title: Cytokeratin 18-Aspartate396 apoptotic fragment for fibrosis detection in patients with non-alcoholic fatty liver disease and chronic viral hepatitis.
abstract: BACKGROUND
  The combination of non-invasive markers for the detection of fibrosis in patients with chronic liver diseases is still a matter of debate.
  
  
  OBJECTIVE
  To test the performance of cytokeratin18-Aspartate396 alone or in combination with transient elastography as a marker of fibrosis, compared to liver biopsy as gold standard.
  
  
  METHODS
  In 259 prospectively enrolled patients with chronic liver diseases, clinical, biochemical, and histological features were assessed. Serum cytokeratin18-Aspartate396 and Fibroscan were performed within 6 months prior to liver biopsy.
  
  
  RESULTS
  Cytokeratin18-Aspartate396 levels predicted both significant and advanced fibrosis in non-alcoholic fatty liver disease group, correctly identifying 83.7% and 80.8% of cases, respectively. Liver stiffness performed best in predicting severe fibrosis in patients with chronic viral infection, correctly identifying 78.7% of chronic hepatitis B and 88.6% of chronic hepatitis C subjects. The combination of cytokeratin18-Aspartate396 and liver stiffness improved their diagnostic performance for the detection of significant and advanced fibrosis in non-alcoholic fatty liver disease group, only (sensitivity=78.3%, specificity=90.7%; sensitivity=91.7%, specificity=71.6%, respectively).
  
  
  CONCLUSIONS
  Cytokeratin18-Aspartate396 and liver stiffness can improve the non-invasive prediction of significant and advanced fibrosis in patients with non-alcoholic fatty liver disease, while in hepatitis B and C virus infected patients their combined use had no advantage over the diagnostic accuracy of transient elastography alone.
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy. Electronic address: crosso3@cittadellasalute.to.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rosso
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Caviglia
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Maria Lorena
authors.initials: ML
authors.lastname: Abate
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Vanni
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Mezzabotta
authors.affiliation: Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Giovanni Antonio
authors.initials: GA
authors.lastname: Touscoz
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Olivero
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marengo
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bugianesi
authors.affiliation: Liver Physiopathology Lab, Department of Medical Sciences, University of Turin, Turin, Italy; Division of Gastroenterology and Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy.
authors.forename: Antonina
authors.initials: A
authors.lastname: Smedile
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D053538:Keratin-18 / Q000097:blood*; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D053538:Keratin-18; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Chronic liver disease; Cytokeratin 18-Asp396; Liver stiffness