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

  • C Spies1,
  • J Herpell1,
  • O Beck5,
  • T Neumann1,
  • C Müller4,
  • H Rommelspacher2,
  • F Pragst3,
  • S Borg6,
  • W Schaffartzik1 and
  • A Helander6
Critical Care19971(Suppl 1):P134

Published: 1 March 1997


Alcohol DependenceAlcohol MisuseBlood Alcohol ConcentrationAlcohol Withdrawal SyndromeUrinary Ratio


The pre-operative detection of patients with chronic alcohol misuse is decisive for decreasing the peri-operative morbidity [1]. However, only 16% are detected in clinical routine [2]. Conventional laboratory parameters have only low sensitivity and specificity [3]. New markers seems to be superior [3]. The urinary ratio of 5-hydroxytryptophol (5-HTOL) and 5-hydroxyindole-3-acetic acid (5-HLAA) inverts due to alcohol consumption [4]. Measurement of the urinary 5-HTOL/5-HLAA ratio could show alcohol consumption the evening prior to operation in a high risk group, which is not possible by determining the blood alcohol concentration. The aim of this study was to determine the pre-operative 5-HTOL/5-HLAA ratio in patients with continuous alcoholic misuse.

Materials and methods

Forty-two patients, scheduled for a tumor resection of the upper digestive tract, participated in this institutionally approved study having received written informed consent prior to operation. The patients were assigned to the chronic alcohol group by meeting the criteria of `The Diagnostic and Statistical Manual of Mental Disorders' (DSM III R) and by consuming = 60 g ethanol daily. In cases of alcohol dependence, pharmacoprophylaxis was administered to counteract postoperative alcohol withdrawal syndrome. The urine samples were taken pre-operative, determined by gas chromatographic-mass spectrometric (5-HTOL) [4,5] and high-performance liquid chromatography (5-HIAA) [4,5]. The 5-HTOL/5-HIAA ratio was calculated. Statistics: Mann-Whitney U-test.


See table.


The urinary ratio of 5-HTOL/5HLAA could improve per-operative detection of high-risk patients, who are posteratively in danger of developing alcohol relation complications. This subsequently leads to a prolonged ICU stay.



Chronic alcoholics

Non -alcoholics


(n = 22)

(n = 20)


Age (years)

52 (36-74)

62 (47-06)


Ethanol consumption (g/day)


0 (0-20)


5-HTOL/5-HIAA-ratio (pmol/nmol)

18.6 (1.8-1082.8)

8.0 (3.5-11.2)


CDT (U/l)

14.4 (2-66.9)

2.5 (2.0-11.30)


MCV (fl)

95.3 (85.2-106.0)

92.3 (84.5-98.3)


?-GT (U/l)

20 (7-61)

23 (6-55)


ICU stay (days)

7 (2-83)

3 (2-26)


Median (range); CDT = carbohydrate-deficiency transferrin; MCV = mean corpuscular volume; ?-GT = gamma-glutamyl-transferase; ICU = intensive care unit.

Authors’ Affiliations

Department of Anaesthesiology and Operative Intensive Care, Germany
Institute of Neuropsychopharmacology, Benjamin Franklin Medical Center, Free University, Berlin, Germany
Department of Toxicologic Chemistry (Institute of Forensic Medicine), Charité
Institute of Clinical Chemistry and Biochemistry, Virchow Medical Center, Humboldt-University of Berlin, Germany
Department of Clinical Pharmacology, Karolinska Hospital, Sweden
Department of Psychiatry, St Göran's Hospital, Karolinska Institute, Stockholm, Sweden


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© Current Science Ltd 1997