MELD-Na > 16 is associated with high peri-procedural and short-term mortality in patients with ruptured hepatocellular carcinoma treated with emergent transarterial embolization

• Published in: Abdominal imaging 2022, Vol.47 (1), p.416-422
• Main Authors: Jundt, Michael C., Owen, Robert L., Thompson, Scott M., Fleming, Chad J., Stockland, Andrew H., Andrews, James C.
• Format: Article
• Language: English
• Subjects: Blood transfusion; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - therapy; Embolization; End Stage Liver Disease; Erythrocytes; Gastroenterology; Hemorrhage; Hepatocellular carcinoma; Hepatology; Humans; Imaging; Interventional Radiology; Intubation; Liver cancer; Liver diseases; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate Analysis; Patients; Portal vein; Prognosis; Proportional Hazards Models; Radiology; Retrospective Studies; Severity of Illness Index; Sodium; Survival; Thrombosis
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-021-03306-2

Purpose To evaluate prognostic factors associated with peri-procedural (30 days) and short-term (90 days) mortality in the United States cohort of patients following emergent transarterial embolization for ruptured hepatocellular carcinoma. Methods Patients with ruptured hepatocellular carcinoma treated with emergent TAE between January 2001 and December 2019 were retrospectively identified ( n  = 24). Average age was 62 years (range, 23–78 year); 15 (62.5%) were men. Univariate and Cox proportional hazard modeling were used to determine independent predictors of overall survival (OS) following TAE. OS stratified by Model for End-Stage Liver Disease-Sodium score was assessed using Kaplan–Meier analysis. Results Twenty-one patients (88%) died during a mean clinical follow-up period of 328 ± 139 days. MELD-Na score (HR 1.22 per 1-unit increase; 95% CI 1.06–1.46; p  = 0.005) and pre-rupture ECOG PS score (HR 8.1; 95% CI 1.28–51.2; p  = 0.026) were independent predictors of decreased overall survival. There was no significant association between overall survival and presence of cardiovascular co-morbidities ( p  = 0.60), hemorrhagic shock on presentation ( p  = 0.16), portal vein thrombus ( p  = 0.08), vasopressor support required ( p  = 0.79), intubation required ( p  = 0.40), acute kidney injury ( p  = 0.58), and number of packed red blood cell transfusions ( p  = 0.22). The median OS was 64 days. Median OS was significantly greater in patients with a MELD-Na score ≤ 16 as compared to those with a MELD-Na score > 16 (166.5 days vs 9 days, p  = 0.011). Cumulative OS rates in those with a MELD-Na score ≤ 16 at 30, 60, 90, and 360 days were 79%, 64%, 64%, and 25%, respectively, vs 33%, 33%, 11%, and 0%, respectively, in those with a MELD-Na score > 16. Conclusion MELD-Na > 16 is associated with very high peri-procedural (67% at 30 days) and short-term (89% at 90 days) mortality in patients with ruptured HCC treated with emergent transarterial embolization. A better understanding of these prognostic factors may help guide treatment decisions and provide realistic expectations when counseling patients and their families.