Time and departments of consultation affecting pyogenic liver abscess diagnosis

This article surveys the time from symptom onset to consultation and diagnosis of pyogenic (bacterial) liver abscess patients, depicts first specialized outpatient visit and hospitalization departments, and analyzes influencing factors to aid early diagnosis.

Patients diagnosed with pyogenic liver abscess from 2013 to 2023 were studied through retrospective medical record review.

191 patients (63.9% male, age 64.8 ± 13.8 years) were included. Patients with pyogenic liver abscess may present with respiratory (33%), neurological (32%), urinary (17%), and cardiovascular (10%) manifestations. Median time from symptom onset to initial medical consultation, initial consultation to diagnosis, and symptom onset to diagnosis were 2 days (IQR 1, 4), 4 days (IQR 2,7), and 7 days (IQR 4, 11), respectively; 16% of patients initially sought specialized outpatient visit in endocrinology, neurology, cardiology, nephrology, and pulmonology departments. Of these, 83% were hospitalized with varied initial diagnoses including diabetes, cerebral infarction, acute coronary syndrome, pneumonia, and acute pyelonephritis. Factors influencing the time to consultation and diagnosis included high fever (Tmax >39°C), emaciation, nausea, differences in initial hospitalization and diagnostic departments, low albumin (<30g/L), and thrombocytopenia.

The non-specific and sometimes misleading symptoms of pyogenic liver abscess leads patients to seek care in inappropriate specialized outpatient departments, resulting in erroneous preliminary diagnoses by physicians and consequently delaying the correct diagnosis. Clinicians should conduct thorough and careful inquiries and physical examinations, choose appropriate and effective diagnostic modalities, and make accurate diagnoses as early as possible.