Prognostic factors for pyogenic abscess of the liver.
BACKGROUND
Percutaneous drainage and antibiotics for pyogenic abscess are well established therapeutic modalities. However, the mortality rate for hepatic abscess of liver remains high.


METHODS
Three hundred fifty-two cases of pyogenic hepatic abscesses were studied to evaluate prognostic factors.


RESULTS
Using univariate analysis, the following factors were associated with a high mortality rate: patient age, gas-forming abscess, rupture of abscess, bilobe involvement, clinical sepsis, bilirubin (more than 2 mg per dL), blood urea nitrogen (more than 20 mg per dL), serum creatinine (more than 2 mg per dL), aspartate aminotransferase (more than 100 U per L), and albumin (less than 2.5 gm per dL). Using multivariate analysis, the following were independent significant factors in predicting mortality: patient age (more than 60 years), blood urea nitrogen (greater than 20 mg per dL), serum creatinine (greater than 2 mg per dL), total bilirubin (greater than 2 mg per dL), and albumin (less than 2.5 gm per dL).


CONCLUSIONS
Systemic effects of hepatic abscess with sepsis and multiple organ failure were significant factors in predicting mortality. Local findings, such as rupture of the abscesses, multiple abscesses, and gas-forming abscesses, were not independent factors. Percutaneous drainage is always considered if the condition of the patient can not be improved with antibiotic therapy. Operative treatment is indicated if the patient is unresponsive to medical treatment and percutaneous drainage or if the patient has complications of biliary tract stone or rupture of the abscess.
Chou
F F
FF
Department of Surgery, Chang Gung Medical College, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Republic of China.
Sheen-Chen
S M
SM
Chen
Y S
YS
Chen
M C
MC
Chen
F C
FC
Tai
D I
DI
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013492:Suppuration / Q000150:complications