Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care.
OBJECTIVE
Despite improvements in diagnosis and treatment, pyogenic liver abscess remains a life-threatening disease. This study evaluated clinical outcome and prognostic factors in patients with pyogenic liver abscess admitted to the intensive care unit.


METHODS
Retrospective study.


METHODS
Medical and surgical intensive care unit in a 1,700-bed university-based hospital.


METHODS
Four hundred and thirty-six adult patients (> or = 18 yrs) with a diagnosis of pyogenic liver abscess were reviewed, and 72 patients with pyogenic liver abscess who required intensive care were enrolled in the study.


METHODS
None.


RESULTS
Twenty of 72 enrolled patients died, yielding an intensive care unit mortality rate of 28%. The most common underlying disease was diabetes mellitus (51%), and the most common microorganism was Klebsiella pneumoniae (74%). Compared with survivors, nonsurvivors had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (22.2 +/- 9 vs. 13.7 +/- 6, p < .001), higher serum creatinine levels (2.9 +/- 2 vs. 1.9 +/- 2 mg/dL, p = .02), and longer prothrombin times (21 +/- 5 vs. 16 +/- 5 s, p = .01) on the first day of intensive care unit admission. In addition, factors associated with mortality included inadequate antibiotic therapy (p = .026), septic shock (p = .002), acute respiratory failure (p < .001), and acute renal failure (p = .043) on the first day of intensive care unit admission. On multivariate logistic regression analysis, factors that independently correlated with mortality were the presence of acute respiratory failure (p = .003, relative risk = 18.7) and APACHE II score > 16 (p = .026, relative risk = 7.43).


CONCLUSIONS
In patients with pyogenic liver abscess requiring intensive care, variables including size of liver abscess, pathogens, comorbidity, and most laboratory data were not associated with mortality. Only the presence of acute respiratory failure and APACHE II score >16 on the first day of intensive care unit admission were significant prognostic factors.
Chen
Wei
W
Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan.
Chen
Chia-Hung
CH
Chiu
Kuo-Liang
KL
Lai
Hsueh-Chou
HC
Liao
Kuan-Fu
KF
Ho
Yung-Jen
YJ
Hsu
Wu-Huei
WH
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D046290:Liver Abscess, Pyogenic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies