The Role of Non-Invasive Tests in Alcohol-Related Liver Disease: from Diagnosis to Prognosis

Abstract Purpose of review Liver fibrosis in alcohol-related liver disease (ALD) closely links to the development of adverse outcomes. However, underreporting of alcohol consumption and subclinical presentation hinder timely assessment. Various non-invasive tests (NITs) may mitigate the challenges. This review summarises the role of NITs in ALD. Recent findings Objective biomarkers (e.g., phosphatidyethanol) quantify alcohol consumption for the diagnosis of ALD. Other readily available blood-based (e.g., Fibrosis-4 index) and imaging-based (e.g., vibration-controlled transient elastography) biomarkers help rule out and/or rule in advanced liver fibrosis with prognosis value, though the results can be confounded by ongoing alcohol consumption. Novel biomarkers and artificial intelligence (AI) models are emerging to refine risk assessment. Summary While NITs help with the unmet needs in the field, careful adoption is needed by taking into consideration of the development of each NIT and the potential confounders to the test results. With the emerging evidence in specialised biomarkers and AI models, there is a future for achieving personalised management in ALD.