{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:22:27Z","timestamp":1790180547197,"version":"4.1.0"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Phosphatidylethanol (PEth), ethyl glucuronide (EtG), and ethyl sulphate (EtS) are highly sensitive and specific biomarkers of alcohol intake. This study investigated their application and relationship to traditional self\u2010report measures in a mixed cohort of liver disease patients to guide decision making in liver transplant populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We recruited 183 participants (mean age 49.2\u2009years, 62% male), with <jats:italic>N<\/jats:italic>\u2009=\u200999 liver disease (88% alcohol\u2010associated liver disease [ALD]), <jats:italic>N<\/jats:italic>\u2009=\u200935 alcohol use disorder (AUD), and <jats:italic>N<\/jats:italic>\u2009=\u200949 healthy volunteers. Patient\u2010reported alcohol intake and AUDIT score served as references and were compared to traditional biomarkers, PEth and serum EtG\/EtS. Receiver operating characteristic (ROC) analysis and a range of biomarker cutoffs were examined to determine optimal test characteristics. A subset of blood samples modified to a standardized hematocrit analyzed the relationship between hematocrit and PEth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to traditional biomarkers, both PEth and EtG were sensitive and specific for alcohol intake. At the limit of detection (LOD), PEth was 95% sensitive at detecting any drinking. PEth cutoff of 300\u2009\u03bcg\/L was 86% sensitive and 92% specific for \u201cheavy drinking,\u201d and 600\u2009\u03bcg\/L was 88% sensitive and specific for \u201cvery heavy drinking.\u201d PEth displayed superior test characteristics (sensitivity, specificity, PPV, NPV, and AUC) to all measured traditional biomarkers over two\u2010day and one\u2010month time frames. A subset of participants suspected of drinking but reporting abstinence had positive PEth tests (35%), suggestive of unreported drinking. PEth was positively correlated with hematocrit (<jats:italic>r<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.83, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and correction to a standardized median resulted in increases in PEth concentration in most cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PEth is clinically useful as an alcohol biomarker in patients with liver disease and is superior to traditional biomarkers, providing good test characteristics for \u201cheavy\u201d and \u201cvery heavy\u201d drinking using stepwise cutoffs. PEth detected a subset of patients underreporting their alcohol use, with implications for the management of patients in liver transplant clinics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70133","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T12:16:29Z","timestamp":1755087389000},"page":"2013-2024","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Validation of blood phosphatidylethanol as an alcohol consumption biomarker in patients with alcohol use disorder and liver disease at a liver transplant center"],"prefix":"10.1111","volume":"49","author":[{"given":"J.","family":"Watt","sequence":"first","affiliation":[{"name":"Addiction Medicine, Central Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"},{"name":"Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology) Drug Health Services  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0868-9928","authenticated-orcid":false,"given":"K. 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S.","family":"Haber","sequence":"additional","affiliation":[{"name":"Addiction Medicine, Central Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"},{"name":"Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology) Drug Health Services  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5614-1599","authenticated-orcid":false,"given":"D.","family":"Seth","sequence":"additional","affiliation":[{"name":"Addiction Medicine, Central Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"},{"name":"Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology) Drug Health Services  Sydney New South Wales Australia"},{"name":"Centenary Institute of Cancer Medicine and Cell Biology The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Volovets","sequence":"additional","affiliation":[{"name":"Anastasia Volovets MBBS, FRACP, AW Morrow Gastroenterology and Liver Centre and Australian National Liver Transplant Unit Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.13471"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.23596"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.12949"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.14512"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/hmer.S420732"},{"key":"e_1_2_8_7_1","first-page":"718","volume-title":"Clinical methods: the history, physical, and laboratory 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