PRO-C3 levels, ADAPT score accurately detect fibrosis in NAFLD

Plasma levels of PRO-C3, a serological biomarker for the detection of the formation of type III collagen, can act as a good indicator of disease activity and fibrosis in nonalcoholic fatty liver disease (NAFLD), a recent study has found.

Moreover, ADAPT, a noninvasive score that incorporates PRO-C3 for the detection of nonalcoholic steatohepatitis (NASH), is superior to other noninvasive predictors.

In a cohort of 517 patients (median age 55.2 years, 52 percent men) with matched biopsy and PRO-C3 measurements, the researchers observed a significant correlation between the biomarker and the severity of fibrosis.

For instance, patients with PRO-C3 above the cut-off concentration of 20.2 ng/mL had higher levels of insulin, alkaline phosphatase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT), as compared to those with levels below the threshold.

In addition, the researchers found that PRO-C3 levels increased with increasing fibrosis stage (p<0.001), as well as with higher grades of ballooning (p<0.001), inflammation (p<0.01), and steatosis (p<0.01). Patients deemed to have steatohepatitis likewise showed elevated PRO-C3 levels relative to NAFLD counterparts (p<0.001).

Multivariate logistic regression confirmed that PRO-C3 was significantly correlated with advanced fibrosis (odds ratio [OR], 1.063, 95 percent confidence interval [CI], 1.043–1.084; p<0.001) and NASH (OR, 1.092, 95 percent CI, 1.039–1.148; p<0.001).

Notably, ADAPT, a composite score that incorporates PRO-C3, type 2 diabetes, platelet count, and age, showed significant superiority to other noninvasive tests for the prediction of fibrosis. In particular, ADAPT outperformed the AST-to-platelet ratio index, fibrosis-4, and AST-to-ALT ratio for detecting significant and advanced fibrosis.