title: Prognostic indications of the failure to treat amoebic liver abscesses.
abstract: OBJECTIVE
  To identify the variables that predict the failure to treat amoebic liver abscesses.
  
  
  METHODS
  We prospectively carried out a case-control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic,  and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous  or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure.
  
  
  RESULTS
  Of 40 patients with amoebic liver abscess, 24 (mean age: 36·7±11·2 years) responded to medical treatment  and 16 (41·8±11·6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0·05)  on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline  phosphatase level, and large abscess volume or diameter.
  
  
  CONCLUSIONS
  The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and  easy tool for determining appropriate therapy.
authors.affiliation: Department of Experimental Surgery, Faculty of Medicine, Universidad Autónoma de San Luis Potosí, Mexico. jemarsan7@hotmail.com
authors.forename: Martín
authors.initials: M
authors.lastname: Sánchez-Aguilar
authors.forename: Onofre
authors.initials: O
authors.lastname: Morán-Mendoza
authors.forename: Miguel F
authors.initials: MF
authors.lastname: Herrera-Hernández
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Hernández-Sierra
authors.forename: Peter B
authors.initials: PB
authors.lastname: Mandeville
authors.forename: J Humberto
authors.initials: JH
authors.lastname: Tapia-Pérez
authors.forename: Martín
authors.initials: M
authors.lastname: Sánchez-Reyna
authors.forename: José Juan
authors.initials: JJ
authors.lastname: Sánchez-Rodríguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Gordillo-Moscoso
mesh_terms: D000328:Adult; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008101:Liver Abscess, Amebic / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013396:Suction; D017211:Treatment Failure
chemical_list: D000981:Antiprotozoal Agents; D008795:Metronidazole