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Pyogenic liver abscess. An audit of experience over the past decade
1Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Objectives:
To audit our experience in managing patients with pyogenic liver abscesses since 1984 and to identify any risk factor associated with hospital mortality.
Design:
Retrospective review.
Setting:
A tertiary referral center.
Patients:
Eighty-three patients with pyogenic liver abscesses were studied to determine demographic characteristics; clinical features, laboratory, imaging, and microbiologic findings; methods of treatment; and final outcome. The median follow-up period was 9.8 months.
Intervention:
All patients were treated with intravenous antibiotic drugs. Fifty-three patients were to image-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in 27 patients. Laparotomy was performed in 27 patients; seven of them underwent an elective operation.
Main Outcome Measure:
Hospital mortality, defined as death within the same hospital admission for management of liver abscess.
Results:
Biliary tract disease was the most frequently identifiable cause. The right lobe abscess was more frequently cryptogenic, while the left lobe abscess was more frequently related to intrahepatic stones (P < .001). The overall hospital mortality rate was 18% (15/83). On univariate analysis, female gender, rupture on presentation, emergency laparotomy, management without aspiration or catheter drainage, presence of malignancy, hyperglycemia, hyperbilirubinemia, elevated prothrombin time, and elevated activated partial thromboplastin time were significantly associated with hospital mortality. On multivariate logistic regression analysis, presence of malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time were found to be independent risk factors.
Conclusions:
Pyogenic liver abscess is still a disease with significant mortality. Early diagnosis and prompt treatment are necessary to further improve our results of management.
Insights
Pyogenic liver abscess management has a high mortality rate. Malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time are independent risk factors for hospital death in these patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Gastroenterology
Background:
- Pyogenic liver abscess (PLA) remains a significant clinical challenge.
- Despite advances in treatment, PLA is associated with considerable morbidity and mortality.
Purpose of the Study:
- To audit the experience in managing patients with pyogenic liver abscesses.
- To identify risk factors associated with hospital mortality in PLA patients.
Main Methods:
- Retrospective review of 83 patients with PLA at a tertiary referral center.
- Data collected included demographics, clinical features, laboratory, imaging, and microbiologic findings.
- Treatment modalities included intravenous antibiotics, image-guided percutaneous aspiration, percutaneous catheter drainage, and laparotomy.
Main Results:
- The overall hospital mortality rate was 18%.
- Biliary tract disease was the most common identifiable cause of PLA.
- Independent risk factors for hospital mortality identified by multivariate analysis included malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time.
Conclusions:
- Pyogenic liver abscess continues to be a disease with significant mortality.
- Early diagnosis and prompt, appropriate treatment are crucial for improving patient outcomes.
- Identifying and managing risk factors like malignancy and coagulopathy are essential.