PDF(Pubmed)
Abstract：
Cytokeratin-18 (CK-18) is a marker of hepatic cell death. Serum CK-18 could serve as a prognostic marker for patients with advanced liver disease (ALD). This meta-analysis aims to explore the association between total CK-18 (M65) and caspase-cleaved CK-18 (M30) levels with the prognosis of ALD patients. Relevant longitudinal observational studies were identified through comprehensive searches of the Medline, Web of Science, and Embase databases. A random-effects model was utilized to synthesize the findings, accommodating heterogeneity among studies. The analysis included 14 datasets from 11 studies. Elevated serum CK-18 levels at admission were linked to a higher risk of death or liver transplantation during follow-up. This association was consistent for both M65 (risk ratio [RR] 1.99, 95% confidence interval [CI] 1.65 to 2.40, p < 0.001; I2 = 43%) and M30 (RR 1.94, 95% CI 1.57 to 2.40, p < 0.001; I2 = 46%). Subgroup analysis revealed that the relationship between serum M65 levels and adverse outcomes was attenuated in studies using multivariate analysis compared to those using univariate analysis (RR 1.78 vs. 2.80, p for subgroup difference = 0.03). Further subgroup analyses indicated that the prognostic significance of CK-18 for ALD patients was not significantly influenced by study design, methods of determining CK-18 cutoff values, or follow-up durations. Elevated serum CK-18 levels at admission indicate a poor prognosis in patients with ALD. This finding holds for both M65 and M30.
摘要：
细胞角蛋白-18(CK-18)是肝细胞死亡的标志物。血清CK-18可作为晚期肝病（ALD）患者的预后指标。这项荟萃分析旨在探讨总CK-18（M65）和caspase裂解的CK-18（M30）水平与ALD患者预后之间的关系。通过对Medline的全面搜索，确定了相关的纵向观察研究，WebofScience,和Embase数据库。利用随机效应模型来综合研究结果，适应研究之间的异质性。该分析包括来自11项研究的14个数据集。入院时血清CK-18水平升高与随访期间死亡或肝移植的风险较高有关。M65(风险比[RR]1.99,95%置信区间[CI]1.65至2.40,p<0.001;I2=43%)和M30(RR1.94,95%CI1.57至2.40,p<0.001;I2=46%)的相关性是一致的。亚组分析显示，与单变量分析相比，使用多变量分析的研究中血清M65水平与不良结局之间的关系减弱（RR1.78vs.2.80，亚组差异p=0.03）。进一步的亚组分析表明，CK-18对ALD患者的预后意义不受研究设计的显著影响。确定CK-18临界值的方法，或后续持续时间。入院时血清CK-18水平升高表明ALD患者预后不良。这一发现适用于M65和M30。
