Groundbreaking new test reveals true toll of ‘hidden’ cause of liver disease… and can help add years to your life
A groundbreaking new screening tool can detect the source of a silent killer using routine blood tests all without asking the patient a single question.
A primary driver of fatty liver disease is excessive alcohol use, a habit that millions of patients would rather not admit to their doctors due to stigma or shame.
This can leave doctors – and patients – in the dark for years, not knowing that a lifestyle change could halt the potentially fatal organ damage in its tracks.
A group of researchers from the US, Sweden and Chile devised a new, simple tool called MAPI to add to standard blood panels without requiring any extra blood draws that can detect whether a patient’s liver disease is driven by alcohol or metabolic factors
This is a term that refers to obesity, diabetes, high blood pressure and cholesterol, years before patients might otherwise come clean about their drinking.
Dr Rohit Loomba, a gastroenterologist at the University of California at San Diego and senior author of the new study, said: ‘This new score gives clinicians a simple and accessible way to uncover hidden alcohol-related liver injury.
‘By improving how we classify liver disease, we can help patients achieve better long-term health outcomes.’
Alcohol-associated liver disease happens after five to 10 years of heavy drinking, which causes toxic fat to build up in the liver. Over time, a fatty liver causes widespread inflammation and scarring. The top treatment is to stop drinking.
A new tool called MAPI, developed by an international research team, can detect alcohol-driven liver disease using routine blood tests, bypassing the need for patients to admit how much they really drink (stock image)
Alcohol-associated liver disease is on the rise. In 2021 alone, it claimed nearly 22,000 lives and accounted for more than 28,000 new diagnoses. Over the past two decades, deaths have jumped nearly 80 percent while cases have grown by more than a third.
Alcohol-related liver damage does not cause symptoms from the earliest stage to the advanced and often up until the final stage, cirrhosis, an irreversible end-stage liver scarring.
Cirrhosis can manifest as yellow, jaundiced skin, vomiting blood and confusion. People who reach this final stage typically die within two to 12 years.
Federica Tavaglione, a liver disease researcher at UC San Diego and first author of the study, said: ‘Our goal was to build something practical.
‘These lab values are already part of standard care, so MAPI can be implemented immediately without adding cost or complexity for clinics.’
The study, published in the journal Gastroenterology, described the new screening tool for alcohol-related liver disease.
Researchers drew on data from 503 adults who were overweight or obese and had fatty liver disease and were enrolled in the San Diego Liver Study.
Obesity drives a condition called metabolic dysfunction-associated steatotic liver disease, or MASLD. It is not caused by heavy drinking. Rather, it results when excess fat accumulates in the liver.
It can trigger inflammation, lead to scarring and eventually progress to cirrhosis, the same end-stage disease caused by decades of heavy drinking.
All of the participants underwent advanced liver imaging and a blood test for phosphatidylethanol (PEth), a biomarker that detects alcohol consumption over the preceding two to four weeks with high accuracy.
By incorporating a PEth blood test into the diagnostics of the disease, the researchers could identify which patients were truly abstaining from alcohol and which were drinking more than they reported.
This allowed them to build a predictive model that distinguishes metabolic dysfunction-associated liver disease (MASLD) from cases where alcohol is a contributing factor, causing alcoholic liver disease (ALD).
The result is the MetALD-ALD Prediction Index, or MAPI.
![The graph shows how accurately the MAPI tool detects hidden alcohol use in liver disease patients. The higher the curve sits above the diagonal line, the more accurate the test. MAPI's score [the blue line] of 0.76 means it correctly identifies alcohol-involved cases 76 percent of the time while the ANI test score [the red line] of 0.69 means it correctly identifies cases 69 percent of the time](http://i.dailymail.co.uk/1s/2026/02/25/19/106678183-15592743-The_graph_shows_how_accurately_the_MAPI_tool_detects_hidden_alco-m-3_1772048389335.jpg)
The graph shows how accurately the MAPI tool detects hidden alcohol use in liver disease patients. The higher the curve sits above the diagonal line, the more accurate the test. MAPI’s score [the blue line] of 0.76 means it correctly identifies alcohol-involved cases 76 percent of the time while the ANI test score [the red line] of 0.69 means it correctly identifies cases 69 percent of the time
The tool uses five variables already collected in routine clinical care, including sex, mean corpuscular volume (MCV), a measure of red blood cell size that rises with heavy drinking, and gamma-glutamyl transferase (GGT), a liver enzyme that spikes in response to alcohol.
The tool also uses HDL cholesterol and hemoglobin A1c (HbA1c), a marker of blood sugar control that tends to be lower in those who drink heavily. No additional blood draws or questionnaires are required.
Doctors input these lab values into a formula to generate a score estimating the probability that a patient’s liver disease involves excessive alcohol use.
The tool was externally validated in a Swedish cohort of nearly 1,800 individuals, demonstrating similar accuracy and outperforming other commonly used indirect alcohol biomarkers.
To measure MAPI’s accuracy, the researchers used a standard statistical test called the area under the receiver operating characteristic curve, or AUROC. A score of 0.5 means the tool is no better than a coin flip; a score of 1.0 means perfect prediction.
MAPI scored 0.76 in the US group and 0.75 in the Swedish group, indicating solid, reliable performance.
The tool also has three key cut-off points. A score below 0.09 effectively rules out alcohol-driven disease with a 94 percent certainty that the patient’s condition is not fueled by hidden drinking.
A score of 0.25 offers the best threshold for identifying true cases of ALD, and a score above 0.33 strongly suggests alcohol is involved, with 91 percent specificity, translating to few false alarms.
The graph shows rates of death due to liver cirrhosis in the US. After falling for about three decades, death rates reversed course in 2006 and have climbed steadily since, rising 26 percent between 2000 and 2019, with alcohol-related deaths surging 47 percent
MAPI outperformed four other common alcohol biomarkers. Then, researchers validated their model using 2,000 statistical simulations and confirmed its accuracy in an entirely separate Swedish population.
PEth is the most accurate biomarker for detecting hidden alcohol use in liver disease patients, but it is expensive and not widely available. Standard blood tests like GGT and MCV are cheaper but lack precision.
The older Alcohol-associated Liver Disease/Nonalcoholic Fatty Liver Disease Index (ANI) score improved things but was developed in narrowly defined patient groups and designed only to detect advanced alcohol-related liver disease.
The new MAPI tool builds on ANI’s foundation with key advantages in that it was developed in a larger, more general population, used advanced imaging to confirm liver fat and employed PEth testing to ensure patients were correctly classified.
This allows MAPI to detect not just ALD but also MetALD, the emerging category where metabolic issues and moderate alcohol use overlap. Identifying these patients matters because they can often halt disease progression simply by cutting back on drinking.
