• D.V. CRAUCIUC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • C.I. STAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • D.A. CHIRAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • G. STATESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Anca SAVA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Diana BULGARU-ILIESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi


The aim of this prospective study is to investigate the forensic cases of the Institute of Legal Medicine (ILM) Iasi compared to a group of living patients, based on chronic alcohol consumption in the past. Material and methods: The study group consisted of 120 subjects, of which 60 cadavers from ILM Iasi, alleged victims of chronic ethanol consumption, and 60 patients admitted to the Cardiology Clinic I of the “Sf. Spiridon” County Clinical Emergency Hospital from Iasi, in order to perform a case-control study. Results: The studied cases are dominated by male patients over 60 years of age, from rural areas. A cut off value of ethyl glucuronide (EtG) greater than 500 ng/ml proves to be a good predictor in the determinism of liver cirrhosis and dilated cardiomyopathy. Conclusions: Elevated levels of EtG have been shown to be a good predictor of liver cirrhosis and dilated cardiomyopathy.

Author Biographies

D.V. CRAUCIUC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Morpho-Functional Sciences (I)

C.I. STAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Morpho-Functional Sciences (I)

D.A. CHIRAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Morpho-Functional Sciences (I)

G. STATESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Morpho-Functional Sciences (I)

Anca SAVA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Morpho-Functional Sciences (I)
“Prof. Dr. N. Oblu” Emergency Clinical Hospital, Iasi, Romania
Department of Pathology

Diana BULGARU-ILIESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (III)
Institute of Legal Medicine, Iasi, Romania


1. Lefebvre L, Tremblay PY: Le syndrome sérotoninergique lors d’intoxications aigues. Tox Clin. 2008; 24(1): 1-8.
2. Thundiyil JG, Rowley F, Papa L, Olson KR, Kearney TE. Risk factors for complications of drug-induced seizures. J Med Toxicol. 2011; 7:16-23 / doi:10.1007/s13181-010-0096-4.
3. Clark JC. Sudden death in the chronic alcoholic. Forensic Sci Int. 1988; 36(1-2): 105-111 / doi:10.1016/0379-0738(88)90222-8.
4. Srividya B. Impact of Alcohol on Drug Metabolism and Alcohol-Drug Pharmacokinetic. Interactions in Alcoholics. Research and Review. J Pharmacol Toxicol Studies 2016; 4(2): 112-119.
5. Jepsen P, Vilstrup H, Mellemkjaer L, et al. Prognosis of patients with a diagnosis of fatty liver - a registry-based cohort study. Hepatogastroenterology 2003; 50(54): 2101-2104.
6. Marsman HA, Heisterkamp J, Halm JA, Tilanus HW, Metselaar HJ, Kazemier G. Management in patients with liver cirrhosis and an umbilical hernia. Surgery 2007; 142(3): 372-375 / doi:10.1016 /j.surg.2007.05.006.
7. Valleur M, Matysiak J, Antonescu A. Patologiile excesului [The pathologies of the excess]. Bucur-essti: Nemira, 2008.
8. Loly JP, Meurisse N, Gast P, Honore P, Louis E, Meurisse M. Alcool et complications pancréatiques [Alcool and pancreatic complications] Rev Med Liege 2019; 74(5-6): 342-348.
9. Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler PM. Alcohol and Atrial Fibrillation: A Sobering Review. J Am Coll Cardiol. 2016; 68(23): 2567-2576 / doi:10.1016/j.jacc.2016.08.074.
10. Pham T, Rubenfeld GD. Fifty Years of Research in ARDS. The Epidemiology of Acute Respiratory Distress Syndrome. A 50th Birthday Review. Am J Respir Crit Care Med 2017; 195(7): 860-870 / doi:10.1164/ rccm.201609-1773CP.
11. Carpenter RW, Treloar Padovano H, Emery NN, Miranda R Jr. Rate of alcohol consumption in the daily life of adolescents and emerging adults. Psychopharmacology (Berl) 2019; 236(11): 3111-3124 / doi:10.1007/s00213-019-05262-8.
12. White LF, Jiang W, Ma Y, So-Armah K, Samet JH, Cheng DM. Tutorial in biostatistics: the use of generalized additive models to evaluate alcohol consumption as an exposure variable. Drug Alcohol Depend 2020; 209: 107944 / doi:10.1016/j.drugalcdep.2020.107944.
13. You M, Arteel GE. Effect of ethanol on lipid metabolism. J Hepatol 2019; 70(2): 237-248 / doi:10.1016/j.jhep.2018.10.037.
14. Jeon S, Carr R. Alcohol effects on hepatic lipid metabolism. J Lipid Res. 2020; 61(4): 470-479 / doi:10.1194/jlr.R119000547.
15. Mazzolini G, Sowa JP, Atorrasagasti C, Kücükoglu Ö, Syn WK, Canbay A. Significance of simple steatosis: an update on the clinical and molecular evidence. Cells. 2020; 9(11): 2458 / doi:10.3390/ cells9112458.
16. Rachakonda V, Bataller R, Duarte-Rojo A. Recent advances in alcoholic hepatitis. F1000Res. 2020; 9:F1000 Faculty Rev-97 / doi:10.12688/f1000research.20394.1.
17. Moure-Rodriguez L, Carbia C, Lopez-Caneda E, Corral Varela M, Cadaveira F, Caamano-Isorna F. Trends in alcohol use among young people according to the pattern of consumption on starting uni-versity: a 9-year follow-up study. PLoS One 2018; 13(4): e0193741 / doi:10.1371/ journal. pone. 0193741.
18. Day E, Rudd JHF. Alcohol use disorders and the heart. Addiction. 2019; 114(9): 1670-1678 / doi:10.1111/add.14703.
19. Rosenbloom JI, Mukamal KJ, Frost LE, Mittleman MA. Alcohol consumption patterns, beverage type, and long-term mortality among women survivors of acute myocardial infarction. Am J Cardiol 2012; 109(2): 147-152 / doi:10.1016/j.amjcard.2011.08.021.
20. Seki E, Schwabe RF. Hepatic inflammation and fibrosis: functional links and key pathways. Hepatol-ogy 2015; 61(3): 1066-1079 / doi:10.1002/hep.27332.
21. Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014; 383(9930): 1749-1761 / doi:10.1016/S0140-6736(14)60121-5.
22. Petrescu F, Petrescu OI, Taisescu CI, et al. Histopathological aspects described in patients with chronic hepatitis C. Rom J Morphol Embryol 2015; 56(2): 439-444.
23. Li X, Nie Y, Lian H, Hu S. Histopathologic features of alcoholic cardiomyopathy compared with idiopathic dilated cardiomyopathy. Medicine (Baltimore) 2018; 97(39): e12259 / doi:10.1097/MD. 0000000000012259.
24. Rocco A, Compare D, Angrisani D, Sanduzzi Zamparelli M, Nardone G. Alcoholic disease: liver and beyond. World J Gastroenterol 2014; 20(40): 14652-14659 / doi:10.3748/wjg.v20.i40.14652.
25. European Association for the Study of the Liver. Electronic address:; European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol 2018; 69(1): 154-181 / doi:10.1016/j.jhep.2018.03.018.
26. Xiao J, Wang F, Wong NK, et al. Epidemiological Realities of Alcoholic Liver Disease: Global Burden, Research Trends, and Therapeutic Promise. Gene Expr 2020; 20(2): 105-118 /doi:10.3727/ 105221620X15952664091823.
27. Karsan HA, Parekh S. Management of alcoholic hepatitis: Current concepts. World J Hepatol 2012; 4(12): 335-341 / doi:10.4254/wjh.v4.i12.335.
28. Fischbach FT. Drug monitoring. In: Fischbach FT, Dunning MB editors. A manual of laboratory and diagnostic tests, 7th edition, Philadelphia: Lippincott Williams & Wilkins, 2004, 415-420.
29. Liang R, Liu A, Perumpail RB, Wong RJ, Ahmed A. Advances in alcoholic liver disease: An update on alcoholic hepatitis. World J Gastroenterol 2015; 21(42): 11893-11903 / doi:10.3748/wjg.v21. i42.11893.
30. Singal AK, Kamath PS, Gores GJ, Shah VH. Alcoholic hepatitis: current challenges and future direc-tions. Clin Gastroenterol Hepatol. 2014; 12(4): 555-564 / doi:10.1016/j.cgh.2013.06.013.
31. Crabb DW, Bataller R, Chalasani NP, et al. Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology. 2016; 150(4): 785-790 / doi:10.1053/j.gastro.2016.02.042.
32. Mehal W, To U. New approaches for fibrosis regression in alcoholic cirrhosis. Hepatol Int. 2016; 10(5): 773-778 / doi:10.1007/s12072-016-9752-3.
33. Tilg H, Day CP. Management strategies in alcoholic liver disease. Nat Clin Pract Gastroenterol Hepatol. 2007; 4(1): 24-34 / doi:10.1038/ncpgasthep0683.
34. Szabo G. Gut-liver axis in alcoholic liver disease. Gastroenterology 2015; 148(1): 30-36 / doi:10.1053/j.gastro.2014.10.042.
35. Dunn W, Shah VH. Pathogenesis of Alcoholic Liver Disease. Clin Liver Dis 2016; 20(3): 445-456 / doi:10.1016/j.cld.2016.02.004.
36. Kong LZ, Chandimali N, Han YH, et al. Pathogenesis, Early Diagnosis, and Therapeutic Management of Alcoholic Liver Disease. Int J Mol Sci 2019; 20(11): 2712 / doi:10.3390/ijms20112712.
37. Higashi T, Friedman SL, Hoshida Y. Hepatic stellate cells as key target in liver fibrosis. Adv Drug Deliv Rev. 2017; 121: 27-42 / doi:10.1016/j.addr.2017.05.007.
38. Adebayo D, Neong SF, Wong F. Refractory Ascites in Liver Cirrhosis. Am J Gastroenterol. 2019; 114(1): 40-47 / doi:10.1038/s41395-018-0185-6.
39. Chaudhary K, Khanna R. Renal replacement therapy in end-stage renal disease patients with chronic liver disease and ascites: role of peritoneal dialysis. Perit Dial Int. 2008; 28(2): 113-117.
40. Taranu T, Florea L, Paduraru D, Georgescu SO, Francu LL, Stan CI. Morphological changes of the peritoneal membrane in patients with long-term dialysis. Rom J Morphol Embryol 2014; 55(3): 927-932.
41. Mehal WZ, Schuppan D. Antifibrotic therapies in the liver. Semin Liver Dis. 2015; 35(2): 184-198 / doi:10.1055/s-0035-1550055.
42. Elpek GO. Cellular and molecular mechanisms in the pathogenesis of liver fibrosis: An update. World J Gastroenterol. 2014; 20(23): 7260-7276 / doi:10.3748/wjg.v20.i23.7260.
43. Friedman SL. Hepatic stellate cells: protean, multifunctional, and enigmatic cells of the liver. Physiol Rev 2008; 88(1): 125-172 / doi:10.1152/physrev.00013.2007.
44. Mederacke I, Hsu CC, Troeger JS, et al. Fate tracing reveals hepatic stellate cells as dominant con-tributors to liver fibrosis independent of its etiology. Nat Commun 2013; 4: 2823 / doi:10.1038/ ncomms3823.
45. Lee YA, Wallace MC, Friedman SL. Pathobiology of liver fibrosis: a translational success story Gut 2015; 64(5): 830-841 / doi:10.1136/gutjnl-2014-306842.
46. Pellicoro A, Ramachandran P, Iredale JP, Fallowfield JA. Liver fibrosis and repair: immune regulation of wound healing in a solid organ. Nat Rev Immunol 2014; 14(3): 181-194 / doi:10.1038/nri3623.
47. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011; 342: d671 / doi:10.1136/bmj.d671.
48. Glymour MM. Alcohol and cardiovascular disease. BMJ 2014; 349: g4334 / doi:10.1136/bmj.g4334.
49. Huang Y, Li Y, Zheng S, Yang X, Wang T, Zeng J. Moderate alcohol consumption and atherosclerosis : Meta-analysis of effects on lipids and inflammation. Wien Klin Wochenschr 2017; 129(21-22): 835-843 / doi:10.1007/s00508-017-1235-6.
50. Puddey IB, Mori TA, Barden AE, Beilin LJ. Alcohol and Hypertension-New Insights and Lingering Controversies. Curr Hypertens Rep 2019; 21(10): 79 / doi:10.1007/s11906-019-0984-1.
51. Piano MR, Phillips SA. Alcoholic cardiomyopathy: pathophysiologic insights. Cardiovasc Toxicol. 2014; 14(4): 291-308 / doi:10.1007/s12012-014-9252-4.
52. Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol. 2014; 6(8): 771-781 / doi:10.4330/wjc.v6.i8.771.
53. Kimball SR, Lang CH. Mechanisms Underlying Muscle Protein Imbalance Induced by Alcohol. Annu Rev Nutr 2018; 38: 197-217 / doi:10.1146/annurev-nutr-071816-064642.
54. Iacovoni A, De Maria R, Gavazzi A. Alcoholic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2010; 11(12): 884-892 / doi:10.2459/JCM.0b013e32833833a3.
55. Mirijello A, Tarli C, Vassallo GA, et al. Alcoholic cardiomyopathy: What is known and what is not known. Eur J Intern Med. 2017; 43: 1-5 / doi:10.1016/j.ejim.2017.06.014.
56. Kryzhanovs.kii SA, Kolik LG, Tsorin IB, et al. Alcoholic Cardiomyopathy: Translation Model. Bull Exp Biol Med 2017; 163(5): 627-631 / doi:10.1007/s10517-017-3865-0.
57. Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet 2017; 390(10092): 400-414 / doi:10.1016/S0140-6736(16)31713-5.
58. Ren J, Wold LE. Mechanisms of alcoholic heart disease. Ther Adv Cardiovasc Dis 2008; 2(6): 497-506 / doi:10.1177/1753944708095137.
59. Brandt M, Wenzel P. Alcohol puts the heart under pressure: Acetaldehyde activates a localized renin angiotensin aldosterone system within the myocardium in alcoholic cardiomyopathy. Int J Cardiol. 2018; 257: 220-221 / doi:10.1016/j.ijcard.2018.01.037.
60. Laurent D, Edwards JG. Alcoholic Cardiomyopathy: Multigenic Changes Underlie Cardiovascular Dysfunction. J Cardiol Clin Res 2014; 2(1): 1022.
61. Fernandez-Sola J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nat Rev Cardiol. 2015; 12(10): 576-587 / doi:10.1038/nrcardio.2015.91.
62. Fatjo F, Sancho-Bru P, Fernandez-Sola J, et al. Up-regulation of myocardial L-type Ca2+ channel in chronic alcoholic subjects without cardiomyopathy. Alcohol Clin Exp Res. 2007; 31(7): 1099-1105 / doi:10.1111/j.1530-0277.2007.00404.x.
63. Molina PE, Gardner JD, Souza-Smith FM, Whitaker AM. Alcohol abuse: critical pathophysiological processes and contribution to disease burden. Physiology (Bethesda) 2014; 29(3): 203-215 / doi:10.1152/physiol.00055.2013.
64. Steiner JL, Lang CH. Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apop-tosis. Int J Biochem Cell Biol. 2017; 89: 125-135 / doi:10.1016/j.biocel.2017.06.009.
65. Simon HU, Haj-Yehia A, Levi-Schaffer F. Role of reactive oxygen species (ROS) in apoptosis induc-tion. Apoptosis. 2000; 5(5): 415-418 / doi:10.1023/a:1009616228304.
66. Wang Y, Li Z, Zhang Y, et al. Targeting Pin1 Protects Mouse Cardiomyocytes from High-Dose Alcohol-Induced Apoptosis. Oxid Med Cell Longev 2016; 2016: 4528906 / doi:10.1155/2016/ 45 28 906.
67. Wang Y, Zhao J, Yang W, et al. High-dose alcohol induces reactive oxygen species-mediated apoptosis via PKC-β/p66Shc in mouse primary cardiomyocytes. Biochem Biophys Res Commun 2015; 456(2): 656-661 / doi:10.1016/j.bbrc.2014.12.012.
68. Urbano-Marquez A, Fernandez-Sola J. Alcohol consumption and heart failure. J Card Fail 2005; 11(5): 329-332 / doi:10.1016/j.cardfail.2005.04.023.
69. El Hajj EC, El Hajj MC, Voloshenyuk TG, et al. Alcohol modulation of cardiac matrix metallopro-teinases (MMPs) and tissue inhibitors of MMPs favors collagen accumulation. Alcohol Clin Exp Res 2014; 38(2): 448-456 / doi:10.1111/acer.12239.
70. Vaideeswar P, Chaudhari C, Rane S, Gondhalekar J, Dandekar S. Cardiac pathology in chronic alco-holics: a preliminary study. J Postgrad Med 2014; 60(4): 372-376 / doi:10.4103/0022-3859.143958.
71. Guzzo-Merello G, Segovia J, Dominguez F, et al. Natural history and prognostic factors in alcoholic cardiomyopathy. JACC Heart Fail. 2015; 3(1): 78-86 / doi:10.1016/j.jchf.2014.07.014.
72. Lam BQ, Srivastava R, Morvant J, Shankar S, Srivastava RK. Association of Diabetes Mellitus and Alcohol Abuse with Cancer: Molecular Mechanisms and Clinical Significance. Cells 2021; 10(11): 3077 / doi:10.3390/cells10113077.
73. Engler PA, Ramsey SE, Smith RJ. Alcohol use of diabetes patients: the need for assessment and intervention. Acta Diabetol 2013; 50(2): 93-99 / doi:10.1007/s00592-010-0200-x.
74. Goonoo N, Bhaw-Luximon A, Ujoodha R, Jhugroo A, Hulse GK, Jhurry D. Naltrexone: a review of existing sustained drug delivery systems and emerging nano-based systems. J Control Release 2014; 183: 154-166 / doi:10.1016/j.jconrel.2014.03.046.
75. Avram I, Lupascu FG, Confederat L, Constantin S, Stan CI, Profire L. Chitosan microparticles loaded with antidiabetic drugs - Preparation and characterization. Farmacia 2017; 65: 443-448.
76. Stan CD, Dragan M, Tataringa G, Stan CI, Tuchilus CG, Mircea C. Monoclonal antibodies -past, present and future. Medical-Surgical Journal - Revista Medico-Chirurgicala. 2017; 121(2): 444-450.
77. Birsan M, Dragan M, Stan CD, et al. Patient satisfaction regarding compounded pharmaceutical products and implications on pharmaceutical practice management. Farmacia 2021; 69: 806-812.