Research Article Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease Sumitro Kosasih, 1 Wong Zhi Qin, 1 Rafiz Abdul Rani, 2 Nazefah Abd Hamid, 3 Ngiu Chai Soon, 1 Shamsul Azhar Shah, 4 Yazmin Yaakob, 5 and Raja Affendi Raja Ali 1 1 Gastroenterology and Hepatology Unit, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia 2 Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Selangor, 40450, Malaysia 3 Department of Medical and Health Science, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, 71800, Malaysia 4 Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia 5 Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia Correspondence should be addressed to Raja Afendi Raja Ali; drafendi@ppukm.ukm.edu.my Received 27 May 2018; Accepted 29 August 2018; Published 27 September 2018 Academic Editor: Heather Francis Copyright © 2018 Sumitro Kosasih et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Backgrounds. Te aim of this study was to appraise the relationship between serum fragmented cytokeratin-18(CK-18), controlled attenuation parameter (CAP), and liver steatosis assessed by ultrasound (US) in nonalcoholic fatty liver disease (NAFLD) patients. Methods. Patients who underwent abdominal US were recruited, followed with measurement of CAP using Fibroscan 5 and serum fragmented CK-18 using enzyme-linked immunosorbent assay. Te degree of liver steatosis assessed by US was categorized into mild (S1), moderate (S2), and severe (S3). Results. A total of 109 patients were included in our study. CAP and fragmented CK-18 level were signifcantly correlated with liver steatosis grade with r  = 0.56 and 0.68, p=0.001, respectively. NAFLD Fibrosis Score was poorly correlated with liver steatosis grade (r s =-0.096, p=0.318). Using fragmented CK-18 level, area under receiver operating characteristic (AUROC) curves for S≥2 and S≥3 were excellent (0.82 and 0.84, respectively). Using CAP, AUROC curves for detection of S≥2 and S≥3 were good (0.76, 0.77, respectively). We also proposed cut-of value of CAP to detect S≥2 and S≥3 to be 263 and 319db/m, respectively, and fragmented CK-18 level to detect S≥2 and S≥3 (194 and 294 U/L, respectively). Conclusions. Both the fragmented CK-18 level and the CAP, but not NAFLD Fibrosis Score, were well correlated with hepatic steatosis grade as assessed by US. 1. Introduction Nonalcoholic fatty liver disease (NAFLD) is the liver pan- demic in this 21 st century, afecting 20-45% population around the world [1–5]. NAFLD has been proven to cause liver fbrosis, liver cirrhosis, and hepatocellular carcinoma [6–9]. Not only does it have an adverse outcome to the liver itself but NAFLD also has been associated with increased rate of metabolic syndrome [10], cardiovascular diseases, and chronic kidney disease [11, 12]. Although NAFLD is usually benign, it may be associated with infammation and hep- atocyte apoptosis resulting in nonalcoholic steatohepatitis (NASH) of 20–30% of subjects. One-ffh of these NASH subjects will progress to develop liver cirrhosis [13]. Liver biopsy is still the gold standard to stage liver fbrosis as it provides a multitude of information on the infammation activity. However, considering its invasive nature, sampling variability, and cost, other noninvasive modalities of imaging and biomarkers have been developed. Te NAFLD fbrosis score (NFS) developed by Angulo et al. utilizes six variables (age, body mass index (BMI), diabetes, aspartatetransami- nase (AST), alaninetransaminase (ALT), and albumin) which are commonly available in patient’s assessment. It has been shown to reduce the need for biopsy in most NAFLD patients [14]. In NASH, liver cell apoptosis and necroinfamma- tion play a major role. Serum caspase-cleaved fragmented cytokeratin-18(CK-18) refects the degree of apoptosis and has been shown as an independent predictor in diagnosis of Hindawi International Journal of Hepatology Volume 2018, Article ID 9252536, 9 pages https://doi.org/10.1155/2018/9252536