Older age as a poor prognostic sign in patients with pyogenic liver abscess

Previous studies have focused on the role of age as a prognostic factor in pyogenic liver abscess (PLA) and results have been controversial. The aim of this study was to compare the clinical characteristics of PLA in elderly (age ≥65 years) and non-elderly patients in order to identify any differences so that an early diagnosis can be made and appropriate therapeutic measures can be instituted promptly.

We performed a retrospective analysis of patients with PLA. The demographic and clinical features, laboratory and imaging findings, management, and clinical outcomes of elderly and non-elderly patients were studied.

Between January 2000 and December 2010 inclusive, 319 patients had PLA; 168 (52.7%) were aged ≥65 years. Elderly patients were more likely to have acute onset of symptoms (4.2 vs. 5.3 days, p < 0.04), co-morbidities, and respiratory symptoms (25.6% vs. 14.6%, p < 0.01). They also had lower serum bilirubin (28.1 vs. 37.1 μmol/l, p < 0.04), alanine aminotransferase (71.6 vs. 94.3 U/l, p < 0.02), and glycosylated hemoglobin (8.1% vs. 10%, p < 0.01), and more often had septal lobulation (64.3% vs. 54.3%, p < 0.04) and pneumobilia (10.1% vs. 4.0%, p < 0.02). Moreover, they required a longer duration of oral antibiotics (2.63 vs. 2.05 weeks, p < 0.01) and had a higher incidence of acute coronary syndrome during the illness (7.7% vs. 2.0%, p < 0.01). Gram-negative organisms were the dominant isolates in both groups, but the elderly had a lower incidence of Gram-positive infections (5.4% vs. 13.2%, p < 0.01). Lastly, old age was associated with local recurrence of PLA (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.0-9.7, p < 0.04) and mortality (OR 3.17, 95% CI 1.25-8.04, p = 0.015).

Elderly patients tend to have a more atypical presentation in PLA, for which clinicians should be on high alert. We found older age to be associated with a higher recurrence of PLA and a higher mortality rate.