DDW: Blood Test May Replace Biopsy In Fatty Liver Diagnosis

May 20, 2007

WASHINGTON -- When fatty liver is the problem, a simple blood test can determine as well as an hepatic biopsy whether the condition is dangerous or benign, a researcher said here.

WASHINGTON, May 20 -- When fatty liver is the problem, a simple blood test can determine as well as an hepatic biopsy whether the condition is dangerous or benign, a researcher said here.

In a large cohort study, the blood test -- for a marker of liver cell death -- was highly accurate in distinguishing non-alcoholic steatohepatitis (NASH) from other forms of fatty liver and from healthy livers, found Ariel Feldstein, M.D., of the Cleveland Clinic.

The test looks for fragments of cytokeratin-18, a liver filament protein that is broken down specifically during liver cell death, Dr. Feldstein told a session at Digestive Disease Week.

The level of cytokeratin-18 fragments is significantly elevated (P

By contrast, those with NASH had a median level of 361, Dr. Feldstein said.

If the cutoff for NASH is set at 246 U/L, he said, the test predicts the disease with a specificity of 81% and a sensitivity of 75%.

The test for the cytokeratin-18 fragments is commercially available, Dr. Feldstein said, but only as a research tool, and it's not likely to be available for clinical use for a couple of years.

The test is "certainly farther along than other biomarkers we've seen for liver disease," commented Jacquelyn Maher, M.D., of the University of California San Francisco.

But "there are still some bugs to be worked out," said Dr. Maher, who was not involved in the research. Specifically, she said, "there's not a lot of wiggle room" between those with frank NASH and those with borderline disease, which may limit diagnostic utility.