title: Outcomes of emergency treatment in ruptured hepatocellular carcinoma in the ED.
abstract: The choice of emergency treatment of ruptured hepatocellular carcinoma (HCC) remains controversial. This study analyzed the prognostic factors for ruptured HCC seen in an ED. Patients were retrospectively classified into survival and mortality groups. Fifty-five patients were enrolled into this study, and the hospital mortality rate was 38.2%. There were no associations of clinical presentation, tumor characteristics, and emergency treatment method with patients' prognoses. Significantly higher mortality rate was noted in patients with poor liver function. The time between admission and emergency chemoembolization was significantly shorter in the mortality group than in the survival group (mean, 255 vs 394 minutes). The 1-month survival rate was 69% in patients who received conservative treatment and 59% in patients who underwent emergency chemoembolization. Routine emergency chemoembolization did not improve outcome and was associated with higher mortality and complication rates, especially in patients with poor liver function. Conservative therapy may be a preferable option for patients with ruptured HCC if they have baseline poor liver function.
authors.affiliation: Department of Emergency Medicine, China Medical University Hospital, Taichung 404, Taiwan, ROC. ercwk@www.cmuh.org.tw
authors.forename: Wei-kung
authors.initials: WK
authors.lastname: Chen
authors.forename: Yu-Tein
authors.initials: YT
authors.lastname: Chang
authors.forename: Yun-ting
authors.initials: YT
authors.lastname: Chung
authors.forename: Horng-ren
authors.initials: HR
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D015897:Comorbidity; D016001:Confidence Intervals; D004621:Embolization, Therapeutic; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012709:Serum Albumin / Q000378:metabolism; D016019:Survival Analysis; D013624:Taiwan
chemical_list: D012709:Serum Albumin