From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China (X.L., Y.Z., X.W., L.Z., G.H., M.L., B.Z., X.X., M.X.); and Department of Medical Ultrasonics, Guangzhou 11th People's Hospital, Guangzhou, People's Republic of China (H.Z.).
Radiology. 2023 Aug;308(2):e223091. doi: 10.1148/radiol.223091.
Background Infectious complications after percutaneous thermal ablation are seldom discussed, but better understanding of risk factors and early prediction is critical. Purpose To estimate the incidence of infectious complications after percutaneous thermal ablation of liver malignancies and to develop prediction models. Materials and Methods This single-center retrospective study reviewed the data of 3167 patients who underwent 7545 percutaneous US-guided thermal ablation procedures of liver malignancies between January 2010 and January 2022. All procedures with infectious complications were included as the case group. For each case, one treatment date-matched control subject without infection was randomly selected following a nested case-control design. Independent factors of overall and hepatobiliary infection were investigated with multivariable logistic regression. Results A total of 80 patients (median age, 59 years; IQR, 51-68 years; 64 men, 16 women) developed infectious complications after 80 ablation procedures; the incidence was 1.1% (80 of 7545 procedures). Of those with infection, 18% (14 of 80 patients) were severe, and 10% (eight of 80 patients) died as a result. Independent risk factors for overall infectious complication included prior biliary intervention (odds ratio [OR], 18.6; 95% CI: 4, 86; < .001), prior transarterial chemoembolization (TACE) (OR, 2.4; 95% CI: 1.0, 5.8; = .045), and the largest tumor size (OR, 1.9; 95% CI: 1.3, 2.8; = .002); on this basis, subcapsular location was an additional risk factor of hepatobiliary infection. Prediction models for overall and hepatobiliary infection had an area under the receiver operating characteristics curve (AUC) of 0.77 and 0.82, respectively, both of which showed better AUC compared with the models, including prior biliary intervention alone (AUC = 0.63 and 0.65, respectively; = .01 and = .005, respectively). Conclusion Infectious complications after percutaneous thermal ablation of liver malignancies were uncommon but potentially fatal. Independent predictors were prior biliary intervention, prior transarterial chemoembolization, and the largest tumor size. © RSNA, 2023 See also the editorial by Ben-Arie and Sosna in this issue.
背景 经皮热消融术后感染并发症很少被讨论，但更好地了解危险因素和早期预测至关重要。
目的 评估经皮热消融治疗肝恶性肿瘤后感染并发症的发生率，并建立预测模型。
材料与方法 本单中心回顾性研究回顾性分析了 2010 年 1 月至 2022 年 1 月期间 3167 例接受 7545 例经皮超声引导热消融治疗肝恶性肿瘤患者的数据。所有发生感染并发症的患者均纳入病例组。采用巢式病例对照设计，每例感染患者随机选择 1 例治疗日期匹配的无感染对照患者。采用多变量逻辑回归分析感染的总发生率和肝胆感染的独立因素。
结果 80 例患者（中位年龄 59 岁；IQR，51-68 岁；64 例男性，16 例女性）在 80 次消融术后发生感染并发症；发生率为 1.1%（80/7545 例）。感染患者中 18%（14/80 例）为严重感染，10%（8/80 例）死亡。感染的独立危险因素包括既往胆道介入（比值比[OR]，18.6；95%CI：4，86；<.001）、既往经动脉化疗栓塞（TACE）（OR，2.4；95%CI：1.0，5.8；=.045）和最大肿瘤大小（OR，1.9；95%CI：1.3，2.8；=.002）；在此基础上，包膜下位置是肝胆感染的另一个危险因素。总体感染和肝胆感染的预测模型的受试者工作特征曲线（AUC）下面积分别为 0.77 和 0.82，均优于包括单纯既往胆道介入的模型（AUC=0.63 和 0.65，分别为=.01 和=.005）。
结论 经皮热消融治疗肝恶性肿瘤后感染并发症并不常见，但可能致命。独立预测因素为既往胆道介入、既往 TACE 和最大肿瘤大小。
