title: Predictors of septic shock in initially stable patients with pyogenic liver abscess.
abstract: OBJECTIVE
  The incidence of pyogenic liver abscess (PLA), a life-threatening condition, is increasing worldwide. This study was designed to evaluate clinical features and outcomes in initially stable patients with PLA and to determine the predictors of septic shock.
  
  
  METHODS
  The medical records of all adult patients who were hemodynamically stable and diagnosed with PLA in the emergency department from January 2010 to December 2014, inclusive, were reviewed. The primary outcome was septic shock.
  
  
  RESULTS
  A review of medical records identified 453 patients (66.7% male), of mean age 61.4 years, diagnosed with PLA. Of these patients, 73 (16.1%) had septic shock and 10 (2.2%) died in-hospital. Of the 73 patients with septic shock, nine (12.3%) died in-hospital. The most common symptom was fever (79.5%), and the most common infectious agent was Klebsiella pneumoniae. Septic shock was significantly associated with age ≥60 years [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.38-6.48], malignancy (OR: 2.11, 95% CI: 1.08-4.09), systolic blood pressure <100 mmHg (OR: 3.63, 95% CI: 1.43-9.21), respiratory rate ≥24/min (OR: 3.15, 95% CI: 1.20-8.28) and lactate concentration ≥2 mmol/L (OR: 4.92, 95% CI: 2.51-9.64). Septic shock also tended to be associated with procalcitonin concentration, but this was not statistically significant (OR: 3.42, 95% CI: 0.96-12.18).
  
  
  CONCLUSIONS
  Septic shock was frequent in initially stable patients with PLA and was associated with older age, malignancy, low blood pressure, tachypnea and elevated lactate concentration.
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Hyunyoung
authors.initials: H
authors.lastname: Cho
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Eu Sun
authors.initials: ES
authors.lastname: Lee
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Yoon-Seon
authors.initials: YS
authors.lastname: Lee
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Youn-Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Dong-Woo
authors.initials: DW
authors.lastname: Seo
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.affiliation: a Department of Emergency Medicine , University of Ulsan College of Medicine, Asan Medical Center , Seoul , South Korea.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000150:complications*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D019344:Lactic Acid / Q000097:blood; D046290:Liver Abscess, Pyogenic / Q000150:complications* / Q000382:microbiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000401:mortality*
chemical_list: D019344:Lactic Acid
keywords: Pyogenic liver abscess; lactic acid; prediction; septic shock