarly oxidizes EG to glycolaldehyde while reducing NAD to NADH.
Fig. 2
Fig. 2
Ethylene glycol concentration by GDH method is plotted in samples determined to be “negative” versus “positive” by GC. The manufacturer’s discriminatory threshold of 6 mg/dL was used to judge the presence of EG by GC. GDH, glycerol dehydrogenase. GC, gas chromatography. EG, ethylene glycol.
Fig. 3
Fig. 3
A Deming regression of the GDH- and GC-derived EG values plotted with slope 1.16 (1.01 to 1.32). The intercept of the plot was −5.3 (−8.9 to −1.7). B Bland–Altman plot of the difference in measured EG concentrations plotted against the GC-derived result. GDH, glycerol dehydrogenase. GC, gas chromatography. EG, ethylene glycol.
See this image and copyright information in PMC

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