PRO‐C3 and ADAPT algorithm accurately identify patients with advanced fibrosis due to alcohol‐related liver disease

BACKGROUND: Alcohol is a main cause of preventable deaths and frequently leads to the development of alcohol‐related liver disease. Due to the lack of diagnostics, patients are commonly diagnosed after developing clinical manifestations. Recently, the biomarker PRO‐C3 was shown to accurately identify fibrosis due to non‐alcoholic fatty liver disease. AIM: To assess the diagnostic accuracy of PRO‐C3, the ADAPT score and best‐performing non‐patented serological test to detect advanced alcohol‐related liver fibrosis. METHODS: We enrolled 426 patients with alcohol overuse in a prospective biopsy‐controlled study. We evaluated the accuracy of PRO‐C3 and the PRO‐C3‐based algorithm ADAPT to detect advanced liver fibrosis. RESULTS: The accuracy of PRO‐C3 was good with an AUROC of 0.85 (95% CI 0.79‐0.90). The best‐performing non‐patented test was the Forns index with an AUROC of 0.83 (95% CI 0.78‐0.89). The ADAPT algorithm performed better as compared to both the Forns index and PRO‐C3 alone with an AUROC = 0.88 (95% CI 0.83‐0.93). CONCLUSION: PRO‐C3 is a new marker with high accuracy to detect advanced alcohol‐related liver fibrosis. The diagnostic accuracy of PRO‐C3 can be further improved by using the ADAPT algorithm in which the test outperforms currently available non‐patented serological fibrosis markers. The study is registered in the Odense Patient Data Exploratory Network (OPEN) under study identification numbers OP_040 (https://open.rsyd.dk/OpenProjects/da/openProject.jsp?openNo=40) and OP_239 (https://open.rsyd.dk/OpenProjects/openProject.jsp?openNo=239&lang=da).