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Factors prognostic of ruptured hepatocellular carcinoma presenting to the emergency department

대한응급의학회지 2019년 30권 6호 p.521 ~ 528
이상훈 ( Lee Sang-Hun ) - Keimyung University School of Medicine Dongsan Medical Center Department of Emergency Medicine

김준성 ( Kim June-Sung ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
유지나 ( Yu Gi-Na ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
김윤정 ( Kim Youn-Jung ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
유승목 ( Ryoo Seung-Mok ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
손창환 ( Sohn Chang-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
김원영 ( Kim Won-Young ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
안신 ( Ahn Shin ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine

Abstract


Objective: This study assessed whether characteristics of ruptured hepatocellular carcinoma (HCC) at presentation to the emergency department (ED) affect patient outcomes, and evaluated factors prognostic of HCC, particularly treatment modalities.

Method: This retrospective study between 2008 and 2017 evaluated patients presenting to an ED with ruptured HCC. Parameters associated with 30- and 90-day mortality were investigated, and clinical characteristics and treatments were analyzed.

Results: In total, 121 patients presented to the ED with ruptured HCC. Of these, 29 died within 30 days. Multivariate logistic regression analysis showed that platelet count (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.976-0.995) and prothrombin time (OR, 16.20; 95% CI, 1.91-137.23) were associated with a 30-day mortality rate, whereas presence or absence of acute abdominal pain and shock at presentation to the ED was not significant. Patients who underwent embolization had a lower 30-day mortality rate than those treated conservatively (OR, 0.04; 95% CI, 0.001-0.20). Sixtyone patients died within 90 days after presentation to the ED. Serum albumin concentration (OR, 0.25; 95% CI, 0.09- 0.71) was associated with 90-day mortality. Moreover, patients who underwent embolization (OR, 0.19; 95% CI, 0.06- 0.60) and emergency hepatectomy (OR 0.09; 95% CI, 0.01-0.99) had lower 90-day mortality rates as compared to patients treated conservatively.

Conclusion: Presence of acute abdominal pain at presentation to the ED does not affect patient outcomes. Early aggressive treatments, such as embolization or emergency hepatectomy, were observed to improve outcomes in patients with ruptured HCC.

키워드

Hepatocellular carcinoma; Prognosis; Rupture; Emergencies
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