J Korean Soc Emerg Med.  2019 Dec;30(6):521-528. 10.0000/jksem.2019.30.6.521.

Factors prognostic of ruptured hepatocellular carcinoma presenting to the emergency department

• Lee SH
• Kim JS
• Yu GN
• Kim YJ
• Ryoo SM
• Sohn CH
• Kim WY
• Ahn S

• KMID: 2470542
• DOI: http://doi.org/10.0000/jksem.2019.30.6.521

Abstract

OBJECTIVE
This study assessed whether characteristics of ruptured hepatocellular carcinoma (HCC) at presentation to the emergency department (ED) affect patient outcomes, and evaluated factors prognostic of HCC, particularly treatment modalities.
METHODS
This retrospective study between 2008 and 2017 evaluated patients presenting to an ED with ruptured HCC. Parameters associated with 30- and 90-day mortality were investigated, and clinical characteristics and treatments were analyzed.
RESULTS
In total, 121 patients presented to the ED with ruptured HCC. Of these, 29 died within 30 days. Multivariate logistic regression analysis showed that platelet count (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.976-0.995) and prothrombin time (OR, 16.20; 95% CI, 1.91-137.23) were associated with a 30-day mortality rate, whereas presence or absence of acute abdominal pain and shock at presentation to the ED was not significant. Patients who underwent embolization had a lower 30-day mortality rate than those treated conservatively (OR, 0.04; 95% CI, 0.001-0.20). Sixtyone patients died within 90 days after presentation to the ED. Serum albumin concentration (OR, 0.25; 95% CI, 0.09-0.71) was associated with 90-day mortality. Moreover, patients who underwent embolization (OR, 0.19; 95% CI, 0.06-0.60) and emergency hepatectomy (OR 0.09; 95% CI, 0.01-0.99) had lower 90-day mortality rates as compared to patients treated conservatively.
CONCLUSION
Presence of acute abdominal pain at presentation to the ED does not affect patient outcomes. Early aggressive treatments, such as embolization or emergency hepatectomy, were observed to improve outcomes in patients with ruptured HCC.

Keyword

Hepatocellular carcinoma; Prognosis; Rupture; Emergencies

MeSH Terms

Abdominal Pain
Carcinoma, Hepatocellular*
Emergencies*
Emergency Service, Hospital*
Hepatectomy
Humans
Logistic Models
Mortality
Platelet Count
Prognosis
Prothrombin Time
Retrospective Studies
Rupture
Serum Albumin
Shock
Serum Albumin