Can Patient Characteristics Help Predict Post-TACE Infection?
Braniff C, Stratton L, Agnew P, McDougall NI, Cash WJ.
The Liver Unit, Royal Victoria Hospital, Belfast
Hepatocellular carcinoma is the third most common cause of cancer death worldwide. At presentation many patients are unsuitable for surgical or curative treatment and trans-arterial chemo-embolisation (TACE) is often used as a palliative treatment. However, TACE is associated with a number of potentially fatal complications including infection. All TACE therapy in Northern Ireland is carried out in the regional Liver Unit, RVH.
To determine the incidence of post-TACE infection and identify any patient characteristics which predict this outcome.
A database of all patients who had undergone TACE therapy in NI from Jan 2006 to Jan 2014 was accessed. Chart review was used to identify which patients had developed post-TACE infections requiring intravenous antibiotics. This group was then compared to a control group of patients who had suffered no complications. We compared data on variables including patient age, gender, tumour size, number of treatments, underlying liver disease, and comorbidities. Pre treatment blood tests were recorded and used to calculate MELD, UKELD and Child Pugh scores.
131 patients underwent TACE in the RVH during the 8 year period. 18 patients (16 men, 2 women) developed infections. 79 patients (65 men, 14 women) had no complications and were included in the control group. There were significant differences between the infection and control group with regards average age (74 vs 65.8 years), creatinine level (102 vs 88.3) and tumour size (7.84 vs 4.98cms). There was a significant difference in co-morbidity. 88.9% of the infection group had a history of cardiac or chest disease compared with 22.8% in the control group. There was no significant difference between the groups with regard MELD, UKELD, Child Pugh scores or afp.
Increasing age, elevated creatinine, large tumour size and cardio-respiratory co-morbidity are associated with higher rates of post TACE infection. This information could aid decisionmaking regarding patient suitability for TACE therapy and raises the question of whether antibiotic prophylaxis should be considered for those at higher risk of infection.