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Serum cytokeratin‐18 in the diagnosis of non‐alcoholic steatohepatitis: A meta‐analysis

2013; Wiley; Volume: 44; Issue: 8 Linguagem: Inglês

10.1111/hepr.12197

1872-034X

Jing Chen, Yueyong Zhu, Qi Zheng, Jiaji Jiang,

Pancreatic and Hepatic Oncology Research

Aim Identifying patients with non‐alcoholic steatohepatitis ( NASH ), a more aggressive form with a worse prognosis than for simple steatosis, is highly important. Liver biopsy still remains the gold standard for diagnosing NASH , but with limitations. The diagnostic value of serum cytokeratin‐18 ( CK ‐18) in predicting NASH is still indefinite. Methods We selected relevant studies by a literature search of the P ub M ed, O vid M edline and C ochrane L ibrary databases up to J anuary 2012. A D er S imonian‐ L aird random effects model was used to compute the pooled estimates of sensitivity ( SEN ), specificity ( SPE ), and diagnostic odds ratio ( DOR ), and a summary receiver operating characteristic ( SROC ) curve was constructed. Stratified analysis was performed to explore the heterogeneity in test accuracy. Funnel plot and E gger's regression were performed to assess publication bias. Results A total of 10 studies with 838 patients were included (nine CK ‐18 fragments and five total CK ‐18 studies) in this meta‐analysis. Among nine CK ‐18 fragment studies with a significant publication bias, the pooled results on SEN , SPE and DOR were 0.83 (95% CI , 0.80–0.86), 0.71 (95% CI , 0.66–0.76) and 11.90 (95% CI , 6.05–23.40), respectively, and age and body mass index were most strongly associated with the observed heterogeneity. Among five total CK ‐18 studies with homogeneity, the pooled results of SEN , SPE and DOR were 0.77% (95% CI , 0.70–0.83), 0.71 (95% CI , 0.65–0.77) and 7.99 (95% CI , 4.09–15.62), respectively. The area under the ROC curve (± SE ) of CK ‐18 fragments and total CK ‐18 were 0.8445 (± 0.0306) and 0.8170 (± 0.0429), respectively. Conclusion Both CK ‐18 fragments and total CK ‐18 have a clinically meaningful benefit in noninvasive diagnosing of NASH , though total CK ‐18 has a relatively low diagnostic accuracy. CK ‐18 fragments may be a useful biomarker for screening rather than identifying NASH .