PURPOSE To develop and validate a scoring system using a combination of imaging and clinical parameters to predict 30-day mortality in ruptured HCC (rHCC) patients after transarterial embolization (TAE). METHODS 98 consecutive patients with rHCC who underwent abdominal CT and subsequent TAE between January 2007 and December 2016 were retrospectively reviewed. The CT scans were reviewed by two radiologists blinded to the patient outcome. Clinical parameters including serum bilirubin, albumin, INR, creatinine, and hemoglobin were recorded. Independent risk factors for 30-day mortality after TAE were identified using multivariate binary logistic regression, for development of a scoring system. The scoring system was then validated in 20 patients between January 2017 and May 2018. RESULTS In the development cohort, bilobar tumor distribution (OR = 29.6), clinical parameters of bilirubin > 2.5 mg/dL (OR = 5.9), and albumin < 30 g/L (OR = 4.1) were independent predictors for 30-day mortality. A 6-point score was derived and yielded area-under-the-receiver-operating-characteristic-curve (AUC) of 0.904. A score ≥ 4 resulted in sensitivity of 80.5% and specificity of 91.2% for 30-day mortality. In the validation cohort, AUC for 30-day mortality was 0.939. A score ≥ 4 resulted in sensitivity of 81.2% and specificity of 88.9%. In both development and validation cohorts, the proposed scoring system was better than biochemical components of Child-Pugh score and serum bilirubin to predict 30-day mortality. CONCLUSION Imaging and clinical parameters can be combined into a scoring system to accurately predict 30-day mortality after TAE in rHCC patients. The score may help identify and counsel high-risk patients.

中文翻译：

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成像和临床评分系统的开发和验证，以预测经动脉栓塞治疗的自发性破裂性肝细胞癌的早期死亡率。

目的开发并验证结合影像学和临床参数的评分系统，以预测经动脉栓塞（TAE）后破裂的HCC（rHCC）患者的30天死亡率。方法回顾性分析2007年1月至2016年12月间行腹部CT及随后TAE的98例rHCC患者。对两名患者不知情的放射线医师对CT扫描进行了检查。记录临床参数，包括血清胆红素，白蛋白，INR，肌酐和血红蛋白。使用多元二元logistic回归确定了TAE后30天死亡率的独立危险因素，以开发评分系统。然后，在2017年1月至2018年5月之间，对20位患者进行了评分系统验证。结果在开发队列中，双叶肿瘤分布（OR = 29.6），胆红素> 2.5 mg / dL（OR = 5.9）和白蛋白<30 g / L（OR = 4.1）的临床参数是30天死亡率的独立预测因子。得出6分得分，接收者操作特征曲线下的面积（AUC）为0.904。分数≥4导致30天死亡率的敏感性为80.5％，特异性为91.2％。在验证队列中，30天死亡率的AUC为0.939。得分≥4导致敏感性为81.2％和特异性为88.9％。在开发和验证队列中，拟议的评分系统均优于Child-Pugh评分和血清胆红素的生化成分，可预测30天死亡率。结论影像学和临床参数可以结合到一个评分系统中，以准确预测rHCC患者TAE后30天的死亡率。