The serum CK-18 fragments can be measured by ELISA, and they significantly increased in patients with NASH compared with simple steatosis and normal controls.61 The circulating levels of CK-18 fragments have been shown to reflect disease activity, and change in their level may correlate with the change in NAFLD activity score.37 In a recent meta-analysis, the pooled AUROC of serum CK-18 for detection of NASH was 0.82 with a sensitivity and specificity of 78% and 87%, respectively.50 This evidence concerns the gene KRT18 and metabolic dysfunction-associated steatotic liver disease.