Prognostic Factors for Mortality in Patients with Pyogenic Liver Abscess: A Systematic Review and Meta-Analysis

Pyogenic liver abscess (PLA) is an infectious and potentially fatal disease, yet no systematic reviews have comprehensively analyzed the prognostic factors associated with mortality. This study aims to identify prognostic factors associated with mortality in PLA.

Databases including PubMed, Cochrane Library, Web of Science, Europe PMC, EMBASE, Airiti Library, LILACS, Google Scholar, ClinicalTrials.gov, and ICTRP were searched from inception to July 31, 2023. Reference lists, relevant reviews, and conference abstracts were also screened. Studies investigating predictors of mortality in PLA were included, with short-term mortality as the primary outcome. Pooled estimates were calculated using a random-effects model. Subgroup, meta-regression, and sensitivity analyses were performed.

Seventy-one observational studies were included in this systematic review, and 57 studies involving 126,056 patients contributed to the meta-analyses. Pooled adjusted estimates identified significant mortality predictors: older age, female sex, malignancy, chronic kidney disease, septic shock, higher APACHE II score, gas-formation, metastatic infection, anemia, thrombocytopenia, hypoalbuminemia, hyperbilirubinemia, elevated ALT, impaired renal function, bacteremia, Escherichia coli infection, anaerobic infection, multidrug-resistant organism infection, pneumonia, and ICU admission. Fever, Klebsiella pneumoniae infection, and percutaneous drainage were associated with lower short-term mortality.

In PLA, significant mortality predictors included demographic, comorbidity, clinical, laboratory, radiographic, microbiological, and complication-related factors. Percutaneous drainage was associated with lower short-term mortality in selected patients, although this association should not be interpreted as causal, and treatment decisions should be individualized according to the underlying etiology and clinical context. Future high-quality prospective studies to identify etiology-specific prognostic factors are warranted.