title: Perihepatic nodes detected by point-of-care ultrasound in acute hepatitis and acute-on-chronic liver disease.
abstract: OBJECTIVE
  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%.
  
  
  CONCLUSIONS
  Point-of-care ultrasonography to detect perihepatic nodal change is valuable for clarifying the etiologies in an episode of acute hepatitis flare.
authors.affiliation: 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.
authors.forename: I Che
authors.initials: IC
authors.lastname: Feng
authors.affiliation: 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.
authors.forename: Szu Jen
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: 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.
authors.forename: Ming Jen
authors.initials: MJ
authors.lastname: Sheu
authors.affiliation: 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.
authors.forename: Lok-Beng
authors.initials: LB
authors.lastname: Koay
authors.affiliation: 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.
authors.forename: Ching Yih
authors.initials: CY
authors.lastname: Lin
authors.affiliation: 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.
authors.forename: Chung Han
authors.initials: CH
authors.lastname: Ho
authors.affiliation: 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.
authors.forename: Chi Shu
authors.initials: CS
authors.lastname: Sun
authors.affiliation: 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.
authors.forename: Hsing Tao
authors.initials: HT
authors.lastname: Kuo
mesh_terms: D000208:Acute Disease; D019540:Area Under Curve; D016009:Chi-Square Distribution; D006505:Hepatitis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology; D006521:Hepatitis, Chronic / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology; D006525:Hepatitis, Viral, Human / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000821:virology; D015999:Multivariate Analysis; D016017:Odds Ratio; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Acute hepatitis A; Acute hepatitis flare; Acute on chronic hepatitis B; Perihepatic lymph node; Point-of-care ultrasonography