Brief Article
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World J Gastroenterol. Apr 28, 2013; 19(16): 2543-2549
Published online Apr 28, 2013. doi: 10.3748/wjg.v19.i16.2543
Computed tomography findings for predicting severe acute hepatitis with prolonged cholestasis
Sang Jung Park, Jin Dong Kim, Yeon Seok Seo, Beom Jin Park, Min Ju Kim, Soon Ho Um, Chang Ha Kim, Hyung Joon Yim, Soon Koo Baik, Jin Yong Jung, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu
Sang Jung Park, Yeon Seok Seo, Soon Ho Um, Chang Ha Kim, Hyung Joon Yim, Jin Yong Jung, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu, Department of Internal Medicine, College of Medicine, Korea University, Seoul 136-705, South Korea
Jin Dong Kim, Department of Internal Medicine, Cheju Halla General Hospital, Jeju 690-766, South Korea
Beom Jin Park, Min Ju Kim, Department of Radiology, College of Medicine, Korea University, Seoul 136-705, South Korea
Soon Koo Baik, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju 220-701, South Korea
Author contributions: Park SJ and Kim JD contributed equally to this work; Park SJ and Kim JD wrote the manuscript and participated in the statistical analysis; Seo YS, Yim HJ and Baik SK coordinated and supported the statistical analysis; Park BJ, Kim MJ, Kim CH and Jung JY collected all the data; Keum B, Jeen YT, Lee HS, Chun HJ, Kim CD and Ryu HS collected all the data, provided analytical tools and were involved in editing the manuscript; Um SH designed and coordinated the entire study, primarily edited the manuscript, and provided the financial support.
Supported by A Grant of the Korea Healthcare Technology R-D Project, Ministry of Health and Welfare, South Korea, No. A102065
Correspondence to: Soon Ho Um, MD, PhD, Department of Internal Medicine, College of Medicine, Korea University, No. 126-1 Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, South Korea. umsh@korea.ac.kr
Telephone: +82-2-9206608  Fax: +82-2-9531943
Received: October 22, 2012
Revised: February 19, 2013
Accepted: March 15, 2013
Published online: April 28, 2013
Processing time: 191 Days and 13 Hours
Abstract

AIM: To evaluate the significance of computed tomography (CT) findings in relation to liver chemistry and the clinical course of acute hepatitis.

METHODS: Four hundred and twelve patients with acute hepatitis who underwent enhanced CT scanning were enrolled retrospectively. Imaging findings were analyzed for the following variables: gallbladder wall thickness (GWT), arterial heterogeneity, periportal tracking, number and maximum size of lymph nodes, presence of ascites, and size of spleen. The serum levels of alanine aminotransferase, alkaline phosphatase, bilirubin, albumin, and prothrombin time were measured on the day of admission and CT scan, and laboratory data were evaluated every 2-4 d for all subjects during hospitalization.

RESULTS: The mean age of patients was 34.4 years, and the most common cause of hepatitis was hepatitis A virus (77.4%). The mean GWT was 5.2 mm. The number of patients who had findings of arterial heterogeneity, periportal tracking, lymph node enlargement > 7 mm, and ascites was 294 (80.1%), 348 (84.7%), 346 (84.5%), and 56 (13.6%), respectively. On multivariate logistic regression, male gender [odds ratio (OR) = 2.569, 95%CI: 1.477-4.469, P = 0.001], toxic hepatitis (OR = 3.531, 95%CI: 1.444-8.635, P = 0.006), level of albumin (OR = 2.154, 95%CI: 1.279-3.629, P = 0.004), and GWT (OR = 1.061, 95%CI: 1.015-1.110, P = 0.009) were independent predictive factors for severe hepatitis. The level of bilirubin (OR = 1.628, 95%CI: 1.331-1.991, P < 0.001) and GWT (OR = 1.172, 95%CI: 1.024-1.342, P = 0.021) were independent factors for prolonged cholestasis in multivariate analysis.

CONCLUSION: In patients with acute hepatitis, GWT on CT scan was an independent predictor of severe hepatitis and prolonged cholestasis.

Keywords: Acute hepatitis; Cholestasis; Computed tomography; Prognosis; Gallbladder

Core tip: Previous studies on the correlation between imaging and laboratory findings in acute hepatitis have shown conflicting results. This study revealed a correlation between abdominal computed tomography findings and liver biochemical parameters. In particular, gallbladder wall thickness (GWT) was the only independent imaging finding that predicts severe hepatitis and prolonged cholestasis. The results of this study suggest that GWT measurement, which is a relatively easy and objective procedure, is helpful to predict severe acute hepatitis or prolonged cholestasis.