title: Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors.
abstract: BACKGROUND
  pyogenic liver abscess (PLA) is a potentially life-threatening disease in middle-to-old aged persons.
  
  
  OBJECTIVE
  to compare the differences in clinical features and outcomes between older and younger PLA patients, and to identify predictors of outcomes in older patients.
  
  
  METHODS
  retrospective chart review of all PLA patients between July 1999 and June 2007.
  
  
  METHODS
  a 1,600-bed primary and tertiary care centre.
  
  
  METHODS
  in total, 339 patients were enrolled and included 118 > or =65 years of age (the elderly group) and 221 patients <65 years of age (the non-elderly group).
  
  
  METHODS
  clinical features, laboratory, imaging and microbiologic findings, treatment and outcomes for each of the included patients were collected. The predictor of outcome was determined using logistic regression and purposeful selection of covariates.
  
  
  RESULTS
  the elderly group had a higher APACHE II score on admission, a biliary abnormality, a malignancy, a pleural effusion, polymicrobial, anaerobic or multi-drug-resistant isolates, inappropriate initial antibiotics, a longer hospitalisation and a longer parenteral antibiotic treatment period than the non-elderly group, whereas the non-elderly group was more likely to be alcoholic men with cryptogenic origin of abscess and Klebsiella pneumoniae infection. There was no difference in case fatality between the elderly (13.6%) and non-elderly (8.6%) groups despite the elderly group having a poorer host status on admission. In multivariate analysis, age (P = 0.028) and APACHE II score at admission > or =15 (P = 0.001) were risk factors, but K. pneumoniae infection (P = 0.012) was a protective factor for fatality in older PLA patients.
  
  
  CONCLUSIONS
  these data suggest that older PLA patients would have a fair outcome compared to younger patients, but require longer hospitalisations.
authors.affiliation: Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Shiuan-Chih
authors.initials: SC
authors.lastname: Chen
authors.forename: Yuan-Ti
authors.initials: YT
authors.lastname: Lee
authors.forename: Chi-Hua
authors.initials: CH
authors.lastname: Yen
authors.forename: Kuang-Chi
authors.initials: KC
authors.lastname: Lai
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.forename: Ding-Bang
authors.initials: DB
authors.lastname: Lin
authors.forename: Po-Hui
authors.initials: PH
authors.lastname: Wang
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Chen
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lee
authors.forename: William R
authors.initials: WR
authors.lastname: Bell
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013396:Suction; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents