Cytokeratin 18, a marker of cell death, is increased in children with suspected nonalcoholic fatty liver disease.
OBJECTIVE
Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with obesity, and is now the most common liver disease in the United States. Cytokeratin 18 (CK18) is an intracellular protein released into the blood by both necrosis and apoptosis of hepatocytes. Levels of CK18 have not been reported previously in children with NAFLD.


METHODS
In a cross-sectional analysis of 62 children (28 normal weight, 14 obese, and 20 suspected NAFLD), we measured CK18 levels as well as alanine aminotransferase, fasting glucose, fasting insulin, and tumor necrosis factor-alpha.


RESULTS
CK18 was significantly elevated in the children with suspected NAFLD compared with obese controls and normal weight controls (median = 424 U/L compared with 243 and 214 respectively, P < 0.001). In multiple logistic regression analysis, CK18 was the best single predictor of suspected NAFLD (prediction accuracy = 84.1%).


CONCLUSIONS
CK18 is elevated in children with suspected NAFLD and should be investigated as a potential diagnostic marker of NAFLD.
Vos
Miriam B
MB
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA. miriam_vos@oz.ped.emory.edu
Barve
Shirish
S
Joshi-Barve
Swati
S
Carew
John D
JD
Whitington
Peter F
PF
McClain
Craig J
CJ
D000293:Adolescent; D000410:Alanine Transaminase / Q000378:metabolism; D017209:Apoptosis / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005215:Fasting; D005234:Fatty Liver / Q000097:blood* / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D053538:Keratin-18 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000097:blood*; D011237:Predictive Value of Tests; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D053538:Keratin-18; D014409:Tumor Necrosis Factor-alpha; D000410:Alanine Transaminase