Predictors of mortality in patients with pyogenic liver abscess.
BACKGROUND
Pyogenic liver abscess (PLA) is uncommon but potentially life-threatening. The objective of this study was to identify the prognostic factors for PLA.


METHODS
The medical records of 253 patients, 148 men and 105 women with a mean age of 56.4 years (SD : 15.0 years), who were hospitalised due to a PLA between January 1995 and June 2007 were reviewed. The underlying medical disorders, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatments, morbidity and mortality were recorded. Factors related to in-hospital case fatality were analysed.


RESULTS
The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at admission in patients with PLA was 8.7 points (SD 5.4 points). The most common co-existing disease was diabetes mellitus (41.9%), followed by biliary stone disorders (32.0%). Klebsiella pneumoniae was the most frequent pathogen, followed by Escherichia coli. The in-hospital case-fatality rate was 9.1%. Multivariate analysis revealed that gas-forming abscess (p=0.019), multi-drug resistant isolates (p=0.026), anaerobic infection (p=0.045), blood urea nitrogen level >7.86 mmol/l (p=0.004), and APACHE II score > or =15 (p= 0.004) were associated with mortality.


CONCLUSIONS
The prognosis of PLA may depend chiefly on the severity of the basic physical condition and underlying pathology. As the primary treatment for PLA is not completely effective, a more aggressive approach should be considered, especially for patients with poor prognosis.
Chen
S C
SC
Department of Family Medicine, Chung Shan Medical University, No.110, Sec.1, South District, Taichung City 40201, Taiwan.
Tsai
S J
SJ
Chen
C H
CH
Huang
C C
CC
Lin
D B
DB
Wang
P H
PH
Chen
C C
CC
Lee
M C
MC
D018806:APACHE; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D005260:Female; D016905:Gram-Negative Bacterial Infections; D016908:Gram-Positive Bacterial Infections; D006305:Health Status Indicators; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
D000890:Anti-Infective Agents