title: Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases.
abstract: OBJECTIVE
  The purpose of this study was to analyze the prognostic factors associated with emergency transcatheter arterial embolization in the treatment of patients in hemodynamically unstable condition caused by rupture of hepatocellular carcinoma.
  
  
  METHODS
  An 8-year retrospective cohort study was conducted to evaluate emergency transcatheter arterial embolization in the treatment of 167 patients in unstable hemodynamic condition (systolic blood pressure < 90 mm Hg at presentation) due to rupture of hepatocellular carcinoma. The clinical, laboratory, and imaging findings of a group who died (survival period, < or = 30 days) were compared with those of a group who survived more than 30 days.
  
  
  RESULTS
  On arrival in the emergency department, the group who died (n = 52) were in significantly worse condition than the group who survived (n = 115). The group who died had a poorer Child-Pugh class, lower hemoglobin and serum albumin levels, higher demand for blood transfusion, higher incidence of acute respiratory failure, worse neurologic status (Glasgow Coma Scale score, < or = 12), greater prevalence of portal vein thrombosis, and higher serum total bilirubin and creatinine levels (p < 0.05, two-sample Student's t test and Fisher's exact or chi-square test). Multivariate logistic regression analysis showed that patients who did not have portal venous thrombosis (odds ratio, 0.241; p = 0.012) or a lower creatinine level (odds ratio, 0.458; p = 0.003) had better probability of survival. Successful hemostasis with transcatheter arterial embolization was achieved in 99% of patients (30-day mortality rate, 31%). Patients with coexistent acute respiratory failure or impaired neurologic status and marked hyperbilirubinemia (> 2.7 mg/dL) had exceptionally high mortality rate (> 70%).
  
  
  CONCLUSIONS
  Emergency transcatheter arterial embolization is effective for hemostasis of ruptured hepatocellular carcinoma in patients in hemodynamically unstable condition being treated in the emergency department. However, patients with portal venous thrombosis, a high serum creatinine level, acute respiratory failure, impaired neurologic status, and a high serum total bilirubin level continue to be at high risk of death.
authors.affiliation: Department of Emergency Medicine, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Chia-Te
authors.initials: CT
authors.lastname: Kung
authors.forename: Ber-Ming
authors.initials: BM
authors.lastname: Liu
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.forename: Tze-Yu
authors.initials: TY
authors.lastname: Lee
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chen
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
mesh_terms: D021721:Balloon Occlusion / Q000706:statistics & numerical data*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D015331:Cohort Studies; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000628:therapy; D016019:Survival Analysis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome