Issue: 2008 > May > original article

Predictors of mortality in patients with pyogenic liver abscess

S.C. Chen, S.J. Tsai, C.H. Chen, C.C. Huang, D.B. Lin, P.H. Wang, C.C. Chen, M.C. Lee


Background: Pyogenic liver abscess (PLA) is uncommon
but potentially life-threatening. The objective of this study was to identify the prognostic factors for PLA.
Methods: The medical records of 253 patients, 148
men and 105 women with a mean age of 56.4 years
(SD : 15.0 years), who were hospitalised due to a PLA
between January 1995 and June 2007 were reviewed.
The underlying medical disorders, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatments, morbidity and
mortality were recorded. Factors related to in-hospital
case fatality were analysed.
Results: The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at admission in patients with PLA was 8.7 points (SD 5.4 points). The most common co-existing disease was diabetes mellitus (41.9%), followed by biliary stone disorders (32.0%). <i>Klebsiella pneumoniae</i> was the most frequent pathogen, followed by <i>Escherichia coli</i>. The in-hospital case-fatality rate was 9.1%. Multivariate analysis revealed that gas-forming abscess (p=0.019), multi-drug resistant isolates (p=0.026), anaerobic infection (p=0.045), blood urea nitrogen level >7.86 mmol/l (p=0.004), and APACHE II score &#8805;15 (p= 0.004) were associated with mortality.
Conclusions: The prognosis of PLA may depend chiefly
on the severity of the basic physical condition and underlying pathology. As the primary treatment for PLA
is not completely effective, a more aggressive approach
should be considered, especially for patients with poor