Initial presentations and final outcomes of primary pyogenic liver abscess: a cross-sectional study

Abstract

BackgroundAlthough pyogenic liver abscess (PPLA) fatalities are decreasing owing to early diagnosis and effective treatments, PPLA-associated complications still exist. The purpose of this study was to analyze the characteristic features of initial presentations and final outcomes of PPLA caused by different pathogens.MethodsThis retrospective study collected and analyzed information regarding initial presentations and final outcomes in patients diagnosed with PPLA at admitted at Changhua Christian Hospital from January 1 to December 31, 2010.ResultsDuring the study period, we analyzed the records of a total of 134 patients with documented PPLA. There were no significant causative pathogen-related differences in symptoms at initial presentation. Compared with the survivor group, patients in the mortality group were characterized by male gender (p < 0.001), malignancy (p < 0.001), respiratory distress (p =0.007), low blood pressure (p = 0.024), jaundice (p = < 0.001), rupture of liver abscess (p < 0.001), endophthalmitis (p = 0.003), and multiple organ failure (p < 0.001). No patients received liver transplantation or were diagnosed with HIV during the study period. According to univariate logistic regression analysis, gender (OR = 1.185, 95% CI: 0.284–11.130, p = 0.006), malignancy (OR = 2.067, 95% CI: 1.174–13.130, p = 0.004), respiratory distress (OR = 1.667, 95% CI: 1.164–14.210, p = 0.006), low blood pressure (OR = 2.167, 95% CI: 2.104–13.150, p = 0.003), jaundice (OR = 1.9, 95% CI: 1.246–3.297, p = 0.008), rupture of liver abscess (OR = 5.167, 95% CI: 2.194–23.150, p = 0.003), endophthalmitis (OR = 2.167, 95% CI: 1.234–13.140, p = 0.005), and multiple organ failure (OR = 3.067, 95% CI: 1.184–15.150, p = 0.001) differed significantly between the mortality and survivor groups.ConclusionAlthough the initial presentations of PPLA caused by different pathogens were similar, there were significant differences in mortality in cases involving: (1) male patients, (2) malignancy, (3) initial respiratory distress, (4) initial low blood pressure, (5) jaundice, (6) rupture of liver abscess, (7) endophthalmitis, , and (8) multiple organ failure. We strongly recommend using a severity score of the disease to determine the risk of mortality for each patient with PPLA. In order to prevent complications and reduce mortality, more attention must be paid to high-risk PPLA patients.

Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes

“…This is consistent with the fact that every recurrence was ipsilateral to the first event. Mortality in our series was 7.8%, similar to that reported in the 16,17,22,27,28 studies have analyzed risk factors for mortality, including the presence of active oncologic 17,22,26,29,30 renal failure, 17,18,22,26,29 hiperbilirrubinemia, 17,29,30 hypoalbuminemia, 17,29 MDRB isolation 17,29 and multiple abscesses 17,22,26,29,30 with inconsistent results. In our series, factors associated with mortality in univariate analysis included biliary disease, multiple abscesses, the bilateral liver involvement, and bilirrubinemia >5 mg/dL.…”

“…PD have been shown to be as effective as open surgical therapy and has become the standard of care in patients with abscesses >3 cm [19][20][21] with case fatality rates of up 8%. 22,23 Still, there is a role for surgical drainage if PD fails, especially in cases with large multilocular abscesses. 12 Even so, these situations can be frequently manage by ''re-drainage'' or improvement of existing drainage systems.…”

Hepatic abscess: a rare complication after liver transplant

“…Limited information exists as to the treatment of hepatic abscess after liver transplantation, with only two large studies and a few case reports . Conversely, there is a plethora of available data regarding abscess treatment in native livers …”

The AST/ALT (De Ritis) Ratio Independently Predicts Adverse Outcomes in Patients with Pyogenic Liver Abscess

“…Our study also noticed that AST/ALT had larger AUCs in contrast to AST and ALT in unfavorable results and mortality estimation (0.821 for death and 0.690 for all the unfavorable results). Some existing research showed other prognosis significance in terms of PLA [24][25][26], covering pleural effusions, concomitant malignancy, multiple abscesses, liver abscess of biliary origin, hemoglobin levels, low albumin, promoted BUN and serum creatinine, and older age.…”