Skip to main content

Advertisement

SpringerLink
Log in

Clinical Significance of Perihepatic Lymphadenopathy in Patients with Chronic Hepatitis C Infection

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Patients with chronic hepatitis C (HCV) infection commonly have perihepatic lymph node enlargement (PLNE). We investigated the prognostic value of PLNE in the development of complicated cirrhosis and death, as well as the clinical and laboratory factors associated with the presence of PLNE in a cohort of HCV-infected veterans.

Methods

Using a retrospective cohort design, we compared the rate of development of decompensated cirrhosis and/or death in a group of HCV-infected patients who did not have evidence of decompensated cirrhosis stratified by the presence or absence of PLNE. We used Kaplan–Meier survival curves. We then evaluated which factors were predictive of detection of PLNE using logistic regression.

Results

A total of 131 patients were included in the study. Fifty-nine patients had PLNE and 72 patients did not. After a mean follow-up of 42 months, survival in the absence of progression to decompensated cirrhosis and/or death was not significantly different between the two groups (log-rank test, p = 0.27). The only factor predictive of progression to decompensated cirrhosis and/or death was the presence of cirrhosis at baseline (HR 13.13, 95% CI 2.21–79.41). In addition, cirrhosis was the only factor predictive of the detection of PLNE on CT scan (OR 3.09: CI 2.1–25.9).

Conclusions

Presence of PLNE in patients with chronic HCV infection is strongly associated with subclinical cirrhosis. However, PLNE does not independently predict the progression of liver disease to decompensated cirrhosis and/or death in HCV-infected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhhert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States. Ann Intern Med. 2006;144:705–714.

    PubMed  Google Scholar 

  2. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127:S35–S50.

    Article  PubMed  Google Scholar 

  3. Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis. 2005;9:383–398.

    Article  PubMed  Google Scholar 

  4. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–1236.

    Article  PubMed  Google Scholar 

  5. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference. J Hepatol. 2001;35:421–430.

    Article  PubMed  CAS  Google Scholar 

  6. Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. 5th ed. Philadelphia, PA: Lippincott, Williams, & Wilkins; 2006:298–299.

    Google Scholar 

  7. Cassani F, Valentini P, Cataleta M, et al. Ultrasound-detected abdominal lymphadenopathy in chronic hepatitis C: high frequency and relationship with viremia. J Hepatol. 1997;26:479–483.

    Article  PubMed  CAS  Google Scholar 

  8. Spinetti A, Matricardi L, Puoti M, et al. Ultrasound evaluation of hepatic lymph nodes in patients with anti-hepatitis C virus antibody reactivity. Ital J Gastroenterol Hepatol. 1999;31:295–330.

    PubMed  CAS  Google Scholar 

  9. Maeda T, Hori Y, Yamaguchi N, et al. Clinical significance of lymphadenopathy in the upper abdomen: ultrasound demonstration. Nippon Acta Radiogica. 1995;55:228–232.

    CAS  Google Scholar 

  10. Choi MS, Lee JH, Koh KC, et al. Clinical significance of enlarged perihepatic lymph nodes in chronic hepatitis B. J Clin Gastroenterol. 2001;32:329–332.

    Article  PubMed  CAS  Google Scholar 

  11. Dietrich CF, Zeuzem S, Caspary WF, Wehrmann T. Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands. Ultraschall Med. 1998;19:265–269.

    Article  PubMed  CAS  Google Scholar 

  12. Kuo H, Lin C, Chen J, Tsai S. Enlarged lymph nodes in porta hepatis: sonographic sign of chronic hepatitis B and C infections. J Clin Ultrasound. 2006;34:211–216.

    Article  PubMed  Google Scholar 

  13. Watanabe T, Sassa T, Hiratsuka H, Hattori S, Abe A. Clinical significance of enlarged perihepatic lymph node on ultrasonography. Eur J Gastroenterol Hepatol. 2005;17:185–190.

    Article  PubMed  Google Scholar 

  14. Dietrich CF, Lee J, Herrmann G, et al. Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C. Hepatology. 1997;26:467–472.

    Article  PubMed  CAS  Google Scholar 

  15. Soresi M, Bonfissuto G, Magliarisi C, et al. Ultrasound detection of abdominal lymph nodes in chronic liver diseases: a retrospective analysis. Clin Radiol. 2003;58:372–377.

    Article  PubMed  CAS  Google Scholar 

  16. Dietrich CF, Stryjek-Kaminska D, Teuber G, Lee J, Caspary WF, Zeuzem S. Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection. Am J Roentgenol. 2000;174:699–704.

    CAS  Google Scholar 

  17. Soresi M, Bonfissuto G, Sesti R, et al. Perihepatic lymph nodes and antiviral response in chronic HCV-associated hepatitis. Ultrasound Med Biol. 2004;30:711–717.

    Article  PubMed  Google Scholar 

  18. Dofman RE, Alpern MB, Gross BH, Sandler MA. Upper abdominal lymph node: criteria for normal size determined with CT. Radiology. 1991;180:319–322.

    Google Scholar 

  19. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhner WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.

    PubMed  Google Scholar 

  20. Richardson D, Fisher M, Sabin CA. Sexual transmission of hepatitis C in MSM may not be confined to those with HIV infection. J Infect Dis. 2008;197:1213–1214.

    Article  PubMed  Google Scholar 

  21. Van de Laar TJW, Van Der Bij AK, Prins M, et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis. 2007;196:230–238.

    Article  PubMed  Google Scholar 

  22. Ferenci P, Laferl H, Scherzer TM, Gschwantler M, Maieron A, Brunner H, et al. Peginterferon alfa-2a and ribavirin for 24 weeks in hepatitis C type 1 and 4 patients with rapid virological response. Gastroenterology. 2008; 135:451–458. 2008 May 27.

    Google Scholar 

  23. Kudo M, Zheng RQ, Kim SR, et al. Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis: a multicenter collaborative study. Intervirology. 2008;51:17–25.

    Article  PubMed  Google Scholar 

  24. Di Bisceglie AM, Sterling RK, Chung RT. Serum alpha-fetoprotein levels in patients with advanced hepatitis C: results from the HALT-C trial. J Hepatol. 2005;43:434–441.

    Article  PubMed  CAS  Google Scholar 

  25. Wai C, Greenson JK, Fontana RJ, Kalbfleisch JD. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–526.

    Article  PubMed  Google Scholar 

  26. Bayati N, Silverman AL, Stuart GC. Serum alpha-fetoprotein levels and liver histology in patients with chronic hepatitis C. Am J Gasteroenterol. 1998;93:2452–2456.

    Article  CAS  Google Scholar 

  27. Choi, PC, Kim HJ, Choi WH, Park D, Park JH, Cho YK, et al. Model for end-stage liver disease, model for end-stage liver disease-sodium and Child-Turcotte-Pugh scores over time for the prediction of complications of liver cirrhosis. Liver international 2009; 221–226.

  28. Soresi M, Carroccio A, Agate V, et al. Evaluation by ultrasound of abdominal lymphadenopathy in chronic hepatitis C. Am J Gastroenterol. 1999;94:497–501.

    Article  PubMed  CAS  Google Scholar 

  29. Dod GD, Baron RL, Oliver JH, Federle MP, Baumgartel PB. Enlarged abdominal lymph nodes in end-stage cirrhosis: CT-histopathologic correlation in 507 patients. Radiology. 1997;203:127–130.

    Google Scholar 

  30. Saadoun D, Asselah T, Resche-Rigon M, Charlotte F, Bedossa P, Valla D, Piette JC, Marcellin P, Cacoub P. Hepatology 2006; 43:1337–1345.

    Google Scholar 

  31. Muller P, Renou C, Harafa A, et al. Lymph node enlargement within the hepatoduodenal ligament in patients with chronic hepatitis C reflects the immunological cellular response of the host. J Hepatol. 2003;39:807–813.

    Article  PubMed  Google Scholar 

  32. Adinolfi LE, Utili R, Andreana A, et al. Serum HCV RNA levels correlate with histological liver damage and concur with steatosis in progression of chronic hepatitis C. Dig Dis Sci. 2001;46:1677–1683.

    Article  PubMed  CAS  Google Scholar 

  33. Rustgi VK. The epidemiology of hepatitis C infection in the United States. J Gasteroenterol. 2007;42:513–521.

    Article  Google Scholar 

  34. Roselle GA, Danko LH, Kralovic SM, Simbartl LA, Kizer KW. National hepatitis C surveillance day in the veterans health administration of the department of veterans affairs. Mil Med. 2002;167:756–759.

    PubMed  Google Scholar 

  35. Briggs ME, Baker C, Hall R, et al. Prevalence and risk factors for hepatitis C virus infection at an urban Veterans Administration medical center. Hepatology. 2001;34:1200–1205.

    Article  PubMed  CAS  Google Scholar 

  36. Ishii H, Saito H. Perihepatic lymphadenopathy in chronic liver disease. J Gasteroenterol Hepatol. 2000;15:695–696.

    Article  CAS  Google Scholar 

  37. Neri S, Ierna D, Mauceri B, et al. Can ultrasounographic findings of perihepatic lymphadenopathy promote investigation to detect possible presence of virus C infection in non-symptomatic subjects? Hepatol Res. 2003;27:124–128.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the Michael E DeBakey Veterans Affairs medical center through resources of which this work was completed.

Conflict of interest

The authors report no conflicts of interest and have not received any financial support for this study.

Author information

Authors and Affiliations

  1. Michael E DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, 111PC, Houston, TX, 77030, USA

    Shahriar Tavakoli-Tabasi & Sheeba Ninan

  2. Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Shahriar Tavakoli-Tabasi

Authors
  1. Shahriar Tavakoli-Tabasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sheeba Ninan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shahriar Tavakoli-Tabasi.

Appendix

Appendix

See Table 3.

Table 3 Analysis of the Variables
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tavakoli-Tabasi, S., Ninan, S. Clinical Significance of Perihepatic Lymphadenopathy in Patients with Chronic Hepatitis C Infection. Dig Dis Sci 56, 2137–2144 (2011). https://doi.org/10.1007/s10620-010-1555-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1555-0

Keywords

Search

Navigation