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An Audit of Experience Over the Past Decade

Kent-Man Chu, MBBS, FRCS(Edin); Sheung-Tat Fan, MS, FRCS(Glas), FACS; Edward C. S. Lai, MS, FRCS(Edin), FRACS, FACS; Chung-Mau Lo, MBBS, FRCS(Edin), FRACS; John Wong, PhD, FRCS(Edin), FRACS, FACS

Arch Surg. 1996;131(2):148-152.

Abstract
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 subjected 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.

(Arch Surg. 1996;131:148-152)

Author Affiliations
From the Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.

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