Pyogenic liver abscess. An audit of experience over the past decade
K. M. Chu, S. T. Fan, E. C. Lai, C. M. Lo and J. Wong
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
OBJECTIVES: To audit our experience in managing patients with pyogenic
liver abscesses since 1984 and to identify any risk factor associated with
hospital mortality. DESIGN: Retrospective review. SETTING: A tertiary
referral center. PATIENTS: Eighty-three patients with pyogenic liver
abscesses were studied to determine demographic characteristics; clinical
features, laboratory, imaging, and microbiologic findings; methods of
treatment; and final outcome. The median follow-up period was 9.8 months.
INTERVENTION: All patients were treated with intravenous antibiotic drugs.
Fifty-three patients were to image-guided percutaneous aspiration of the
abscess. A percutaneous drainage catheter was inserted after aspiration in
27 patients. Laparotomy was performed in 27 patients; seven of them
underwent an elective operation. MAIN OUTCOME MEASURE: Hospital mortality,
defined as death within the same hospital admission for management of liver
abscess. RESULTS: Biliary tract disease was the most frequently
identifiable cause. The right lobe abscess was more frequently cryptogenic,
while the left lobe abscess was more frequently related to intrahepatic
stones (P < .001). The overall hospital mortality rate was 18% (15/83).
On univariate analysis, female gender, rupture on presentation, emergency
laparotomy, management without aspiration or catheter drainage, presence of
malignancy, hyperglycemia, hyperbilirubinemia, elevated prothrombin time,
and elevated activated partial thromboplastin time were significantly
associated with hospital mortality. On multivariate logistic regression
analysis, presence of malignancy, hyperbilirubinemia, and elevated
activated partial thromboplastin time were found to be independent risk
factors. CONCLUSIONS: Pyogenic liver abscess is still a disease with
significant mortality. Early diagnosis and prompt treatment are necessary
to further improve our results of management.
