Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

Abstract

Background: A simple noninvasive test that accurately distinguishes NASH from NAFL as well as determines the disease severity is urgently needed. Recently, it was found that determination of cytokeratin-18 (CK-18) fragments in the blood, predicts and correlates with histological NASH in which there is development of lobular inflammation, cell ballooning and fibrosis, supporting its usefulness in clinical practice.

Aims: To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients.

Patients and methods: 90 subjects were divided into 3 groups: group I: including 30 patients with NASH, group II: including 30 patients with NAFL, and group III: including 30 healthy subjects as control. Diagnosis of NASH and its discrimination from NAFL was done by liver biopsy. CK-18 level in plasma was measured for all subjects using ELISA.

Results: CK-18 was significantly elevated in patients of group I in comparison to group II and III patients, with mean ± SD: 460 ± 279, 167± 56 and 149± 57, respectively, andP value: 0.001. The (ROC) curve diagnostic performance of CK18 in diagnosis of NASH shows: cutoff value of >240 U/L, with sensitivity 76.7%, specificity 95.0%. Ck-18 was found to correlate with disease severity assessed by NAS scoring system with P value: 0.001.

Conclusion: Measurement of CK18 in NASH is a useful screening, diagnostic and staging biomarker.

Keywords: Cytokeratin 18; NASH; NAFLD; NAFLD activity score; Liver biopsy; Keratins