title: Serum levels of CK18 M30 and leptin are useful predictors of steatohepatitis and fibrosis in paediatric NAFLD.
abstract: BACKGROUND
  With the alarming growth in prevalence of paediatric nonalcoholic fatty liver disease (NAFLD), there is a need for noninvasive methods of stratifying disease severity. Our aim was to evaluate a combination of serum biomarkers as a measure of disease activity in paediatric NAFLD.
  
  
  METHODS
  Forty-five children with biopsy-proven NAFLD were enrolled. Caspase-cleaved CK18 fragments (CK18 M30), hyaluronic acid, leptin, and adiponectin were measured in serum using enzyme-linked immunosorbent assays and high-sensitivity C-reactive protein using a colorimetric assay.
  
  
  RESULTS
  Median age was 12.7 years (55% boys). Median body mass index z score was 1.7. CK18 M30 levels were significantly higher in patients with NAFLD versus controls, median 288 IU/L versus 172 IU/L (P < 0.001), and in those with steatohepatitis, median 347 IU/L versus simple steatosis (NAFLD activity score < 3), median 191 IU/L (P = 0.006). Significant fibrosis (≥F2) could be differentiated from no/minimal fibrosis (<F2), median 393 IU/L versus 243 IU/L (P = 0.03). Leptin could distinguish <F2 from ≥F2; 28.9 ng/mL versus 70.1 ng/mL (P = 0.037). Adiponectin, hyaluronic acid, and high-sensitivity C-reactive protein did not achieve significance in predicting steatohepatitis nor significant fibrosis.
  
  
  CONCLUSIONS
  The present study combines use of markers for different processes in the development of steatohepatitis. Serum biomarkers, especially CK18 M30, are useful in stratifying disease severity in paediatric NAFLD.
authors.affiliation: Paediatric Liver, GI, and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK. emer.fitzpatrick@kcl.ac.uk
authors.forename: Emer
authors.initials: E
authors.lastname: Fitzpatrick
authors.forename: Ragai R
authors.initials: RR
authors.lastname: Mitry
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
authors.forename: Munther J
authors.initials: MJ
authors.lastname: Hussain
authors.forename: Ruth
authors.initials: R
authors.lastname: DeBruyne
authors.forename: Anil
authors.initials: A
authors.lastname: Dhawan
mesh_terms: D052242:Adiponectin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D002648:Child; D003124:Colorimetry; D004797:Enzyme-Linked Immunosorbent Assay; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D053538:Keratin-18 / Q000097:blood*; D020738:Leptin / Q000097:blood*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D053538:Keratin-18; D020738:Leptin; D006820:Hyaluronic Acid; D002097:C-Reactive Protein