title: Clinical outcomes and prognostic factors of cancer patients with pyogenic liver abscess.
abstract: OBJECTIVE
  Pyogenic liver abscess (PLA) of cancer patients often has a poor prognosis, but corresponding prognostic factors are less investigated. This study aimed to identify predictors of mortality in cancer patients with PLA.
  
  
  METHODS
  Medical records of 85 consecutive cancer patients (46 with hepatobiliary pancreatic cancer, 14 with gastrointestinal cancer, and 25 with non-digestive system cancer) having PLA who were admitted to two university hospitals were retrospectively reviewed. The predictors of mortality were determined using Cox regression model.
  
  
  RESULTS
  The overall case fatality rate was 33%. In multivariate analysis, the greater Acute Physiology and Chronic Health Evaluation II score (P = 0.028), multiloculated abscess (P = 0.025), and polymicrobial infection (P = 0.003) were associated with mortality. In subgroup analysis of the 25 patients with multiloculated abscess undergoing percutaneous catheter drainage as primary treatment, the case fatality rates of patients with a solitary smaller abscess (size < 5 cm), those with a solitary larger abscess (size > 5 cm), and those with larger multiple abscesses were 0%, 36%, and 85%, respectively (P = 0.002; using χ (2) for trend).
  
  
  CONCLUSIONS
  The advanced disease stage, multiloculated abscess, and polymicrobial infection posed a greater mortality risk in cancer patients with PLA. Moreover, an early surgical approach should be considered for cancer patients having large, multiloculated complex PLAs.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.
authors.forename: Shiuan-Chih
authors.initials: SC
authors.lastname: Chen
authors.forename: Yuan-Ti
authors.initials: YT
authors.lastname: Lee
authors.forename: Shih-Jei
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Kuang-Chi
authors.initials: KC
authors.lastname: Lai
authors.forename: Chi-Chou
authors.initials: CC
authors.lastname: Huang
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
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001442:Bacteroides Infections; D004927:Escherichia coli Infections; D005260:Female; D006801:Humans; D007710:Klebsiella Infections; D007711:Klebsiella pneumoniae; D046290:Liver Abscess, Pyogenic / Q000150:complications / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents