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Using Phosphatidylethanol as an Adjunct to Self-Reported Alcohol Use Improves Identification of Liver Fibrosis Risk
Pamela M Murnane1,2, Majid Afshar3, Gabriel Chamie4
1Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
The American Journal of Gastroenterology
|October 31, 2024
Summary
Phosphatidylethanol (PEth) blood levels are a stronger indicator of liver fibrosis risk than self-reported alcohol use (AUDIT-C). Measuring PEth can improve the identification and management of alcohol-related liver disease.
Area of Science:
- Biomarkers and Disease Risk Assessment
- Hepatology and Liver Disease
- Addiction Medicine and Public Health
Background:
- Accurate assessment of alcohol consumption is crucial for preventing and managing liver disease.
- Phosphatidylethanol (PEth), a direct alcohol biomarker, may offer a more objective measure of alcohol intake compared to self-report.
- The association between PEth and liver fibrosis risk, particularly in individuals with and without HIV, requires further investigation.
Purpose of the Study:
- To determine if phosphatidylethanol (PEth) blood concentrations are associated with liver fibrosis risk independently of self-reported alcohol use (AUDIT-C).
- To compare the strength of association between PEth and liver fibrosis versus AUDIT-C and liver fibrosis.
- To evaluate the utility of PEth in identifying individuals at risk for liver fibrosis, including those living with HIV.
Main Methods:
- Pooled individual-level data from 12 international studies (USA, Russia, Uganda, South Africa).
- Included measurements of PEth, Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and fibrosis-4 (FIB-4) scores.
- Mixed-effects logistic regression analyzed the relationship between PEth and AUDIT-C with high FIB-4 (≥2.67), adjusting for relevant covariates.
Main Results:
- Among 4,644 adults, 12% had high FIB-4. Higher PEth levels showed a significant association with high FIB-4 (aOR per 83.3 ng/mL: 1.15; 95% CI: 1.08-1.22).
- Higher AUDIT-C scores were also associated with high FIB-4 (aOR per unit: 1.03; 95% CI: 1.00-1.07).
- The association between PEth and high FIB-4 was stronger than that of AUDIT-C and high FIB-4.
Conclusions:
- Phosphatidylethanol (PEth) is independently associated with liver fibrosis risk.
- PEth demonstrates a stronger association with liver fibrosis than the AUDIT-C, suggesting it is a more sensitive biomarker for detecting at-risk individuals.
- PEth measurement holds potential for improving the identification, prevention, and management of alcohol-related liver disease.
