López-Cano Gómez M, Laguna Del Estal P, García Montero P, Gil Navarro M, Castañeda Pastor A. [Pyogenic liver abscess: clinical presentation and predictors of unfavorable outcome].
GASTROENTEROLOGIA Y HEPATOLOGIA 2012;
35:229-35. [PMID:
22365110 DOI:
10.1016/j.gastrohep.2012.01.001]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/08/2012] [Accepted: 01/10/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES
To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome.
MATERIAL AND METHODS
We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for>30 days, death, readmission).
RESULTS
There were 54 patients with PLA (65% men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33%, recent admission in 20%, alcoholism in 15%, diabetes mellitus in 15%, a history of gastrointestinal neoplasm in 11% and abdominal surgery in 11%. The cause was cryptogenic in 65%, biliary in 31%, and portal in 4%. Symptoms consisted of fever in 100%, abdominal pain in 65%, vomiting in 37%, enlarged liver in 33%, systemic inflammatory response syndrome in 26%, and jaundice in 9%. Blood and pus cultures were positive in 40% and 65%, respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72% (surgical drainage was also performed in 6%), and antibiotic treatment alone was administered in 28%. Outcome was unfavorable in 52% and was associated with greater age (p=0.016), a history of biliopancreatic disease (p=0.007), systemic inflammatory response syndrome at diagnosis (p=0.005), coagulation alterations (p=0.043), aspartate aminotransferase elevation (p=0.033), and biliary etiology (p<0.001).
CONCLUSIONS
PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9%, but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations.
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