Diagnostic accuracy of spider naevi for liver disease detection in alcoholics
- Fernández Somoza, Juan Manuel
- Rodríguez López, I.
- Tomé Martínez de Rituerto, Santiago
- Bermúdez, María
- Gude Sampedro, Francisco
- Barrio Gómez, Emilio
- González Quintela, Arturo
ISSN: 0304-4866, 1989-3922
Year of publication: 2014
Volume: 75
Issue: 1
Pages: 7-11
Type: Article
More publications in: Galicia Clínica
Abstract
Introduction: Spider naevi are traditionally considered a sign of liver cirrhosis, particularly in patients with alcoholism. However, systematic evaluation of their diagnostic value in alcoholic patients has been scarcely performed. The aim of this study was to determine the diagnostic accuracy of the presence of spider neavi for liver disease detection in alcoholics using percutaneous liver biopsy as the reference standard. Methods: Cross-sectional study of 229 alcoholics admitted to the hospital (67% males) undergoing percutaneous liver biopsy. Results: Spiders were least prevalent in patients with fatty liver (4/104 cases, 4%). The prevalence of spiders was greater in patients with alcoholic hepatitis (15/80, 19%) than in patients with fatty liver (P=0.002). Prevalence was even higher in patients with cirrhosis (6/21, 29%, P<0.001), and was highest in patients with cirrhosis and superimposed alcoholic hepatitis (11/24, 46%, P<0.001). The presence of spiders had a sensitivity of 25% (95% CI 18-34%), a specificity of 95% (95% CI 90-99%), and a positive likelihood ratio of 6.6 (95% CI 2.4-18.2) for the diagnosis of severe underlying liver disease (alcoholic hepatitis, liver cirrhosis, or both). The presence of spiders was associated with biological markers of liver dysfunction and with additional cutaneous stigmata (facial telangiectasia and palmar erythema). Conclusion: The presence of spiders in an alcoholic patient strongly indicates the presence of severe underlying liver disease (liver cirrhosis and/or alcoholic hepatitis).