Fever and infectious complications after percutaneous acetic acid injection therapy for hepatocellular carcinoma: incidence and risk factor analysis.

Abstract

BACKGROUND:

Ultrasound-guided percutaneous acetic acid injection (PAI) therapy is effective for hepatocellular carcinoma (HCC). Posttreatment fever (>37.5 degrees C) may occur owing to acetic acid-induced tumor necrosis, but its incidence and clinical significance are not clear.

METHODS:

A total of 402 treatment sessions in 127 consecutive patients undergoing PAI for HCC were prospectively studied. The incidence and risk factors associated with post-PAI fever were analyzed.

RESULTS:

There were 37 (9.2%) episodes of fever occurring in 29 HCC patients after PAI. Patients who developed fever more often had large-sized (3.5+/-1.3 cm vs. 2.7+/-1.2 cm, P=0.0002) tumor and a higher injection volume (2.6+/-0.1 mL vs. 2.2+/-0.1 mL, P=0.001) of acetic acid compared with those without fever. Multivariate logistic regression analysis showed that tumor size >3 cm was the only significant predictor associated with occurrence of posttreatment fever (odds ratio: 4.4, 95% confidence interval: 2.2-8.9, P<0.001). Three patients, all of whom had HCC diameter >3 cm, had 4 episodes of bacteremia after treatment; one of them developed liver abscess that required percutaneous drainage.

CONCLUSIONS:

Fever after PAI is not an uncommon event. Patients with tumor size >3 cm have a higher risk of posttreatment fever. Bacteremia and significant infectious complication could occur in a minority of patients. Prophylactic antibiotics before treatment may be necessary for high-risk patients.

• Authors: Teh-Ia Huo, Yi-Hsiang Huang, Hui-Chun Huang, Jaw-Ching Wu, Pui-Ching Lee, Full-Young Chang, Shou-Dong Lee
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 40 Issue 7 Pg. 639-42 (Aug 2006) ISSN: 0192-0790 [Print] United States
• PMID: 16917410 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Acetic Acid

Topics

• Abscess (chemically induced)
• Acetic Acid (administration & dosage)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bacteremia (chemically induced)
• Carcinoma, Hepatocellular (drug therapy)
• Child
• Female
• Fever (chemically induced)
• Humans
• Injections, Intralesional
• Liver Neoplasms (drug therapy)
• Logistic Models
• Male
• Middle Aged
• Prospective Studies
• Risk Factors