Maximal diameter of liver abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess

Chang Hun Lee,Gum Mo Jung,Sang Wook Kim,Seong Hun Kim,Hoon Gil Jo,Eun Young Cho,Yong Keun Cho,Soo Teik Lee,Seung Young Seo,Jae Sun Song,Seung Ok Lee,In Hee Kim

doi:10.1186/s12879-021-05873-7

Abstract

Background/aimsThis study aimed to investigate the factors associated with prolonged hospital stay and in-hospital mortality in patients with pyogenic liver abscess.MethodsWe retrospectively reviewed data from patients with pyogenic liver abscess who were admitted between 2005 and 2018 at three tertiary hospitals in Jeonbuk province, South Korea. Prolonged hospital stay was defined as a duration of hospital admission of more than 21 days.ResultsA total of 648 patients (406 men and 242 women) diagnosed with pyogenic liver abscess were enrolled in the study. The mean maximal diameter of the liver abscess was 5.4 ± 2.6 cm, and 74.9% of the lesions were single. The three groups were divided according to the maximal diameter of the abscess. Laboratory parameters indicated a more severe inflammatory state and higher incidence of complications and extrahepatic manifestations with increasing abscess size. Rates of percutaneous catheter drainage (PCD) insertion, multiple PCD drainage, and salvage procedures as well as duration of drainage were also higher in the large liver abscess group. Of note, the duration of hospitalization and in-hospital mortality were significantly higher in the large hepatic abscess group. A multivariate analysis revealed that underlying diabetes mellitus, hypoalbuminemia, high baseline high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and large maximal abscess diameter were independent factors associated with prolonged hospital stay. Regarding in-hospital mortality, acute kidney injury at admission and maximal diameter of the abscess were independent factors associated with in-hospital mortality.ConclusionsA large maximal diameter of the liver abscess at admission indicated prolonged hospitalization and poor prognosis. More aggressive treatment strategies with careful monitoring are warranted in patients with large liver abscesses.

Highlights

Liver abscess is a disease in which the pathogen invades the liver, proliferates, and forms pus through the body’s inflammatory responses
There have been several reports on hepatic abscess treatment and clinical outcomes, there are insufficient real-world data regarding clinical courses and outcomes related to the liver abscess size. To address these gaps in the literature, we evaluated the clinical characteristics of patients with liver abscess according to the maximal diameter of the abscess and analyzed the factors associated with prolonged hospitalization and prognosis
Laboratory results showed that inflammatory markers, such as white blood cells, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein levels were higher in patients with large liver abscesses; procalcitonin (PCT) levels were lower

Summary

Introduction

Liver abscess is a disease in which the pathogen invades the liver, proliferates, and forms pus through the body’s inflammatory responses. Antibiotic use, comorbid diseases, such as diabetes and underlying hepatobiliary disease, and regular use of proton-pump inhibitors may facilitate the incidence of liver abscess [5,6,7]. It has become an emerging infectious disease, especially in Southeast Asia [8, 9]. A meta-analysis showed an association between colorectal cancer and liver abscess [12]

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