title: Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis- a prospective analysis.
abstract: BACKGROUND
  Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC.
  
  
  METHODS
  Of 290 patients with HCC (July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI).
  
  
  RESULTS
  84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63 (34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions (n = 77)] or B; ascites and portal vein invasion was present in 18 (16.2%) and 15 (13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28 (25.2%), NV 4 (3.6%), abdominal pain 9 (8.1%), infection 7 (6.3 %), AHD 13 (11.7%), AKI 3 (2.7 %)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p = 0.046) and low serum albumin (p = 0.035) predicted PEF while low serum albumin (p = 0.021) and low platelet counts (p = 0.041) predicted AHD. In the multivariate model, factors with p < 0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p = 0.029, OR = 1.412), ascites (p = 0.030, OR = 1.212), elevated serum bilirubin (p = 0.007, OR = 4.357) and large tumour size (p = 0.036, OR = 3.603) were independent risk factors for PEF. Tumour diameter >5 cm (p = 0.049, OR = 2.410) and elevated serum bilirubin (p = 0.036, OR = 1.517) predicted AHD.
  
  
  CONCLUSIONS
  In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5 cm with elevated bilirubin predicted AHD post-TACE.
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. rohansiriwardana@yahoo.com.
authors.forename: Rohan Chaminda
authors.initials: RC
authors.lastname: Siriwardana
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. maduniln@yahoo.co.uk.
authors.forename: Madunil Anuk
authors.initials: MA
authors.lastname: Niriella
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. anuradhadassa@gmail.com.
authors.forename: Anuradha Supun
authors.initials: AS
authors.lastname: Dassanayake
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. chandikaliyanage@hotmail.com.
authors.forename: Chandika Anuradha Habarakada
authors.initials: CA
authors.lastname: Liyanage
authors.affiliation: Department of Radiology, North Colombo Teaching Hospital, Ragama, Sri Lanka. aupasena@yahoo.com.
authors.forename: Angappulige
authors.initials: A
authors.lastname: Upasena
authors.affiliation: Department of Radiology, North Colombo Teaching Hospital, Ragama, Sri Lanka. chandrasirigampala@gmail.com.
authors.forename: Chandra
authors.initials: C
authors.lastname: Sirigampala
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. hjanakadesilva@gmail.com.
authors.forename: Hithanadura Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D007239:Infections / Q000139:chemically induced; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D017093:Liver Failure / Q000139:chemically induced*; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors; D047368:Tumor Burden; D014839:Vomiting / Q000139:chemically induced
chemical_list: D001663:Bilirubin