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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

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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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.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Masaya Saito, Yasushi Seo, Yoshihiko Yano, Akira Miki, Masaru Yoshida & Takeshi Azuma

  2. Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshihiko Yano

  3. Division of Metabolomics Research, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Masaru Yoshida

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  1. Masaya Saito
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Correspondence to Takeshi Azuma.

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Supplementary material 1 (DOCX 16 kb)

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

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