Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis- a prospective analysis

Abstract

BackgroundTransarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC.MethodsOf 290 patients with HCC (July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI).Results84 patients [90.5 % males, 89.2 % cirrhotics, 89.2 % nodular HCC, median age 63 (34–84) years] underwent 111 TACE sessions. All were Child class A [69.4 % sessions (n = 77)] or B; ascites and portal vein invasion was present in 18 (16.2 %) and 15 (13.6 %), respectively.42 (38.2 %) TACE procedures resulted in complications [PEF 28 (25.2 %), NV 4 (3.6 %), abdominal pain 9 (8.1 %), infection 7 (6.3 %), AHD 13 (11.7 %), AKI 3 (2.7 %)]. There were no immediate post-TACE deaths.On univariate analysis elevated serum bilirubin (p = 0.046) and low serum albumin (p = 0.035) predicted PEF while low serum albumin (p = 0.021) and low platelet counts (p = 0.041) predicted AHD. In the multivariate model, factors with p < 0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p = 0.029, OR = 1.412), ascites (p = 0.030, OR = 1.212), elevated serum bilirubin (p = 0.007, OR = 4.357) and large tumour size (p = 0.036, OR = 3.603) were independent risk factors for PEF. Tumour diameter >5 cm (p = 0.049, OR = 2.410) and elevated serum bilirubin (p = 0.036, OR = 1.517) predicted AHD.ConclusionIn NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5 cm with elevated bilirubin predicted AHD post-TACE.

Risk Factors for the Development of Postembolization Syndrome after Transarterial Chemoembolization for Hepatocellular Carcinoma Treatment

“…This finding was also pointed out in a previous study by Siriwardana et al 2 Another study by Wang et al 18 also showed that female gender correlates with a higher incidence of postprocedural nausea, particularly in premenopausal women. 18 In that study, they found no statistically significant difference in the incidences of nausea and vomiting between male over 50 years and female patients who have entered menopause, a finding that raised the suspicion that these associations could be due to hormonal causes, namely the estradiol level.…”

“…These factors were also not related to PES in previous studies. 2,6 The main limitation of our study is its retrospective design. We had to rely on the information of the clinical charts of the patients.…”

“…At least two previous studies also pointed out this risk factor and established a cut-off of 5 cm, above which the risk of PES increases. 2,6 Another study by Li et al demonstrated that a tumor size > 3 cm was associated with a higher risk of PES. 16 On one hand, a larger tumor size is generally associated with a higher dose used, which we already found is a risk factor for PES development.…”

“…Some studies showed that lipiodol dose was associated with the risk of PES 2,6,19 and a study by Jun et al 6 established a dose ≥ 7 ml as a cut-off. In our study, both in the PES and control group, the procedures in which injection of lipiodol occurred, the dose was always small (≤ 6 ml) and so it was not expected to increase the risk of PES.…”

Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

“…The main complications of TACE are liver failure, acute kidney injury, liver abscess, puncture site bleeding, bone marrow suppression and infection (8,9), all of which occur at a low incidence. HCC patients usually have pre-existing cirrhosis (10,11) and, therefore, have a high incidence of liver dysfunction and portal hypertension, conditions that may cause reductions in white blood cell (WBC) and platelet (PLT) counts.…”