Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization

• Published in: PloS one Vol. 15; no. 12; p. e0243780
• Main Authors: Sohn, Won, Ham, Cheol Bae, Kim, Nam Hee, Kim, Hong Joo, Cho, Yong Kyun, Jeon, Woo Kyu, Kim, Byung Ik
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.12.2020; Public Library of Science (PLoS)
• Subjects: Acute Kidney Injury - etiology; Acute renal failure; Aged; Antineoplastic Agents - administration & dosage; Ascites; Biology and Life Sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Care and treatment; Chemoembolization; Chemoembolization, Therapeutic - adverse effects; Creatinine; Creatinine - blood; Doxorubicin - administration & dosage; Embolization; Female; Gastroenterology; Hepatocellular carcinoma; Hepatoma; Hospitals; Humans; Internal medicine; Kidneys; Liver cancer; Liver cirrhosis; Liver diseases; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Male; Medical prognosis; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Mortality; Neoplasm Staging; Odds Ratio; Patient outcomes; Prognosis; Proportional Hazards Models; Risk analysis; Risk Factors; Serum albumin; Serum Albumin - analysis; Severity of Illness Index; Survival; Survival Rate; Therapeutic embolization; Veins & arteries; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243780

The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). A total of 347 HCC patients with Child-Pugh class A and pre-TACE serum creatinine (SCr) ≤1.5 mg/dL undergoing TACE as an initial therapy 2000-2014 were analyzed. Overall survival with related risk factors including AKI was investigated. We assessed AKI based on the International Club of Ascites (ICA)-AKI criteria. The mean age was 60.9 years. Of 347 patients, death was observed in 109 patients (31.4%). The mean SCr levels at pre-TACE, one day, two months, and four months after TACE were 0.9, 0.9, 0.9, and 1.1 mg/dL, respectively. The AKI within four months after TACE developed in 37 patients (11%). The AKI stages were non-AKI in 310 (89%), stage 1 in 10 (3%), stage 2 in 10 (3%), and stage 3 in 17 patients (5%). Multivariable analysis showed that the risk factors for overall survival were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.58, p = 0.027), BCLC stage B (HR 2.07, p = 0.008), BCLC stage C (HR 3.96, p<0.001), bilobar tumor location (HR 1.66, p = 0.022), AKI stage 1 (HR 6.09, p<0.001), AKI stage 2 (HR 8.51, p<0.001), and AKI stage 3 (HR 17.64, p<0.001). AKI is a crucial prognostic factor for overall survival in HCC patients undergoing TACE. The assessment of AKI based on the ICA-AKI criteria can facilitate evaluation of the prognosis of HCC patients undergoing TACE.