Clinical characteristics of bacterial liver abscess in patients with type 2 diabetes mellitus

Abstract

Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without type 2 diabetes mellitus, in order to guide clinical diagnosis and treatment. Methods The clinical data of 110 patients with bacterial liver abscess at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Among them, 45 cases with type 2 diabetes mellitus and 65 cases without type 2 diabetes mellitus were included in the study. The demographic data, clinical signs and symptoms, laboratory findings, pathogenic results, imaging findings, treatment and prognosis were compared between the two groups. Differences among the quantitative data with normal distribution were compared using t test, while count data were compared with χ2 test or Fisher exact test. Multivariate Logistic regression was used to determine the prognostic risk factors of two groups. Results Fever as initial symptom in diabetic group and non-diabetic group were 37 cases and 40 cases, respectively, while abdominal pain presented in 7 cases and 22 cases of the two groups, respectively, both with statistically significant difference (χ2=5.417 and 4.582, respectively, both P<0.05). As for laboratory examination, neutrophil counts in the two groups were (12.87±8.83)×109/L and (10.24±4.86)×109/L, respectively, the percentages of neutrophils were 0.841±0.077 and 0.799±0.103, respectively, albumin levels were (28.36±4.65) g/L and (30.67±6.16) g/L, respectively, with statistically significant difference (t=2.010, 2.317 and -2.265, respectively, all P<0.05). Patients with elevated blood urea nitrogen in the two groups were 13 cases and 8 cases, respectively, patients with elevated creatinine were 9 cases and 4 cases, respectively, with statistically significant difference (χ2=4.733 and 4.892, respectively, both P<0.05). In diabetic group, pus culture was positive in 13 out of 19 cases, and blood culture was positive in 7 out of 21 cases. In non-diabetic group, pus culture was positive in 9 out of 13 cases, and blood culture was positive in 6 out of 25 cases. The positive rates of Klebsiella pneumoniae in the two groups were 37.5% (15/40) and 15.8% (6/38) , respectively, with statistically significant difference (χ2=4.669, P=0.031). The effective rates of the two groups with glycemic control were 84.4% (38/45) and 84.6% (55/65), respectively, and the mortality rates of the two groups were 2.2% (1/45) and 1.5% (1/65), respectively. Multivariate Logistic regression showed that multiple abscess (OR=34.61, 95% CI: 1.601-748.457, P=0.024) was prognostic risk factor and invasive intervention (OR=0.028, 95%CI: 0.001-0.984, P=0.049) was protective factor in the diabetes mellitus group. Hypoalbuminemia (OR=14.793, 95% CI: 1.605-136.322, P=0.017) and the history of abdominal surgery within two years (OR=7.624, 95% CI: 1.294-44.913, P=0.025) were prognostic risk factors in the non-diabetic group. Conclusions Patients with bacterial liver abscess showing symptoms of severe infection in diabetic group are more frequently than patients in non-diabetic group. Klebsiella pneumoniae infection rate is also higher in diabetic group. Patients with bacterial liver abscess and diabetes mellitus should receive antibiotic treatment combined with invasive therapy in time. Key words: Bacterial liver abscess; Diabetes mellitus; Clinical characteristics; Therapy; Prognosis