Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in both children and adults. While simple steatosis is the usual form and is benign, non-alcoholic steatohepatitis (NASH) can be a very serious condition. Until now, only an invasive liver biopsy, which carries a risk of complications, could distinguish between the two.
Led by Anna Wieckowska, M.D. of the Department of Gastroenterology and Hepatology at the Cleveland Clinic Foundation, researchers considered a non-invasive way to diagnose NASH and assess histologic severity using a simple blood test. They looked for indicators of liver cell death, specifically, caspase-generated CK-18 fragments which have been shown to label early apoptotic cells.
They tested the blood of 39 patients undergoing liver biopsy for suspected NAFLD and compared the results to the biopsies, and also to the blood of 35 healthy age-matched controls. The plasma levels of CK-18 fragments ranged from 105.5 to 2306.4 U/L and were significantly higher in patients undergoing liver biopsy compared to the healthy controls. The levels were strikingly higher in patients whose liver biopsies resulted in a definite diagnosis of NASH.
Additionally, caspase activity levels independently predicted the presence of NASH. The risk of definitive NASH on liver biopsy increased with increasing plasma levels of caspase 3-generated CK-18 fragments. For every 50 U/L increase in CK-18 levels, the likelihood of having "definitive NASH" increased 86 percent.
"In summary, our findings suggest that non-invasive monitoring of hepatocyte apoptosis in blood of patients with NAFLD is a reliable tool to differentiate NASH from 'not NASH' in patients with suspected NAFLD," the authors report.
MEDICA.de; Source: John Wiley & Sons, Inc.