Quantification of alcohol intake in patients with steatotic liver disease and excessive alcohol intake
Emil Deleuran Hansen,
Nikolaj Torp,
Stine Johansen,
Johanne Kragh Hansen,
Marianne Lerbæk Bergmann,
Camilla Dalby Hansen,
Sönke Detlefsen,
Peter Andersen,
Ida Villesen,
Katrine Bech,
Katrine Thorhauge,
Gitte Hedegaard Jensen,
Katrine Prier Lindvig,
Torben Hansen,
Emmanuel A. Tsochatzis,
Jonel Trebicka,
Maja Thiele,
Aleksander Krag,
Mads Israelsen
Affiliations
Emil Deleuran Hansen
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Nikolaj Torp
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Stine Johansen
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Johanne Kragh Hansen
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Marianne Lerbæk Bergmann
Department of Biochemistry and Immunology, University Hospital of Southern Denmark, Vejle, Denmark
Camilla Dalby Hansen
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Sönke Detlefsen
Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Pathology, Odense University Hospital, Odense, Denmark
Peter Andersen
Department of Gastroenterology and Hepatology, Odense, Denmark
Ida Villesen
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Katrine Bech
Department of Gastroenterology and Hepatology, Odense, Denmark
Katrine Thorhauge
Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Gitte Hedegaard Jensen
Department of Pathology, Odense University Hospital, Odense, Denmark
Katrine Prier Lindvig
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Torben Hansen
Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
Emmanuel A. Tsochatzis
Department of Gastroenterology and Hepatology, Odense, Denmark; UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
Jonel Trebicka
Department of Gastroenterology and Hepatology, Odense, Denmark; Department of Internal Medicine B, Münster University Hospital, WWU, Münster, Germany; European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
Maja Thiele
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
Aleksander Krag
Department of Gastroenterology and Hepatology, Odense, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Corresponding author. Address: Odense Liver Research Centre; Department of Gastroenterology and Hepatology; Odense University Hospital, Denmark; Kloevervaenget 10, Entrance 112; 5000 Odense C, Denmark.
Mads Israelsen
Department of Gastroenterology and Hepatology, Odense, Denmark
Background & Aims: Quantifying alcohol intake is crucial for subclassifying participants with steatotic liver disease (SLD) and interpreting clinical trials of alcohol-related liver disease (ALD) and metabolic and alcohol-related liver disease (MetALD). However, the accuracy of self-reported alcohol intake is considered imprecise. We compared the diagnostic and prognostic utility of self-reported alcohol intake with blood-based biomarkers of alcohol intake: phosphatidylethanol (PEth) and carbohydrate-deficient transferrin (CDT). Methods: We studied 192 participants from two randomized controlled trials on MetALD and ALD, all with current or former excessive alcohol intake (≥24/36 [♀/♂] grams daily for at least 1 year) and biopsy-proven liver disease. We assessed self-reported alcohol intake, PEth, and CDT at four time points. We collected follow-up data on hepatic decompensation and death manually through electronic medical records. Results: Most participants were male (n = 161, 84%) with a mean age of 59 (SD 9) years and 73 participants reported 1-week abstinence before inclusion; the remaining reported a median alcohol intake of 43 g/day. Median PEth was 0.5 μmol/L (IQR: 0.0–1.3) and %CDT = 1.9 (IQR: 1.6–2.3). Of 32 patients reporting at least 6 months of abstinence; 27 (84%) was confirmed by PEth <0.05 μmol/L. Self-reported alcohol intake correlated well with PEth (r = 0.617) and moderately with CDT (r = 0.316). Self-reported alcohol intake, PEth, and CDT all predicted hepatic decompensation and death. However, PEth showed the highest prediction, surpassing self-reported alcohol intake (Harrel’s C, PEth = 0.80 vs. self-reported = 0.68, p = 0.026). Conclusions: Self-reported abstinence can be considered reliable in clinical trials. However, PEth is superior in predicting hepatic decompensation and death in patients with MetALD and ALD. Impact and implications: An accurate quantification of alcohol intake is crucial in the clinical phenotyping of patients with steatotic liver disease and when designing clinical trials. This study found self-reported abstinence to be reliable but phosphatidylethanol was a more accurate prognostic biomarker of hepatic decompensation and death in a clinical trial setting. Findings may inform the design of future trials in patients with steatotic liver disease.
