title: Risk factors for mortality in patients with multifocal and diffuse hepatic hemangiomas.
abstract: OBJECTIVE
  Multifocal and diffuse hepatic hemangiomas are true infantile hemangiomas, which likely exist in a continuum. We reviewed our hepatic hemangioma registry to identify prognostic indicators for mortality.
  
  
  METHODS
  Registry records entered between 1995 and 2012 were reviewed. Clinical characteristics were evaluated for prognostic significance using the multivariable Cox proportional hazards model. Survival data were analyzed using the Kaplan-Meier product-limit method.
  
  
  RESULTS
  We identified 123 patients with multifocal (n=91) and diffuse (n=32) hepatic hemangiomas. Mortality was 16% (n=20); 40% (n=8) had multifocal and 60% (n=12) had diffuse lesions. A diagnosis of diffuse disease (hazard ratio: 9.9, 95% CI: 2.0-50.8, P=.002) and congestive heart failure (CHF) (hazard ratio: 3.9, 95% CI: 1.3-14.2, P=.031) were significant risk factors for mortality across the continuum; age at presentation, cardiomegaly, presence of shunts, and hypothyroidism were not statistically significant independent risk factors. Among patients with diffuse lesions, eight (67%) who died had abdominal compartment syndrome, which was also associated with mortality (P=.002).
  
  
  CONCLUSIONS
  Hepatic hemangioma patients with CHF or diffuse disease are at higher risk for mortality. Patients with multifocal lesions without CHF may go undetected until lesions become diffuse. Aggressive treatment of symptomatic patients and close follow-up of asymptomatic patients may improve mortality.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Rialon
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Rudy
authors.initials: R
authors.lastname: Murillo
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Fevurly
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kulungowski
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Christison-Lagay
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Harry P W
authors.initials: HP
authors.lastname: Kozakewich
authors.affiliation: Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Ahmad I
authors.initials: AI
authors.lastname: Alomari
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA; Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. Electronic address: steven.fishman@childrens.harvard.edu.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishman
mesh_terms: D000368:Aged; D005260:Female; D006391:Hemangioma / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Hepatic hemangioma; Infantile hemangioma; Liver hemangioma; Vascular anomaly