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Clinical Features and Prognosis of Gas-Forming and Non-Gas-Forming Pyogenic Liver Abscess: A Comparative Study
Jia Zhang1,2, Yi Gao1,2,3, Zhaoqing Du1,2
1National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Abstract:
Gas-forming pyogenic liver abscess (GFPLA) accounts for up to 30% of all pyogenic liver abscess (PLA) cases. However, little is known of the differences in clinical features and prognosis between GFPLA and non-GFPLA. This retrospective study compared the clinical features and prognosis of GFPLA and non-GFPLA. Data for 392 patients with PLA treated from January 1, 2007 to December 31, 2016 were reviewed. Gas-forming pyogenic liver abscess was defined as gas in the abscess. Liver abscesses were considered non-GFPLA (n = 326) or GFPLA (n = 66). The clinical features and outcomes of patients with GFPLA were compared with that of patients without GFPLA. The groups were similar in gender ratio, age, smoking, drinking, and comorbidities. Klebsiella pneumoniae was the most common pathogenic bacteria, but the negative rate of bacterial culture of the non-GFPLA group was higher than that of the GFPLA. In etiologies, the GFPLA group had more biliary source infection and less cryptogenic infection. In addition, the GFPLA group had a higher rate of previous hepatobiliary surgery, especially biliary enteric anastomosis. Compared with the non-GFPLA group, the percentage of the GFPLA group with antibiotic agents combined with percutaneous drainage was higher, whereas the percentages given antibiotic agents alone and antibiotic agents combined with surgical drainage were lower. Patients with GFPLA had higher rates of sepsis and pleural effusion, and longer hospital stays than did non-GFPLA patients. No patient died during hospitalization. The GFPLA group had more biliary source infection and less cryptogenic infection in etiologies. Gas-forming pyogenic liver abscess is associated with past hepatobiliary surgery, especially biliary enteric anastomosis and has high rates of sepsis and long hospitalization. Thus, the patients with PLA with a history of hepatobiliary surgery should be monitored more closely in the early stage of the PLA. It needs to be recognized as a distinct clinical entity.
Insights
Gas-forming pyogenic liver abscess (GFPLA) is linked to biliary issues and prior surgery, leading to sepsis and longer hospital stays. Patients with a history of hepatobiliary surgery require closer monitoring for pyogenic liver abscess (PLA).
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Gastroenterology
Background:
- Gas-forming pyogenic liver abscess (GFPLA) constitutes a significant portion (up to 30%) of pyogenic liver abscess (PLA) cases.
- Limited understanding exists regarding the distinct clinical features and prognostic outcomes differentiating GFPLA from non-GFPLA.
- This study addresses the knowledge gap by comparing GFPLA and non-GFPLA patient cohorts.
Purpose of the Study:
- To compare the clinical characteristics and prognosis of patients with GFPLA versus non-GFPLA.
- To identify specific etiological factors and risk associations for GFPLA.
- To inform clinical management and monitoring strategies for PLA patients.
Main Methods:
- Retrospective analysis of 392 patients diagnosed with PLA between January 1, 2007, and December 31, 2016.
- Classification of liver abscesses into GFPLA (presence of gas) and non-GFPLA groups.
- Comparison of demographic data, comorbidities, etiology, bacterial cultures, treatment modalities, and clinical outcomes between the two groups.
Main Results:
- GFPLA patients exhibited a higher prevalence of biliary source infections and a history of hepatobiliary surgery, particularly biliary enteric anastomosis.
- The GFPLA group showed increased rates of sepsis and pleural effusion, alongside longer hospitalizations compared to non-GFPLA.
- While *Klebsiella pneumoniae* was common in both, GFPLA had a lower rate of negative bacterial cultures.
Conclusions:
- GFPLA is associated with specific etiologies (biliary source, prior hepatobiliary surgery) and distinct clinical outcomes (sepsis, prolonged hospitalization).
- Patients with PLA and a history of hepatobiliary surgery warrant closer early-stage monitoring.
- GFPLA should be recognized as a distinct clinical entity requiring tailored management approaches.
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