Serum cytokeratin-18 levels in patients with alcoholic liver disease with and without alcoholic hepatitis: A cross-sectional study at a tertiary care hospital in East Sikkim

Abstract

Background: Alcoholic liver disease (ALD) spans from steatosis to cirrhosis often presenting with or without alcoholic hepatitis (AH). Cytokeratin-18 (CK-18) has emerged as a potential biomarker in alcohol-related liver injury and may provide additional information beyond conventional liver enzymes. Aims and Objectives: The aim of the study is to evaluate serum CK-18 levels as a potential biomarker in identifying AH among patients with ALD. Materials and Methods: This hospital-based cross-sectional study was conducted among 70 patients with ALD, categorized into those with and without AH. Serum CK-18, aspartate aminotransferase (AST), and alanine aminotransferase levels were measured in the study participants. Alcohol consumption patterns, including duration, quantity, and frequency, were recorded, and their statistical analysis included the Mann–Whitney U test, Chi-square test, receiver operating characteristic (ROC) curve analysis, and a binary logistic regression. Results: Of the 70 ALD patients, 16 (22.9%) had AH. The study population was predominantly male (78.6%) with a mean age of 46.1±11.2 years. Alcohol consumption was largely long-standing, with a significant association between higher daily alcohol intake and AH (P=0.049). CK-18 levels did not differ significantly between ALD patients with and without AH (P=0.438), whereas AST levels were significantly higher in the AH group (P<0.001). ROC analysis demonstrated poor diagnostic performance of CK-18 (area under the curve=0.467). Logistic regression identified AST as an independent predictor of AH while CK-18 was not statistically significant. Conclusion: Serum CK-18 demonstrated limited utility in differentiating AH from non-hepatitis ALD in this cohort. In contrast, AST emerged as an independent predictor of AH, highlighting the continued diagnostic relevance of conventional biochemical markers.