Blood Test–Based Scoring Tool Detects Hidden Alcohol-Related Liver Disease: Study

A newly developed panel of biomarkers, known as the Metabolic Dysfunction and Alcohol-Associated Liver Disease Prediction Index (MetALD-ALD Prediction Index) or MAPI, has been shown to accurately identify cases of metabolic dysfunction and alcohol-associated liver disease without the need for phosphatidylethanol (PEth) testing, according to a study conducted by an international team of researchers. A strong diagnostic performance of MAPI was seen in both American and European study groups.

The derivation cohort consisted of 503 community-dwelling adults with overweight and obesity and steatotic liver disease living in Southern California. All participants underwent prospective assessment using magnetic resonance imaging and magnetic resonance elastography for liver disease severity and PEth testing for objective assessment of alcohol exposure.

The mean age of the participants was 51 (13) years. The mean body mass index of the participants was 32.9 (5.8) kg/m². The participants had a predominantly obese population at high risk of developing metabolic syndrome. The main outcome was the presence of MetALD-ALD. The investigators incorporated the use of PEth in the diagnostic classification.

The investigators developed an optimal predictive model using bidirectional stepwise logistic regression. The investigators performed internal validation of the model using 2000 bootstrap samples. The investigators evaluated model discrimination using the area under the receiver operating characteristic curve.

Key findings:

• In a derivation cohort of 503 adults with overweight/obesity and steatotic liver disease (mean age 51 years and mean BMI 32.9 kg/m²), the newly developed MAPI score was found to have an AUROC of 0.76 for the detection of MetALD-ALD defined by PEth.

• The model included five variables: sex, mean corpuscular volume, gamma-glutamyltransferase, HDL cholesterol, and hemoglobin A1c.

• Internal validation was done using 2000 bootstrap samples.

• The model was externally validated in a Swedish population-based cohort of 1777 individuals. The AUROC was found to be 0.75.

• Among all indirect markers of alcohol consumption tested, the best performance was found for the MAPI.

MAPI is a new, accurate, and scalable indirect biomarker panel for identifying MetALD-ALD in patients with steatotic liver diseases. The excellent performance of MAPI has been demonstrated across different populations worldwide. Therefore, it could aid PEth testing and help identify cases with ARLD.

Reference:

Tavaglione, F., Vaz, J., Jamialahmadi, O., Díaz, L. A., Ajmera, V., Contrano, D., Madamba, E., Singh, S., Bettencourt, R., Richards, L., Hagström, H., & Loomba, R. (2026). The MetALD-ALD Prediction Index: A phosphatidylethanol-driven biomarker panel for identifying individuals with steatotic liver disease and excessive alcohol use. Gastroenterology. https://doi.org/10.1053/j.gastro.2025.11.022