title: The comparison of clinical course and results of treatment between gas-forming and non-gas-forming pyogenic liver abscess.
abstract: OBJECTIVE
  To study and review the clinical manifestations, courses, and results of treatment in 83 cases of verified gas-forming pyogenic liver abscess.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Both primary and referral hospital care.
  
  
  METHODS
  Four hundred twenty-four patients with clinical diagnosis of pyogenic liver abscess were enrolled in the study. Eighty-three patients had gas-forming abscesses and 341 had non-gas-forming abscesses. The clinical manifestations, duration of symptoms, incidence of septic shock, laboratory findings, concurrent diabetes mellitus, cause of abscess, size of abscess, and results of treatment were recorded.
  
  
  METHODS
  A chi 2 test for qualitative data and Student's test for quantitative data.
  
  
  RESULTS
  Duration of symptoms were shorter (mean +/- SD, 5.2 +/- 5.3 vs 7.6 +/- 10 days) (P < .005) and the incidence of septic shock was higher in the gas-forming than in the non-gas-forming group (32.5% vs 11.7%) (P < .01). Laboratory findings revealed high levels of blood glucose, aspartate aminotransferase, alkaline phosphatase, and serum urea nitrogen in the gas-forming group. The size of abscess was usually bigger (> 5 cm) in this group. In the gas-forming group, 71 patients (85.5%) had diabetes mellitus and 65 patients (78.3%) had conditions of cryptogenic origin. Klebsiella pneumoniae was the main bacteria, in blood culture and liver aspirates, especially in gas-forming liver abscess. Medical treatment and/or aspiration carried a high mortality rate (44.4%) in the gas-forming group; also, the overall mortality rate was higher in this group than in the non-gas-forming group (27.7% vs 14.4%) (P < .01).
  
  
  CONCLUSIONS
  The gas-forming liver abscess may be a disease of wide spectrum of severity and may run a fulminating course. Strong antibiotics with early adequate drainage are mandatory. Surgery should not be delayed if necessary.
authors.affiliation: Department of Surgery, Chang Gung Medical School, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Republic of China.
authors.forename: F F
authors.initials: FF
authors.lastname: Chou
authors.forename: S M
authors.initials: SM
authors.lastname: Sheen-Chen
authors.forename: Y S
authors.initials: YS
authors.lastname: Chen
authors.forename: T Y
authors.initials: TY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005740:Gases; D006801:Humans; D008100:Liver Abscess / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged
chemical_list: D005740:Gases