Clinical significance and risk factors of postembolization fever in patients with hepatocellular carcinoma

Table 1 Comparison of transcatheter arterial chemoembolization sessions with or without postembolization fever

Variables	Patients with PEF (n = 117)	Patients without PEF (n = 326)	P-value
Sex (M/F)	94/23	276/50	0.309
Age (yr)	62.26 ± 10.79	62.16 ± 9.98	0.971
Cause of HCC (HBV/HCV/alcohol/other)	66/25/14/11	180/44/73/25	0.088
Tumor type (well defined/poorly defined)	57/44	202/90	0.021
Portal vein thrombosis (yes/no)	9/93	39/253	0.292
Poor blood glucose control (yes/no)	29/88	116/210	0.039
Favorable tumor response	61 (52.5%)	155 (48.5%)	0.516
20-mo mortality	60 (51.7%)	172 (53.4%)	0.828
Initial WBC/mm3	5969 ± 3497	5547 ± 2535	0.194
Initial AST U/L	68.87 ± 45.49	64.11 ± 44.79	0.358
Initial ALT U/L	50.84 ± 41.58	43.89 ± 33.16	0.129
Initial CRP mg/dL	1.23 ± 1.66	0.86 ± 0.93	0.116
Initial AFP IU/mL	2778 ± 8014	2600 ± 8656	0.857
Child-Pugh score	5.66 ± 0.72	5.77 ± 0.97	0.296
TNM stage	1.95 ± 1.05	1.83 ± 1.07	0.305
Interval from 1st TACE to 2nd TACE (d)	157 ± 225	180 ± 270	0.412
Total TACE sessions	1.48 ± 3.45	4.02 ± 3.62	0.230

TACE: Transcatheter arterial chemoembolization; AFP: α-fetoprotein; PEF: Postembolization fever; TNM: Tumor, node, metastases; CRP: C-reactive protein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HCC: Hepatocellular carcinoma; M: Male; F: Female; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Multivariate and univariate analysis for postembolization fever, 20-mo mortality, and tumor progression-free survival

Variables	HR	95%CI	P-value
Multivariate analysis1
ALT value after TACE	1.002	1.00-1.005	< 0.05
Lipiodol dose (< 7 mL)	0.539	0.329-0.881	< 0.05
Univariate analysis2
Poor BS control	2.673	1.77-4.034	< 0.01
Portal vein thrombosis	3.048	1.536-6.06	< 0.01
Poor CT response	2.638	1.785-3.891	< 0.01
Initial AST	1.006	1.001-1.011	< 0.05
Initial CRP	1.348	1.011-1.796	< 0.05
Tumor size	1.31	1.198-1.433	< 0.01
TNM	1.555	1.26-1.92	< 0.01
Lipiodol dose	1.12	1.058-1.185	< 0.01
Multivariate analysis3
Tumor size	1.252	1.108-1.414	< 0.01
Poor BS control	2.442	1.310-4.55	< 0.01
Portal vein thrombosis	3.344	1.021-10.98	< 0.05
Cox regression analysis4
Poor CT response after TACE	0.302	0.192-0.765	< 0.0
Lipiodol dose (≥ 7 mL)	0.494	0.279-0.874	< 0.05

¹Predictors for postembolization fever;

²Risk factors for 20-mo mortality;

³Predictors for 20-mo mortality;

⁴Predictors for tumor progression-free survival. HR: Hazard ratio; CRP: C-reactive protein; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TNM: Tumor, node, metastases; TACE: Transcatheter arterial chemoembolization; BS: Base of support.