CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S9-S10
DOI: 10.1055/s-0041-1730671
Abstract

Correlation between 30-Day Mortality and Albumin-Bilirubin and Platelet-Albumin-Bilirubin Score Grades Following Transarterial Embolization for Ruptured Hepatocellular Carcinoma: A Retrospective Single-Center Study

Omar Bashir
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Mohammad Arabi
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Refaat Salman
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Shahbaz Qazi
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Abdulrahman Alvi
King Abdulaziz Medical City, Riyadh, Saudi Arabia
,
Yousof Al Zahrani
King Abdulaziz Medical City, Riyadh, Saudi Arabia
› Author Affiliations

Background: Although uncommon, hepatocellular carcinoma (HCC) presenting as acute rupture has a mortality rate reported to be high as 25%–75%. Management strategies include conservative treatment, surgical resection, as well as transarterial embolization (TAE). TAE can be an effective option to achieve hemodynamic stability in the acute phase though the overall 30-day mortality remains high. The recently developed Albumin-Bilirubin (ALBI) and Platelet-Albumin-Bilirubin (PALBI) grades have been shown to be accurate indicators of hepatic reserve in HCC patients. The purpose of our retrospective study was to assess the technical success and 30-day mortality of bland TAE for ruptured HCC. We also sought to correlate ALBI and PALBI grades with 30-day mortality rate. Methods: Data from electronic medical records and Radiology reporting system for all TAE procedures for patients diagnosed with ruptured HCC between 2012 and 2017 were retrospectively reviewed. We analyzed demographics, medical history, laboratory findings, and corresponding ALBI and PALBI grades, imaging findings, technical details, and clinical outcome. Results: A total of 24 TAE procedures were performed on 22 patients (16 males and 6 females) presenting with ruptured HCC between 2012 and 2017. Mean age at first presentation was 69.4 years (range: 24–103 years). Majority of the cases presented with abdominal pain and/or distention (n = 22) and were diagnosed on computed tomography (n = 21). Seven patients had solitary lesion, whereas 15 patients had either two (n = 2) or more (n = 13) lesions. Of the 22 patients, 20 patients had liver cirrhosis and 15 patients were known to have a diagnosis of HCC prior to rupture. The mean ruptured lesion size was 8.9 cm (range: 2.6–22 cm). Baseline ALBI grade at presentation was 2 (n = 10) and 3 (n = 13), while PALBI grade was calculated at 1 (n = 22) and 2 (n = 1). Gelfoam was the embolic agent in 12 (50%) and polyvinyl alcohol in 10 (42%) cases. Active contrast extravasation was noted in only 6 (25%) TAE procedures. All cases were technically successful (defined as satisfactory occlusion of artery feeding the ruptured tumor). Clinical success (defined as stabilization of hemoglobin levels 48 h post-TAE without need for re-intervention) was achieved in all but two interventions (one patient died within 48 h postintervention and another required a repeat embolization on the next day). 30-day mortality rate (27%) was calculated for 22 interventions (one patient lost to follow-up after being discharged on day 6). There was no correlation between 30-day mortality and ALBI grade (P = 0.8), PALBI grade (P = 1), and largest ruptured lesion diameter (P = 0.7). Conclusion: Despite technically successful TAE for ruptured HCC, there is a high 30-day mortality. There was no correlation between 30-day mortality and ALBI and PALBI grades in our study.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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