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

There is controversy regarding the various proposed steatotic liver disease (SLD) subtypes, with the most recent definition suggesting that patients with elevated alcohol consumption and MASLD should be classified as having MetALD. Here, we address this challenge by classifying patients with SLD using phosphatidylethanol (PEth), a direct and reliable biomarker for recent alcohol consumption. Our analysis of 46,406 patients revealed that PEth may be a valuable tool for distinguishing between MASLD and MetALD, and that PEth is strongly associated with the risk of liver outcomes in individuals with and without known SLD. Integrating PEth testing into routine diagnostic evaluations could enhance knowledge on the underlying pathophysiology in SLD, reduce the potential for misclassification, and ultimately improve patient outcomes by enabling clinicians to offer appropriate therapies. Further research is needed to validate these findings in other populations and to explore the potential integration of PEth into broader clinical guidelines for managing SLD.