Phosphatidylethanol levels distinguish steatotic liver disease subgroups and are associated with risk of major liver outcomes

作者：Juan Vaz, Patrik Nasr, Anders Helander, Ying Shang, Axel Wester, Rickard Strandberg, Emilie Toresson Grip, Hannes Hagström · 发表于：Journal of Hepatology · 年份：2025 · DOI：10.1016/j.jhep.2025.04.019 · 被引用次数：56 · 研究领域：Alcohol Consumption and Health Effects、Liver Disease Diagnosis and Treatment、Alcoholism and Thiamine Deficiency

BACKGROUND & AIMS: Phosphatidylethanol (PEth) is an ethanol metabolite used as a specific biomarker for recent alcohol consumption. We aimed to determine the proportion of patients with or at risk for metabolic dysfunction-associated steatotic liver disease (MASLD) who had PEth levels indicative of harmful alcohol consumption, and to assess associations between PEth levels and the risk of major adverse liver outcomes (MALOs). METHODS: We conducted a cohort study involving persons tested for PEth in Stockholm, Sweden between 2012 and 2020 (N = 46,406), including patients with various steatotic liver disease (SLD) subtypes and individuals without SLD. Cumulative incidences of MALOs were calculated for the different groups while accounting for competing risk. Cox regression was used to evaluate the association between baseline PEth levels and the incidence of MALOs. RESULTS: Among 6,377 patients with presumed MASLD, 1,294 (20%) had baseline PEth levels between 0.05 and 0.30 μmol/L (35-210 ng/ml), indicating excessive alcohol intake (MetALD), while 854 patients (13%) had values >0.30 μmol/L, indicating alcohol-related liver disease (ALD). Patients with MASLD and PEth levels between 0.05-0.30 μmol/L had similar median FIB-4 and cirrhosis prevalence as those with MASLD and PEth levels <0.05 μmol/L. However, patients with PEth levels between 0.05-0.30 μmol/L had higher cumulative incidences of MALOs compared to those with PEth levels <0.05 μmol/L. Elevated PEth levels were linked to...