Prognosis of hepatic visceral crisis in different types of cancer: a retrospective study

Introduction: Hepatic visceral crisis is a life-threatening condition that can be defined as severe hepatic dysfunction, established by clinical changes, laboratory changes (rapid increase in bilirubin > 1.5 times the upper limit of normality, in the absence of Gilbert’s syndrome or biliary tract obstruction) and rapid progression of metastatic cancer. The benefit of treatment and survival data in such conditions are lacking.

Objectives: This is an observational and retrospective study from a single oncologic center, analyzing survival rate of hospitalized patients with hepatic visceral crisis, defined as the time from the diagnosis of the visceral crisis until death or last information available; to evaluate the proportion of patients who received treatment; and to compare overall survival of those who received treatment or not.

Method: The survival curves were constructed according to the Kaplan-Meier method, and mean, median and standard error values were calculated for the overall survival of all patients and of those who received or not treatment. The survival curves were compared using the log-rank test.

Results: From August 2021 to June 2024, 106 patients were diagnosed with hepatic visceral crisis. 92.5% were female, 47.2% were between 36 and 55 years old, and 71.3% had ECOG 1 or 2. Breast cancer was the most common primary tumor. The most common symptoms were abdominal pain, nausea, vomiting and fatigue. 93.4% had other metastases sites, and the most frequent of them were bones, lymph nodes and lungs. 21 (19.8%) patients received treatment and 85 (80.2%) were not treated. The average time from diagnosis to the start of treatment was 7.6 days. Until the completion of the data analysis of this study, 100 (94.3%) deaths occurred. The median overall survival was 12 days in the total population. The survival probability at 7, 15, 30 and 60 days was, respectively, 100%, 85.7%, 57.1% and 32.7% in those who received treatment, compared to, respectively, 56.0%, 27.4%, 10.7% and 3.2% in those who did not receive treatment. The median overall survival of those who received treatment was significantly higher, 37 days, compared to 9 days of those who were not treated (HR 3.85; 2.17-6.82; p<0.001).

Conclusion: Despite the short overall survival of patients with hepatic visceral crisis, those who were treated had a longer overall survival than those who were not treated.

Corresponding author: Nathane Maduro Ramos (e-mail: nathy_mramos@hotmail.com).