S2884 Prognostic Value of Phosphatidylethanol (PEth) in Non-Hepatic Complications Among Patients With Steatotic Liver Disease: A Real-World Multicenter Cohort Study

Introduction: Phosphatidylethanol (PEth) is a biomarker of alcohol consumption with a detection window of up to 4 weeks. Recent studies have demonstrated its utility in differentiating subgroups within steatotic liver disease (SLD). However, the prognostic significance of PEth in relation to non-hepatic complications remains unclear. We designed a nationwide cohort study to evaluate the prognostic value of PEth in predicting non-liver-related complications among patients with steatotic liver disease. Methods: We conducted a retrospective cohort study using the TriNetX. We identified adult patients diagnosed with SLD, using International Classification of Diseases, Tenth Revision Clinical Modification code corresponding to K70, K74, or K76, and who underwent PEth testing from inception through May 30, 2025. Patients with a diagnosis of hepatocellular carcinoma or liver cancer were excluded. Unhealthy alcohol consumption was defined as a PEth level >25 mg/dL at any time point. Propensity score matching was performed using 37 covariates, including demographics, comorbidities, medication use (e.g., diuretics, beta-blockers, and statins), laboratory values, and body mass index (BMI), to balance baseline characteristics between groups. The primary outcomes were healthcare encounters for alcohol withdrawal, incident acute pancreatitis, traumatic injury, cardiovascular events, major adverse liver outcomes (MALO), and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results: A total of 3,122 matched cohort pairs were included in the final analysis. Baseline characteristics were well balanced between groups with the exception of gamma-glutamyl transferase (GGT) and total cholesterol levels. Patient with low PEth levels were associated with lower all-cause mortality (HR 0.76, 95% CI: 0.67–0.86), acute pancreatitis (HR 0.43, 95% CI: 0.35–0.52), alcohol withdrawal (HR 0.24, 95% CI: 0.16–0.35), alcohol intoxication (HR 0.36, 95% CI: 0.29–0.45), falls (HR 0.68, 95% CI: 0.55–0.84), and fractures (HR 0.78, 95% CI: 0.65–0.93). Patients with low PEth levels also showed a trend toward lower incidence of MALO, but this association did not reach statistical significance (HR 0.90, 95% CI: 0.77–1.06). Conclusion: PEth is a biomarker for recent alcohol intake with potential prognostic value in identifying patients with SLD at elevated risk for non-hepatic complications. These findings support the integration of PEth testing into routine risk stratification protocols for patients with SLD.