Gut-derived microbial metabolites are dysregulated in the plasma of patients in various stages of the alcohol-associated liver disease (ALD) spectrum. (A) Heatmap of metabolite concentrations in patients with ALD compared to healthy controls. Log fold change was measured for HD (n = 10), patients with mAH (n = 16), sAH (n = 40), and AC (n = 10) and compared to HC (n = 29). (B) Concentrations of indole-3-propionic acid, serotonin, p-cresol sulfate, and p-cresol glucuronide were measured in the plasma of patients with ALD using liquid chromatography with tandem mass spectrometry. (C) ROC curves for distinguishing patients with ALD from healthy controls. AUROC for each group is illustrated. Values represent means ± SEM. Statistical analysis was conducted in SAS; values with different superscripts are significantly different (p < 0.05). Abbreviations: 4-EPS, 4-ethylphenyl sulfate; AC, alcohol-associated cirrhosis; ALD, alcohol-associated liver disease; HC, healthy controls; HD, heavy drinkers, mAH, moderate alcohol-associated hepatitis; sAH, severe alcohol-associated hepatitis; TMAO, trimethylamine N-oxide.