3:09 PM Abstract No. 172 The McALBI score: a simplified predictive model for postprocedure hepatic dysfunction following microwave ablation of hepatocellular carcinoma in cirrhotic patients

Abstract

To determine the risk factors and create a simplified predictive model for postprocedure hepatic dysfunction following microwave ablation (MWA) of hepatocellular carcinoma (HCC) in cirrhotic patients. An IRB-approved retrospective review of all MWA procedures for HCC in cirrhotic patients at a single academic institution between May 2011 and September 2015 was performed. Preprocedure demographic and laboratory data was collected, as well as intraprocedure data regarding extent of ablation performed. Clinical and laboratory review was undertaken to detect the development of postprocedure hepatic dysfunction or liver failure in the 90 days following MWA. Postprocedure hepatic dysfunction was defined as any one of the following: increase in Child-Pugh score by 2 or more; increase in total bilirubin by 2 or more; or new ascites or encephalopathy. Postprocedure liver failure was defined as all three of the following: increase in bilirubin to 5 or greater; increase in international normalized ratio (INR) to 1.5 or greater; and development of ascites or encephalopathy. Multiple regression analysis was performed based on preprocedure and intraprocedure parameters to create a predictive model for development of hepatic dysfunction. 291 MWA procedures in 243 patients had complete preprocedure, intraprocedure, and postprocedure data. 37 procedures (12.7%) resulted in postprocedure hepatic dysfunction, which was often transient, and 4 procedures (1.4%) resulted in liver failure. Multiple regression analysis showed that a simple predictive tool, obtained by subtracting the total bilirubin from the albumin (McALBI score), accurately predicted the presence or absence of postprocedure hepatic dysfunction. Hepatic dysfunction occurred in 36/180 (20%) procedures with a McALBI score of 3 or lower, but in only 1/110 (0.9%) procedures with a McALBI score greater than 3. Postprocedure hepatic dysfunction occurs in 12.7% of cirrhotic patients following MWA for HCC, and can be predicted using a novel and simple measurement of albumin minus total bilirubin (McALBI score). Hepatic dysfunction is extremely unlikely in the setting of a McALBI score greater than 3.