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Objective:
This study aimed to estimate the incidence of infectious complications after percutaneous thermal ablation of liver malignancies and develop prediction models.

Materials and Methods:
This single-center retrospective study reviewed the data of 3167 patients who underwent 7545 procedures of percutaneous ultrasound-guided thermal ablation 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 without infection was randomly selected, following a nested case-control design. Independent factors of overall and hepatobiliary infection were investigated by multivariable logistic regression.

Results:
Eighty patients (median age, 59 years; IQR, 51 - 68 years; 64 men) developed infectious complications after 80 procedures of ablation; the incidence was 1.1% (80/7545). Of those with infection, 18% (14/80) were severe, and 10% (8/80) died as a result. Independent risk factors for overall infectious complication included prior biliary intervention (odds ratio [OR], 18.6; 95% CI: 4, 86; <em>P</em> ? .001), prior transarterial chemoembolization (OR, 2.4; 95% CI: 1.0, 5.8; <em>P</em> = .045), the largest tumor size (OR, 1.9; 95% CI: 1.3, 2.8; <em>P</em> = .002); on this basis, the subcapsular location was an additional risk factor of hepatobiliary infection. Prediction models for overall and hepatobiliary infection had areas-under-the-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 of 0.63 and 0.65; <em>P</em> = .01 and <em>P</em> = .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.