Acute liver injury after transcatheter arterial chemoembolization in patients with hepatitis B virus-related intermediate or advanced hepatocellular carcinoma stages

Table 1 Comparison of baseline data of 172 cases of hepatitis B virus-related intermediate to advanced hepatocellular carcinoma, mean ± SD/n (%)

	Non-ALI group (n = 110)	ALI group (n = 62)	Statistic value	P value
Sex			χ2 = 0.572	0.449
Male	91 (82.7)	54 (87.1)
Female	19 (17.3)	8 (12.9)
Age	60.9 ± 9.85	59.3 ± 10.2	t = 1.000	0.319
Child-Pugh stage			χ2 = 5.496	0.019
A	72 (65.5)	51 (82.3)
B	38 (34.5)	11 (17.7)
BCLC			χ2 = 0.011	0.917
B	47 (42.7)	27 (43.5)
C	63 (57.3)	35 (56.5)
Weight (kg)	66.5 ± 10.4	67.2 ± 11.0	t = -0.439	0.661
Height (m), median (IQR)	1.70 (1.62, 1.73)	1.65 (1.64 ,1.72)	Z = -0.646	0.518
Duration of TACE (minute), median (IQR)	60.0 (49.2, 60.0)	60.0 (51.0, 60.0)	Z = -0.538	0.590
Number of TACE			χ2 = 6.305	0.012
First time	73 (66.4)	29 (46.8)
Non first time	37 (33.6)	33 (53.2)
Tumor diameter (mm), median (IQR)	40.5 (20.2, 63.0)	52.0 (36.2, 75.8)	Z = -2.515	0.012
Tumor number			χ2 = 0.570	0.450
Single	38 (34.5)	25 (40.3)
Multiple	72 (65.5)	37 (59.7)
PNI, median (IQR)	193 (173, 210)	211 (190, 221)	Z = -2.912	0.004
CONUT, median (IQR)	5.00 (4.00, 6.00)	5.00 (4.00, 6.00)	Z = -1.807	0.071
GNRI	101 ± 11.8	104 ± 10.2	t = -1.975	0.050
TC (mmol/L), median (IQR)	3.82 (3.29, 4.47)	3.85 (3.36, 4.77)	Z = -1.013	0.311
AFP (ng/mL), median (IQR)	75.0 (6.10, 716)	92.9 (2.97, 1956)	Z = -0.15	0.881
HBsAg (log10 IU/mL), median (IQR)	3.61 (2.40, 3.78)	3.61 (2.07, 3.79)	Z = -0.204	0.838
HBeAg (log10 IU/mL)			χ2 = 1.168	0.280
Negative	78 (70.9)	39 (62.9)
Positive	32 (29.1)	23 (37.1)
HBV DNA (IU/mL)			χ2 = 9.253	0.010
< 20	60 (54.5)	19 (30.6)
20-2000	32 (29.1)	26 (41.9)
> 2000	18 (16.4)	17 (27.4)
ALT (U/L), median (IQR)	25.0 (17.2, 40.0)	25.0 (20.2, 41.0)	Z = -0.49	0.624
AST (U/L), median (IQR)	39.0 (23.0, 64.8)	34.5 (27.0, 51.0)	Z = -0.067	0.947
GGT (U/L), median (IQR)	89.0 (45.2, 140)	87.0 (39.8, 160)	Z = -0.408	0.683
TBIL (μmol/L), median (IQR)	15.5 (11.5, 21.6)	13.2 (10.4, 24.1)	Z = -0.955	0.339
ALB (g/L), median (IQR)	37.8 (33.2, 40.7)	41.0 (36.6, 43.0)	Z = -2.829	0.005
PT (seconds), median (IQR)	12.8 (12.1, 13.9)	12.2 (11.4, 13.3)	Z = -2.253	0.024
INR, median (IQR)	1.16 (1.09, 1.27)	1.11 (1.05, 1.21)	Z = -2.061	0.039
NLR, median (IQR)	2.45 (1.59, 3.63)	2.65 (1.70, 3.61)	Z = -0.115	0.909
WBC (× 109/L), median (IQR)	4.00 (2.80, 5.92)	4.60 (3.32, 5.70)	Z = -1.300	0.194
NE (× 109/L), median (IQR)	2.25 (1.58, 3.44)	2.69 (1.87, 4.01)	Z = -1.403	0.161
LYM (× 109/L), median (IQR)	1.00 (0.60, 1.40)	1.10 (0.80, 1.48)	Z = -1.341	0.180
PLT (× 109/L), median (IQR)	97.0 (68.0, 172)	116 (76.5, 160)	Z = -0.601	0.548

Prognostic nutritional index = albumin + lymphocyte × 5. TACE: Transcatheter arterial chemoembolization; ALI: Acute liver injury; BCLC: Barcelona clinic liver cancer staging system; IQR: Interquartile range; PNI: Prognostic nutritional index; CONUT: Controlling nutritional status; GNRI: Geriatric nutritional risk index; TC: Total cholesterol; AFP: Alpha-fetoprotein; HBsAg: Hepatitis B surface antigens; HBeAg: Hepatitis B e antigens; ALT: Alanine aminotransferase; AST: Aspartate transaminase; HBV: Hepatitis B virus; GGT: Gamma-glutamyl transpeptidase; TBIL: Total bilirubin; ALB: Albumin; PT: Prothrombin time; INR: International normalized ratio; NLR: Neutrophils to lymphocytes ratio; WBC: White blood cell; NE: Neutrophil; LYM: Lymphocyte; PLT: Platelet.

Table 2 Risk factors for post-transcatheter arterial chemoembolization acute liver injury in patients with hepatitis B virus-related hepatocellular carcinoma

Clinical factor	Univariate logistic regression			Multivariate logistic regression
	OR	95%CI	P value	OR	95%CI	P value
Sex	0.710	0.291-1.731	0.451
Age	0.984	0.953-1.015	0.312
Child-Pugh stage	0.409	0.191-0.875	0.021	0.320	0.136-0.701	0.006
BCLC	0.967	0.516-1.813	0.917
Weight (kg)	1.007	0.978-1.037	0.654
Height (m)	0.663	0.009-50.362	0.852
Duration of TACE	1.004	0.987-1.021	0.671
Number of TACE	2.245	1.188-4.244	0.013	2.131	1.078-4.259	0.030
Tumor diameter (mm)	1.006	0.998-1.014	0.121
Tumor number	0.781	0.411-1.484	0.451
PNI	1.009	0.999-1.02	0.083
CONUT	0.838	0.698-1.006	0.058
GNRI	1.027	0.998-1.058	0.067
TC (mmol/L)	1.125	0.849-1.492	0.411
AFP (ng/mL)	1.000	1.000-1.000	0.429
HBsAg (log10 IU/mL)	0.934	0.753-1.158	0.532
HBeAg (log10 IU/mL)	1.437	0.743-2.78	0.281
HBV DNA (< 20) (IU/mL)	Reference	Reference	Reference	Reference	Reference	Reference
HBV DNA (20-2000) (IU/mL)	2.566	1.236-5.328	0.011	2.568	1.207-5.573	0.015
HBV DNA (> 2000) (IU/mL)	2.982	1.288-6.909	0.011	2.843	1.166-7.052	0.022
ALT (U/L)	1.004	0.992-1.017	0.468
AST (U/L)	1.000	0.994-1.006	0.998
GGT (U/L)	1.000	0.999-1.002	0.623
TBIL (μmol/L)	1.003	0.974-1.033	0.823
ALB (g/L)	1.047	0.993-1.105	0.09
PT (seconds)	0.812	0.651-1.012	0.063
INR	0.152	0.016-1.428	0.099
NLR	1.027	0.959-1.099	0.443
WBC (× 109/L)	1.048	0.928-1.184	0.449
NE (× 109/L)	1.052	0.911-1.214	0.491
LYM (× 109/L)	1.204	0.735-1.972	0.461
PLT (× 109/L)	1.000	0.996-1.004	0.845

OR: Odds ratio; CI: Confidence interval; TACE: Transcatheter arterial chemoembolization; BCLC: Barcelona clinic liver cancer staging system; PNI: Prognostic nutritional index; CONUT: Controlling nutritional status; GNRI: Geriatric nutritional risk index; TC: Total cholesterol; AFP: Alpha-fetoprotein; HBsAg: Hepatitis B surface antigens; HBeAg: Hepatitis B e antigens; HBV: Hepatitis B virus; ALT: Alanine aminotransferase; AST: Aspartate transaminase; GGT: Gamma-glutamyl transpeptidase; TBIL: Total bilirubin; ALB: Albumin; PT: Prothrombin time; INR: International normalized ratio; NLR: Neutrophils to lymphocytes ratio; WBC: White blood cell; NE: Neutrophil; LYM: Lymphocyte; PLT: Platelet.

Table 3 Adjustment models

	Model 1			Model 2			Model 3
	OR	95%CI	P value	OR	95%CI	P value	OR	95%CI	P value
HBV DNA (< 20) (IU/mL)	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
HBV DNA (20-2000) (IU/mL)	2.566	1.236-5.328	0.011	2.669	1.274-5.709	0.010	2.879	1.331-6.376	0.008
HBV DNA (> 2000) (IU/mL)	2.982	1.288-6.909	0.011	2.987	1.278-7.097	0.012	3.610	1.438-9.325	0.007
TACE	2.245	1.188-4.244	0.013	2.180	1.137-4.221	0.019	2.321	1.170-4.663	0.017
Child-Pugh stage	0.409	0.191-0.875	0.021	0.404	0.180-0.851	0.021	0.352	0.121-0.943	0.044

Model 1 was adjusted for none. Model 2 was adjusted for age, gender, weight and height. Model 3 was adjusted for age, gender, weight, height, alanine aminotransferase, aspartate transaminase, gamma-glutamyl transpeptidase, total bilirubin and albumin. OR: Odds ratio; CI: Confidence interval; TACE: Transcatheter arterial chemoembolization; HBV: Hepatitis B virus.