title: Initial presentations and final outcomes of primary pyogenic liver abscess: a cross-sectional study.
abstract: BACKGROUND
  Although pyogenic liver abscess (PPLA) fatalities are decreasing owing to early diagnosis and effective treatments, PPLA-associated complications still exist. The purpose of this study was to analyze the characteristic features of initial presentations and final outcomes of PPLA caused by different pathogens.
  
  
  METHODS
  This retrospective study collected and analyzed information regarding initial presentations and final outcomes in patients diagnosed with PPLA at admitted at Changhua Christian Hospital from January 1 to December 31, 2010.
  
  
  RESULTS
  During the study period, we analyzed the records of a total of 134 patients with documented PPLA. There were no significant causative pathogen-related differences in symptoms at initial presentation. Compared with the survivor group, patients in the mortality group were characterized by male gender (p < 0.001), malignancy (p < 0.001), respiratory distress (p =0.007), low blood pressure (p = 0.024), jaundice (p = < 0.001), rupture of liver abscess (p < 0.001), endophthalmitis (p = 0.003), and multiple organ failure (p < 0.001). No patients received liver transplantation or were diagnosed with HIV during the study period. According to univariate logistic regression analysis, gender (OR = 1.185, 95% CI: 0.284-11.130, p = 0.006), malignancy (OR = 2.067, 95% CI: 1.174-13.130, p = 0.004), respiratory distress (OR = 1.667, 95% CI: 1.164-14.210, p = 0.006), low blood pressure (OR = 2.167, 95% CI: 2.104-13.150, p = 0.003), jaundice (OR = 1.9, 95% CI: 1.246-3.297, p = 0.008), rupture of liver abscess (OR = 5.167, 95% CI: 2.194-23.150, p = 0.003), endophthalmitis (OR = 2.167, 95% CI: 1.234-13.140, p = 0.005), and multiple organ failure (OR = 3.067, 95% CI: 1.184-15.150, p = 0.001) differed significantly between the mortality and survivor groups.
  
  
  CONCLUSIONS
  Although the initial presentations of PPLA caused by different pathogens were similar, there were significant differences in mortality in cases involving: (1) male patients, (2) malignancy, (3) initial respiratory distress, (4) initial low blood pressure, (5) jaundice, (6) rupture of liver abscess, (7) endophthalmitis, , and (8) multiple organ failure. We strongly recommend using a severity score of the disease to determine the risk of mortality for each patient with PPLA. In order to prevent complications and reduce mortality, more attention must be paid to high-risk PPLA patients.
authors: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao St,, Changhua City, Changhua County 500, Taiwan. changhua@cch.org.tw.
authors: Chang-Hua
authors: CH
authors: Chen
authors: Shung-Sheng
authors: SS
authors: Wu
authors: Hung-Chi
authors: HC
authors: Chang
authors: Yu-Jun
authors: YJ
authors: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003430:Cross-Sectional Studies; D009877:Endophthalmitis / Q000150:complications; D004927:Escherichia coli Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005674:Fusobacterium Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007022:Hypotension / Q000150:complications; D007565:Jaundice / Q000150:complications; D007710:Klebsiella Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008099:Liver / Q000000981:diagnostic imaging*; D046290:Liver Abscess, Pyogenic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011379:Prognosis; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000150:complications; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D013624:Taiwan; D014463:Ultrasonography; D055815:Young Adult