Hemangiomas y compromiso hepático si más de 5...

                                 Published in Dermatology

Journal Scan / Research · December 16, 2020

Screening for Infantile Hepatic Hemangioma in Patients With Cutaneous Infantile Hemangioma

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• In this study, patients with 1 to 2 (n=980) or at least 3 cutaneous hemangiomas (n=676) received abdominal ultrasonography to screen for infantile hepatic hemangioma (IHH). Rates of IHH increased with number of cutaneous infantile hemangiomas (<5: 0.4%, 5–9: 8.3% [P < .001]; 10–30: 24.1% [P = .011]; >30: 33.3%  [P = .701]). ROC curve analysis identified a cutoff point for the number of cutaneous infantile hemangiomas of 5 to screen for IHH. Participants with IHH were also screened for potential complications, including congestive heart failure (present in 1/31 patients with EKG and echocardiogram), consumptive hypothyroidism (present in 3/31 patients with thyroid function tests), and liver dysfunction (present in 2/31 patients with liver function tests), coagulation function, and alpha fetoprotein levels.

• Diffuse IHH can cause hypothyroidism, congestive heart failure, and abdominal compartment syndrome; thus, early identification is paramount. This study demonstrates that the risk of IHH increases with increasing numbers of cutaneous hemangiomas and validates the recommendation that infants with 5 or more cutaneous hemangiomas be screened with abdominal ultrasound for IHH.

– Margaret Hammond, MD

Abstract

BACKGROUND

Abdominal ultrasonography has been proposed for screen infantile hepatic hemangioma (IHH) in patients with multiple cutaneous infantile hemangiomas (IHs).

OBJECTIVES

The aim of this study was to establish the optimal cutoff point for the number of cutaneous IHs needed to screen for IHH.

METHODS

We performed a prospective, multicenter study to screen for IHH in patients younger than 9 months of age who had multiple cutaneous IHs (n ≥3) on ultrasonography. For comparison, a group of patients with 1 to 2 focal cutaneous IHs was also recruited.

RESULTS

In total, 676 patients with at least 3 cutaneous IHs, and 980 patients with 1 to 2 focal cutaneous IHs were enrolled. Thirty-one patients were found to have IHH. A higher number of cutaneous IHs was associated with an increased risk of IHH (R = 0.973, P < 0.001). Receiver operating characteristic curve analysis revealed that 5 cutaneous IHs was the optimal cutoff point to screen for IHH, with an area under the curve of 0.872 (P <0.001; 95% CI, 0.789-0.955).

LIMITATIONS

This was an uncontrolled study.

CONCLUSIONS

Screening for IHH is recommended in patients younger than 9 months of age who present with 5 or more cutaneous IHs.

TRIAL REGISTRATION

Clinicaltrial.gov identifier: NCT03331744.

Journal of the American Academy of Dermatology

Screening for Infantile Hepatic Hemangioma in Patients With Cutaneous Infantile Hemangioma: A Multicenter Prospective Study

J Am Acad Dermatol 2020 Dec 04;[EPub Ahead of Print], Y Ji, S Chen, K Yang, B Xiang, X Jiang, X Xu, L Li, T Qiu, J Zhou, S Dai, X Zhang, G Lu, F Kong, G Yang, Q Qiu