| Factors prognostic of ruptured hepatocellular carcinoma presenting to the emergency department |
Sang-Hun Lee1
, June-Sung Kim2
, Gi Na Yu2
, Youn-Jung Kim2
, Seung Mok Ryoo2
, Chang Hwan Sohn2
, Won Young Kim2
, Shin Ahn2
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1Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
2Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea |
| Correspondence |
Shin Ahn ,Tel: 02-3010-5327, Fax: 02-3010-3360, Email: ans1023@gmail.com,
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Received: May 3, 2019; Revised: August 7, 2019 Accepted: September 4, 2019. Published online: December 31, 2019. |
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| 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.
Method:
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. |
| Key words:
Hepatocellular carcinoma; Prognosis; Rupture; Emergencies |
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