Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess

Abstract

Background/aims This study aimed to investigate the factors associated with prolonged hospital stay and in-hospital mortality in patients with pyogenic liver abscess. Methods We retrospectively reviewed data from patients with pyogenic liver abscess who were admitted between 2005 and 2018 at three tertiary hospitals in Jeonbuk province, South Korea. Prolonged hospital stay was defined as a duration of hospital admission of more than 21 days. Results A total of 648 patients (406 men and 242 women) diagnosed with pyogenic liver abscess were enrolled in the study. The mean maximal diameter of the liver abscess was 5.4 ± 2.6 cm, and 74.9% of the lesions were single. The three groups were divided according to the maximal diameter of the abscess. Laboratory parameters indicated a more severe inflammatory state and higher incidence of complications and extrahepatic manifestations with increasing abscess size. Rates of percutaneous catheter drainage (PCD) insertion, multiple PCD drainage, and salvage procedures as well as duration of drainage were also higher in the large liver abscess group. Of note, the duration of hospitalization and in-hospital mortality were significantly higher in the large hepatic abscess group. A multivariate analysis revealed that underlying diabetes mellitus, hypoalbuminemia, high baseline high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and large maximal abscess diameter were independent factors associated with prolonged hospital stay. Regarding in-hospital mortality, acute kidney injury at admission and maximal diameter of the abscess were independent factors associated with in-hospital mortality. Conclusions A large maximal diameter of the liver abscess at admission indicated prolonged hospitalization and poor prognosis. More aggressive treatment strategies with careful monitoring are warranted in patients with large liver abscesses.

Early percutaneous catheter drainage in protecting against prolonged fever among patients with pyogenic liver abscess: a retrospective cohort study

“…Though E. coli was less common than K. pneumoniae in PLA, it showed higher rate of antibiotic resistance with 42.9% producing ESBL. These findings were similar to previous studies in Asian countries [ 25 , 26 ]. The bacterial spectrum may be useful in empiric antibiotic decision making.…”

Multidisciplinary out-patient treatment with monitoring by telemedicine for a large-volume multifocal pyogenic liver abscess in times of the pandemic

“…[1,12,17] In their randomised trial, Lee et al showed that particular predictors for protracted hospital admissions were: diabetes mellitus; arterial hypertension; positive identification of bacteria in culture; and reduced Hb values at the time of diagnosis Independent risk factors identified as part of the trial also included an abscess diameter of >5 cm, and a significantly elevated CRP. [15] If these factors were to be considered for the case we have presented here, then the initially poor prognosis for our case would have been associated with an indication for an in-patient hospital stay >14 days as well as surgical treatment of the liver abscess with percutaneous drainage. [9,18] There are no data that recommend or consider purely conservative therapy possible for large or multifocal liver abscesses.…”

“…Mortality increases with increasing size of the abscess, and with decreasing Hb values. [14,15] Case A 50-year-old male patient was referred to our clinic with the diagnosis of "liver tumour of unclear type". On examination the patient was obese (115kg; 187cm; BMI: 32.9), and had presented to the doctor due to a deterioration in his condition.…”

Multidisciplinary out‐patient treatment with monitoring by telemedicine for a large‐volume multifocal pyogenic liver abscess in times of the pandemic

“…In their randomized trial, Lee et al showed that particular predictors for protracted hospital admissions were as follows: diabetes mellitus; arterial hypertension; positive identification of bacteria in culture; and reduced Hb values at the time of diagnosis. Independent risk factors identified as part of the trial also included an abscess diameter of >5 cm and a significantly elevated CRP 15 . If these factors were to be considered for the case we have presented here, then the initially poor prognosis for our case would have been associated with an indication for an in‐patient hospital stay >14 days as well as surgical treatment for the liver abscess with percutaneous drainage 9,18 …”

“…Liver abscesses with a diameter of up to 5 cm can be treated conservatively using antibiotics alone with a very good prognosis; larger abscesses, by contrast, should be additionally treated using percutaneous drainage or surgery. Mortality increases with increasing size of the abscess and with decreasing Hb values 14,15 …”