title: Risk factors and a predictive model for acute hepatic failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Acute hepatic failure (AHF) is one of the most serious complications of transcatheter arterial chemoembolization (TACE). The aims of this study were to investigate risk factors of AHF after TACE and to establish a predictive model for AHF.
  
  
  METHODS
  In the evaluation set, a total of 820 patients who underwent TACE as a first treatment for hepatocellular carcinoma were included. The demographic, laboratory, radiological and treatment-related factors were analysed to identify risk factors for AHF after TACE and a predictive model was established using the identified risk factors. In the validation set, a different cohort of 438 patients was included to validate the predictive model.
  
  
  RESULTS
  The incidence of post-TACE AHF was 15.1% (124/820). Multivariate analysis revealed that presence of portal vein thrombosis, high aspartate aminotransferase, bilirubin, and log alpha-foetoprotein levels, and low albumin and sodium levels were independent risk factors. A mathematical model was established using these independent risk factors, and the area under the receiver operating characteristic curve of the model was 0.773 (95% confidence interval, 0.726-0.820). The cut-off value of 9 had a sensitivity of 78.2%, a specificity of 72.3%, a positive likelihood ratio of 2.82, a negative likelihood ratio of 0.30, a positive predictive value of 28.9% and a negative predictive value of 95.8%.
  
  
  CONCLUSIONS
  The risk factors of post-TACE AHF were presence of portal vein thrombosis, high aspartate aminotransferase, bilirubin, and alpha-foetoprotein levels, and low serum albumin and sodium levels. A mathematical model to predict post-TACE AHF was established.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yang Won
authors.initials: YW
authors.lastname: Min
authors.forename: Jeong
authors.initials: J
authors.lastname: Kim
authors.forename: Seonwoo
authors.initials: S
authors.lastname: Kim
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Sung
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Paik
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
authors.forename: Joon Hyeok
authors.initials: JH
authors.lastname: Lee
mesh_terms: D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D016013:Likelihood Functions; D017114:Liver Failure, Acute / Q000453:epidemiology* / Q000209:etiology*; D008113:Liver Neoplasms / Q000628:therapy*; D008954:Models, Biological; D015999:Multivariate Analysis; D011169:Portal Vein / Q000473:pathology; D011237:Predictive Value of Tests; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D018709:Statistics, Nonparametric; D020246:Venous Thrombosis / Q000473:pathology; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D012709:Serum Albumin; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D001663:Bilirubin