Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12620-12627
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12620
Perihepatic nodes detected by point-of-care ultrasound in acute hepatitis and acute-on-chronic liver disease
I Che Feng, Szu Jen Wang, Ming Jen Sheu, Lok-Beng Koay, Ching Yih Lin, Chung Han Ho, Chi Shu Sun, Hsing Tao Kuo
I Che Feng, Ming Jen Sheu, Lok-Beng Koay, Ching Yih Lin, Chi Shu Sun, Hsing Tao Kuo, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Yongkang District, Tainan 710, Taiwan
Szu Jen Wang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan 736, Taiwan
Chung Han Ho, Department of Medical Research, Chi Mei Medical Center, Yongkang District, Tainan 710, Taiwan
Hsing Tao Kuo, Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
Author contributions: Feng IC and Wang SJ contributed equally for data collection, data analysis, and manuscript writing; Sheu MJ, Koay LB, Lin CY and Sun CS instructed the research; and Ho CH contributed to the data analysis; Kuo HT designed and performed the research.
Institutional review board statement: The study was approved by Institutional Review Board of the Chi Mei Medical Center.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at kuohsu2003@yahoo.com.tw.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hsing-Tao Kuo, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, Tainan 710, Taiwan. kuohsu2003@yahoo.com.tw
Telephone: +886-6-2812811-57111 Fax: +886-6-2750630
Received: April 5, 2015
Peer-review started: April 7, 2015
First decision: June 19, 2015
Revised: July 7, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: November 28, 2015
Abstract

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.

Keywords: Point-of-care ultrasonography, Perihepatic lymph node, Acute on chronic hepatitis B, Acute hepatitis A, Acute hepatitis flare

Core tip: The nodal manifestation in acute hepatitis flare has never been well studied especially in an endemic area of chronic hepatitis B. Our findings encouraged point-of-care ultrasonography to be performed as early as possible for clarifying the etiologies as well as early treatments. Those subjects with viral origin have a higher prevalence of nodal enlargement and larger nodal size as compared with those of non-viral origin. A 5 mm cut-off value for nodal shortest diameter (width) is convenient for defining nodal enlargement.