Non-invasive tests for alcohol-associated liver disease

Mads Israelsen; Wiramon Rungratanawanich; Maja Thiele; Suthat Liangpunsakul

doi:10.1097/HEP.0000000000000885

Non-invasive tests for alcohol-associated liver disease

Hepatology. 2024 Apr 12. doi: 10.1097/HEP.0000000000000885. Online ahead of print.

Authors

Mads Israelsen^{1

2}, Wiramon Rungratanawanich³, Maja Thiele^{1

2}, Suthat Liangpunsakul^{4

5

6}

Affiliations

¹ Fibrosis Fatty Liver and Steatohepatitis Research Centre, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
² Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
³ Section of Molecular Pharmacology and Toxicology, National Institute on Alcohol Abuse and Alcoholism, 9000 Rockville Pike, Bethesda, Maryland, USA.
⁴ Division of Gastroenterology and Hepatology Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁵ Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁶ Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA.

PMID: 38607723
DOI: 10.1097/HEP.0000000000000885

Abstract

Alcohol consumption is a global phenomenon and a major contributor to alcohol-associated liver disease (ALD). Detecting individuals at risk of ALD has been challenging, with only a small fraction of patients being identified at early stages compared to other chronic liver diseases. In response to this challenge, non-invasive tests (NITs) have become essential tools for the detection of ALD, offering opportunities for early identification and intervention to mitigate the disease burden. Non-invasive alcohol consumption biomarkers are crucial in estimating individuals' recent alcohol intake, providing valuable insights into their drinking patterns. Various NITs have been investigated for the initial screening of asymptomatic individuals at risk of ALD, as well as for identifying specific stages of the disease. These NITs are applied in two main clinical scenarios: population-based stratification for identifying and predicting liver-related symptoms, and diagnosing and prognosticating compensated cirrhosis or advanced chronic liver disease in secondary or tertiary care settings. Moreover, NITs play a significant role in the prognostic assessment of patients with various manifestations of ALD, including alcohol-associated hepatitis, decompensated cirrhosis, and metabolic and alcohol-associated liver disease. These tests guide appropriate treatment decisions and predict outcomes. In this review, various NITs for the early detection and monitoring of alcohol consumption were discussed. Additionally, the evaluation of NITs for screening and predicting ALD and liver complications was addressed comprehensively. Future perspectives of NITs for ALD were explored, alongside a thorough discussion of the opportunities and challenges associated with NITs for ALD screening.