Risk factors for hepatic failure after transarterial chemoembolization in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Hepatic failure is a potentially fatal complication in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). However, there is a lack of clear predictive factors for hepatic failure after TACE in HCC patients. This study aimed to identify all available data and determine the risk factors associated with hepatic failure after TACE in HCC patients. A systematic review and meta-analysis included 9 studies with a total of 1654 patients. The results showed that factors significantly associated with hepatic failure after TACE included female sex [odds ratio (OR) = 1.38, 95% confidence interval (CI) 1.09-1.75], low albumin [mean difference (MD) = -0.34, 95% CI: -0.61 to -0.07] and platelet (MD = -15.84, 95% CI: -23.62 to -8.05), high total bilirubin (MD = 0.64, 95% CI: 0.24-1.04), aspartate aminotransferase (MD = 25.45, 95% CI: 3.88-47.01), alanine aminotransferase (MD = 8.79, 95% CI: 0.15-17.42), international normalized ratio (MD = 0.18, 95% CI: 0.03-0.32), alpha-fetoprotein (MD = 74.05, 95% CI: 64.12-83.99), Model for End-Stage Liver Disease (MD = 3.41, 95% CI: 0.95-5.87), and high Child-Turcotte-Pugh class (OR = 4.66, 95% CI: 1.52-14.28), larger tumor size (MD = 7.75, 95% CI: 6.87-8.63), presence of portal vein thrombosis (OR = 1.78, 95% CI: 1.19-2.67), and high indocyanine green retention test after 15 min (ICG-R15 test) (MD = 16.75, 95% CI: 13.16-20.34). These findings may help clinicians with treatment planning, patient counseling, and postprocedural monitoring.