Abstract
Background
Transcatheter arterial chemoembolization (TACE) is an effective treatment for hepatocellular carcinoma (HCC) that can cause deterioration of liver function. We aimed to make an early predictive model of long-term liver dysfunction after TACE.
Methods
We performed a prospective cohort study involving 109 HCC patients who underwent TACE at Kobe University Hospital. Indirect calorimetry and blood biochemical examinations were performed before and 7 days after TACE. As an indicator of liver function, the Child’s score was evaluated before and 3 months after TACE. Patients with and without Child’s score deterioration were compared, and the independent risk factors for Child’s score deterioration were statistically examined. An early predictive model of Child’s score deterioration after TACE was developed using multivariate logistic regression.
Results
Multivariate analyses showed that the non-protein respiratory quotient (npRQ) and prealbumin (preAlb) ratios (7 days after/before TACE) were independent determinants of Child’s score deterioration (p = 0.039 and 0.020, respectively). Decreases of the npRQ and preAlb ratios were significantly related to increases of Child’s score 3 months after TACE (p = 0.007 and 0.002, respectively). The following predictive model of Child’s score deterioration was developed: exp(−6.383 × npRQ ratio − 3.038 × preAlb ratio + 7.755)/(1 + exp(−6.383 × npRQ ratio − 3.038 × preAlb ratio + 7.755)). The model discriminated well between patients with and without Child’s score deterioration (area under the receiver operating curve [ROC]; AUC 0.713; 95% confidence interval [CI] 0.613–0.812). The optimal cut-off point for the Child’s score was 0.449, and the sensitivity and specificity of the model were 57.1 and 79.1%, respectively.
Conclusions
Reductions in npRQ and preAlb 7 days after TACE were associated with the long-term deterioration of liver function. With our model, we were able to identify high-risk patients.
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Abbreviations
- AC:
-
Arm circumference
- AIC:
-
Akaike’s Information Criterion
- ALT:
-
Alanine aminotransferase
- Alb:
-
Albumin
- AFP:
-
Alpha fetoprotein
- AUC:
-
Area under ROC
- AST:
-
Aspartate aminotransferase
- BMI:
-
Body mass index
- BCAA:
-
Branched-chain amino acids
- BTR:
-
Branched-chain amino acid/tyrosine ratio
- ChE:
-
Cholinesterase
- CT:
-
Computed tomography
- CI:
-
Confidence interval
- CRP:
-
C-reactive protein
- Crn:
-
Creatinine
- FPG:
-
Fasting plasma glucose
- γ-GTP:
-
γ-glutamyltranspeptidase
- HbA1c:
-
Hemoglobin A1c
- HCC:
-
Hepatocellular carcinoma
- HA:
-
Hyaluronic acid
- IBW:
-
Ideal body weight
- IRI:
-
Immunoreactive insulin
- ICG:
-
Indocyanine green
- INR:
-
International normalized ratio
- MELD:
-
Model for end-stage liver disease
- npRQ:
-
Non-protein respiratory quotient
- PEI:
-
Percutaneous ethanol injection
- Plt:
-
Platelets
- preAlb:
-
Prealbumin
- PEM:
-
Protein energy malnutrition
- PT:
-
Prothrombin time
- REE:
-
Resting energy expenditure
- T-Bil:
-
Total bilirubin
- RFA:
-
Radiofrequency ablation
- TACE:
-
Transcatheter arterial chemoembolization
- TNM:
-
Tumor node metastasis
- VIF:
-
Variance inflation factor
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Acknowledgments
We thank the nurses and our colleagues in the Department of Gastroenterology and the Gastroenterology Ward at Kobe University Hospital for their participation in the study. We also thank the dietitians of the department for their excellent technical assistance with this study. We are grateful to Dr. Miguel A. Tanimoto and Dr. Shin Nishiumi for their invaluable help in preparing the manuscript.
Conflict of interest
We declare that we have no conflicts of interest.
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535_2012_535_MOESM2_ESM.tif
Supplementary Fig. 1. Discrimination: Area under the ROC curve (AUC) for Child’s score deterioration. The AUC demonstrated that the model had good ability to discriminate between the Child’s score deteriorated group and the unchanged group.(TIFF 566 kb)
535_2012_535_MOESM3_ESM.tif
Supplementary Fig. 2. The correlation between deterioration of the Child’s score and that of the MELD score 3 months after TACE. The increase of the Child’s score was significantly correlated with that of the MELD score 3 months after TACE by Pearson’s correlation coefficient test (r = 0.540, p < 0.001).(TIFF 540 kb)
535_2012_535_MOESM4_ESM.tif
Supplementary Fig. 3. Discrimination: AUC for MELD score deterioration. The AUC demonstrated that the model had fairly good ability to discriminate between the deteriorated MELD score group and the unchanged group. (TIFF 596 kb)
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Saito, M., Seo, Y., Yano, Y. et al. Short-term reductions in non-protein respiratory quotient and prealbumin can be associated with the long-term deterioration of liver function after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. J Gastroenterol 47, 704–714 (2012). https://doi.org/10.1007/s00535-012-0535-x
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DOI: https://doi.org/10.1007/s00535-012-0535-x