Non-invasive tests for alcohol-associated liver disease

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.

Clinical features of individuals with laboratory values suggestive of advanced liver fibrosis when first treated for alcohol use disorder

“…In such settings, the use of the FIB-4 index serves as a practical alternative, especially considering its high diagnostic performance in predicting advanced fibrosis in patients with ALD, as demonstrated in previous studies (Chrostek et al, 2019;Nguyen-Khac et al, 2018). Nevertheless, incorporating transient elastography into the evaluation of patients with AUD in primary care settings could enhance the assessment of liver fibrosis and disease severity (Israelsen et al, 2024). The lack of data on ascites or encephalopathy limits the ability to assess disease severity using traditional scoring systems like the Child-Pugh score.…”

“…Taken together, it is necessary to screen for underlying ALD especially those who are at risk for advanced disease or fibrosis. However, screening for ALD in the general AUD population presents challenges due to the low prevalence of ALD among a large population of at-risk individuals, making cost-effective screening more difficult (Israelsen et al, 2024;Liangpunsakul & Crabb, 2016). Risk stratification may offer a solution by targeting screening efforts toward individuals at higher risk for advanced liver disease (Israelsen et al, 2024).…”

“…However, screening for ALD in the general AUD population presents challenges due to the low prevalence of ALD among a large population of at-risk individuals, making cost-effective screening more difficult (Israelsen et al, 2024;Liangpunsakul & Crabb, 2016). Risk stratification may offer a solution by targeting screening efforts toward individuals at higher risk for advanced liver disease (Israelsen et al, 2024). Tools such as transient elastography and 2-dimensional shear wave elastography have shown promise in screening individuals at risk for liver fibrosis due to alcohol consumption (Thiele et al, 2016).…”

“…Liver fibrosis, a hallmark of ALD progression, can be detected even in individuals with normal levels of aspartate aminotransferase (AST), highlighting the limitations of relying solely on traditional biomarkers for early detection (Chang et al, 2021). Noninvasive screening methods, such as liver elastography and serum markers like the Enhanced Liver Fibrosis (ELF) test and FibroTest, offer promising alternatives to liver biopsy for detecting underlying fibrosis (Israelsen et al, 2024;Nguyen-Khac et al, 2018). These methods have shown favorable performance compared to biopsy and could facilitate early detection and risk stratification in clinical practice.…”