Risk factors and a predictive model for acute hepatic failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

Abstract Background/Aims Acute hepatic failure ( AHF ) is one of the most serious complications of transcatheter arterial chemoembolization ( TACE ). The aims of this study were to investigate risk factors of AHF after TACE and to establish a predictive model for AHF . Methods In the evaluation set, a total of 820 patients who underwent TACE as a first treatment for hepatocellular carcinoma were included. The demographic, laboratory, radiological and treatment‐related factors were analysed to identify risk factors for AHF after TACE and a predictive model was established using the identified risk factors. In the validation set, a different cohort of 438 patients was included to validate the predictive model. Results The incidence of post‐ TACE AHF was 15.1% (124/820). Multivariate analysis revealed that presence of portal vein thrombosis, high aspartate aminotransferase, bilirubin, and log alpha‐foetoprotein levels, and low albumin and sodium levels were independent risk factors. A mathematical model was established using these independent risk factors, and the area under the receiver operating characteristic curve of the model was 0.773 (95% confidence interval, 0.726–0.820). The cut‐off value of 9 had a sensitivity of 78.2%, a specificity of 72.3%, a positive likelihood ratio of 2.82, a negative likelihood ratio of 0.30, a positive predictive value of 28.9% and a negative predictive value of 95.8%. Conclusions The risk factors of post‐ TACE AHF were presence of portal vein thrombosis, high aspartate aminotransferase, bilirubin, and alpha‐foetoprotein levels, and low serum albumin and sodium levels. A mathematical model to predict post‐ TACE AHF was established.