Effective Tuesday, April 29, 2014, the University of Iowa Hospitals and Clinics core clinical chemistry laboratory will begin running an automated urine nicotine metabolite (cotinine) assay: NICOTINE METABOLITE, RAPID SCREEN (Epic # LAB8071).

This new assay will have turnaround time within 1 hour of receipt in the core laboratory 24 hours a day, 7 days a week.  Recommended specimen is 6 mL urine in clear top tube.

Positive results for the assay indicate tobacco/nicotine use within 1 week.  Both a qualitative positive/negative result (using a cut-off of 300 ng/mL cotinine) and a quantitative result for positive tests will be reported.  Urine cotinine concentrations exceeding 1,000 ng/mL (and in some cases approaching 10,000 ng/mL) indicate active use of tobacco or high-dose nicotine patch.

Non-users of tobacco or those with only passive exposure to tobacco smoke have urine cotinine concentrations well below 300 ng/mL (typically less than 20 ng/mL) and will be negative by this assay.  There is less data on e-cigarettes than for tobacco or nicotine patches; however, limited studies show similar cotinine concentrations in body fluids for experienced e-cigarette users as compared to tobacco cigarette smokers.

Tobacco use is a demonstrated risk factor in elective surgery (with extensive published literature especially for plastic surgery), with high complication rates (including need for reoperation) and tissue necrosis rates in smokers as compared to non-smokers. Studies have shown that patients may not be forthcoming in disclosing smoking history.  This new nicotine metabolite provides option for assessing nicotine usage with rapid turnaround.

With the addition of this assay, there are now three order options for nicotine testing (see table below).  The bottom two options in the table provide a detailed profile of nicotine and tobacco tar metabolites but are mailout tests with turnaround times of 2 days or more.

Epic Name of Test	Epic #	Methodology	Turnaround time
NICOTINE METABOLITE, RAPID SCREEN	LAB8071	Immunoassay	1 hr upon receipt in laboratory
NICOTINE & METABOLITE, URINE	LAB414	HPLC/tandem mass spectrometry	2-5 days (mailout)
NICOTINE AND METABOLITE, SERUM DRUG LEVEL	LAB3714	HPLC/tandem mass spectrometry	2-5 days (mailout)

Questions should be directed to Matthew Krasowski, MD, PhD, Director of Clinical Laboratories (384-9380, matthew-krasowski@uiowa.edu).