MSACL 2023 Abstract

INTRODUCTION: Cotinine is a widely used biomarker for classifying cigarette smoking status; however, cotinine cannot differentiate use of combustible vs noncombustible tobacco products. Herein, we evaluated urinary 2-cyanoethylmercapturic acid (2CyEMA), a metabolite of acrylonitrile, as a complementary urinary biomarker for assessing smoke exposure.

OBJECTIVES: The primary objective of this study is to establish a reference cutoff value of urinary 2CyEMA for differentiating users of cigarettes from users of noncombustible tobacco product.
METHOD: We performed a receiver operating characteristic (ROC) curve analysis of a representative sampling of the adult U.S. population (NHANES 2011-2016, the special smoker subset, ages >20) for identifying optimal cutoff concentration by maximizing Youden’s J index. Smoking status was categorized based on the recent tobacco use questionnaire.

RESULTS: The cutoff concentration was 7.32 ng/ml with high sensitivity and specificity (≥0.925). When stratified by demo¬graphic 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) com¬pared 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: Urinary 2CyEMA is a selective smoke exposure biomarker that effectively distinguishes between people who use cigarettes from those using noncombustible tobacco products, including ecigarettes. Measuring urinary 2CyEMA in conjunction with cotinine can unequivocally assess tobacco smoke exposure.

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