背景：经皮热消融术后的感染并发症很少被讨论，但对危险因素和早期预测的更好理解至关重要。目的：评估肝恶性肿瘤经皮热消融术后感染并发症的发生率并建立预测模型。材料和方法：本单中心回顾性研究回顾了2010年1月至2022年1月期间进行了7545例肝恶性肿瘤经皮US引导热消融术的3167名患者的数据。所有有感染并发症的术后都被包括在案例组中。为每个案例选择一个与治疗日期相匹配但没有感染的对照组受试者，采用巢式病例-对照设计。通过多因素logistic回归分析无菌和肝胆感染的独立因素。结果：共有80名患者（年龄中位数为59岁；IQR，51-68岁；男性64例，女性16例）在80次消融手术后发生感染并发症；发生率为1.1%（80/7545）。其中，14例（18%）感染为重度感染，8例（10%）患者因此而死亡。整体感染并发症的独立危险因素包括术前胆道介入（比值比[OR]为18.6，95%可信区间[CI]为4-86，P < .001）、术前经动脉化学栓塞栓塞（OR为2.4，95% CI为1.0-5.8，P = .045）和最大肿瘤大小（OR为1.9，95% CI为1.3-2.8，P = .002）；在此基础上，肝胆感染的额外危险因素是包膜下位置。整体感染和肝胆感染的预测模型ROC曲线下面积（AUC）分别为0.77和0.82，两者较仅包括术前胆道介入的模型（AUC分别为0.63和0.65，P = .01和P = .005）具有更好的AUC。结论：经皮热消融术后的感染并发症不常见但有潜在致命风险。独立预测因子为术前胆道介入、术前经动脉化学栓塞栓塞和最大肿瘤大小。© RSNA，2023。为本文提供的补充材料可供参考。此外，参见本期Ben-Arrie和Sosna的社论。

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; P < .001), prior transarterial chemoembolization (TACE) (OR, 2.4; 95% CI: 1.0, 5.8; P = .045), and the largest tumor size (OR, 1.9; 95% CI: 1.3, 2.8; P = .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; P = .01 and P = .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 Supplemental material is available for this article. See also the editorial by Ben-Arie and Sosna in this issue.