Perihepatic nodes detected by point-of-care ultrasound in acute hepatitis and acute-on-chronic liver disease

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 44; pp. 12620 - 12627
• Main Authors: Feng, I Che, Wang, Szu Jen, Sheu, Ming Jen, Koay, Lok-Beng, Lin, Ching Yih, Ho, Chung Han, Sun, Chi Shu, Kuo, Hsing Tao
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 28.11.2015
• Subjects: Acute Disease; Area Under Curve; Chi-Square Distribution; Hepatitis - diagnostic imaging; Hepatitis - epidemiology; Hepatitis - virology; Hepatitis, Chronic - diagnostic imaging; Hepatitis, Chronic - epidemiology; Hepatitis, Chronic - virology; Hepatitis, Viral, Human - diagnostic imaging; Hepatitis, Viral, Human - epidemiology; Hepatitis, Viral, Human - virology; Humans; Logistic Models; lymph; Lymph Nodes - diagnostic imaging; Lymphatic Diseases - diagnostic imaging; Lymphatic Diseases - epidemiology; Lymphatic Diseases - virology; Multivariate Analysis; Odds Ratio; Point-of-care; Point-of-Care Testing; Predictive Value of Tests; Prevalence; Reproducibility of Results; Retrospective Cohort Study; Retrospective Studies; Risk Factors; ROC Curve; Taiwan - epidemiology; ultrasonography;Perihepatic; Perihepatic lymph node; Point-of-care ultrasonography; Acute on chronic hepatitis B; Acute hepatitis flare; Acute hepatitis A
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i44.12620

AIM: To study the manifestations of perihepatic lymph nodes during the episode of acute hepatitis flare by point-of-care ultrasonography.METHODS: One hundred and seventy-six patients with an episode of acute hepatitis flare(ALT value > 5 × upper normal limit) were enrolled retrospectively. Diagnosis of etiology of the acute hepatitis flare was based on chart records and serological and virological assays. The patients were categorized into two groups(viral origin and non-viral origin) and further defined into ten subgroups according to the etiologies. An ultrasonograpy was performed within 2 h to 72 h(median, 8 h). The maximum size of each noticeable lymph node was measured. Correlation between clinical parameters and nodal manifestations was analyzed RESULTS: Enlarged lymph nodes(width ≥ 5mm)were noticeable in 110(62.5%) patients, mostly in acute on chronic hepatitis B(54.5%). The viral group had a higher prevalence rate(89/110 = 80.9%) and larger nodal size(median, 7 mm) than those of the non-viral group(21/66 = 31.8%; median, 0 mm)(P < 0.001 for both). Meanwhile, there were significant differences in the nodal size between acute and chronic viral groups(P < 0.01), and between acute hepatitis A and non-hepatitis A viral groups(P < 0.001). In logistical regression analysis, the nodal width still showed strong significance in multivariate analysis(P < 0.0001) to stratify the two groups. The area under the curve of ROC was 0.805, with a sensitivity of 80.9%, a specificity of 68.2%, positive predictive value of 80.92%, negative predictive value of 68.18%, and an accuracy of 76.14%. CONCLUSION: Point-of-care ultrasonography to detect perihepatic nodal change is valuable for clarifying the etiologies in an episode of acute hepatitis flare.