Absceso hepático piógeno: presentación clínica y predictores de evolución desfavorable

Abstract

ObjectivesTo describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome. Material and methodsWe 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). ResultsThere 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). ConclusionsPLA 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.