Diabetes Metab J. 2024;48(2):302-311.

Impact of Hyperglycemia on Complication and Mortality after Transarterial Chemoembolization for Hepatocellular Carcinoma.

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제1저자 문선준, 안창호 · 교신저자 조영민, 신주영

PMID 38171144 PMC10995496 DOI 10.4093/dmj.2022.0255 IF 8.2 내분비대사내과

소속 (4)

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

Abstract

BACKGRUOUND Current guidelines regarding periprocedural glycemic control to prevent complications after nonsurgical invasive procedures are insufficient. Transarterial chemoembolization (TACE) is a widely used treatment for unresectable hepatocellular carcinoma. We aimed to investigate the association between diabetes mellitus (DM) per se and the degree of hyperglycemia with postprocedural complications after TACE.

METHODS A total of 22,159 TACE procedures performed at Seoul National University Hospital from 2005 to 2018 were retrospectively analyzed. The associations between DM, preprocedural glycosylated hemoglobin (HbA1c), and periprocedural average glucose with postprocedural adverse outcomes were evaluated. The primary outcome was occurrence of postprocedural bacteremia. Secondary outcomes were acute kidney injury (AKI), delayed discharge and death within 14 days. Periprocedural glucose was averaged over 3 days: the day of, before, and after the TACE procedures. Propensity score matching was applied for procedures between patients with or without DM.

RESULTS Periprocedural average glucose was significantly associated with bacteremia (adjusted odds ratio per 50 mg/dL of glucose, 1.233; 95% confidence interval, 1.071 to 1.420; P=0.004), AKI, delayed discharge, and death within 14 days. DM per se was only associated with bacteremia and AKI. Preprocedural HbA1c was associated with delayed discharge. Average glucose levels above 202 and 181 mg/dL were associated with a significantly higher risk of bacteremia and AKI, respectively, than glucose levels of 126 mg/dL or lower.

CONCLUSION Periprocedural average glucose, but not HbA1c, was associated with adverse outcomes after TACE, which is a nonsurgical invasive procedure. This suggests the importance of periprocedural glycemic control to reduce postprocedural complications.

Keywords

Carcinoma, hepatocellularChemoembolization, therapeuticComplicationsHyperglycemiaMortality

Figures

**Fig. 1.** Case inclusion flow chart. Age, sex, body mass index (BMI), Model for End-Stage Liver Disease (MELD) score, estimated glomerular filtration rate, year of transarterial chemoembolization (TACE), and order of TACE were matched using the 1:1 nearest method. HCC, hepatocellular carcinoma; SNUH, Seoul National University Hospital; ER, emergency department; ESRD, endstage renal disease; AFP, alpha fetoprotein; DM, diabetes mellitus; HbA1c, glycosylated hemoglobin.

**Fig. 2.** Association of diabetes, glycosylated hemoglobin (HbA1c), and periprocedural glucose with postprocedural adverse outcomes. Adjusted odds ratios of (A) diabetes mellitus (DM), (B) HbA1c (per 1%), and (C) periprocedural average glucose (per 50 mg/dL) for bacteremia, acute kidney injury (AKI), delayed discharge, and death within 14 days. Age, sex, body mass index, Model for End-Stage Liver Disease (MELD) score, estimated glomerular filtration rate, serum alpha fetoprotein, year of transarterial chemoembolization (TACE), and order of TACE were adjusted as covariates. CI, confidence interval.

**Fig. 3.** Probability of periprocedural adverse outcomes versus periprocedural glucose and glycosylated hemoglobin (HbA1c). The probabilities (solid line) and 95% confidence interval (dotted line) of (A, E) bacteremia, (B, F) acute kidney injury (AKI), (C, G) delayed discharge, and (D, H) death within 14 days versus continuous levels of periprocedural average glucose and HbA1c. A dotted straight line parallel to the x axis is the probability of each adverse outcome at a level of periprocedural average glucose of 126 mg/dL and HbA1c of 6.5% (48 mmol/mol). Age, sex, body mass index, Model for End-Stage Liver Disease (MELD) score, estimated glomerular filtration rate, serum alpha fetoprotein, year of transarterial chemoembolization (TACE), and order of TACE were adjusted as covariates.

**Fig. 4.** Association of periprocedural adverse outcomes with preprocedural and postprocedural average glucose levels. Adjusted odds ratios of (A) preprocedural average glucose (per 50 mg/dL) and (B) postprocedural average glucose (per 50 mg/dL) for bacteremia, acute kidney injury (AKI), delayed discharge, and death within 14 days. Age, sex, body mass index, Model for End-Stage Liver Disease (MELD) score, estimated glomerular filtration rate, serum alpha fetoprotein, year of transarterial chemoembolization (TACE), and order of TACE were adjusted as covariates. CI, confidence interval.

그림 출처: PubMed Central 공개 논문 (PMC10995496)

Conflict of interest statement

CONFLICTS OF INTEREST . No potential conflict of interest relevant to this article was reported.

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