Plasma cytokeratin-18 level as a novel biomarker for liver fibrosis in children with nonalcoholic fatty liver disease

Chetan Mandelia, Elizabeth Collyer, Sana Mansoor, Rocio Lopez, Sara Lappe, Valerio Nobili, Naim Alkhouri

Research output: Contribution to journalArticlepeer-review


Objectives: Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity epidemic and affects approximately 10% of children in the US. The presence of hepatic fibrosis may be the most important factor in determining the prognosis of NAFLD. Noninvasive methods to identify the presence of fibrosis in children with NAFLD are greatly needed. Hepatocyte apoptosis activates hepatic stellate cells and plays a central role in fibrosis progression in NAFLD. The aim of the present study was to evaluate the use of plasma cytokeratin-18 (CK18) fragment levels, a marker of hepatocyte apoptosis, as a noninvasive biomarker in detecting liver fibrosis in pediatric NAFLD. Methods: Consecutive children with biopsy-proven NAFLD were included and blood samples and anthropometric measurements were collected at the time of the biopsy. NAFLD activity score was calculated (0-8) and fibrosis stage was scored (0-4). We measured plasma CK18 levels using the M30-Apoptosense enzyme-linked immunosorbent assay kit. Results: A total of 201 subjects were enrolled in the study. The mean age was 10.7±2.5 years, and 37%were boys. Sixty-eight percent of the patients had any fibrosis, with 56% having F1, 6% having F2, and 6 % having F3. CK18 levels were found to be significantly higher in subjects with any fibrosis compared with those without fibrosis (304.6±124.8 vs 210.4±70.9, P

Original languageEnglish
Pages (from-to)181-187
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number2
Publication statusPublished - Jul 26 2016


  • Apoptosis
  • Cytokeratin-18
  • Fibrosis
  • Nonalcoholic fatty liver disease
  • Noninvasive

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health


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