Outcomes of Gas-Forming Pyogenic Liver Abscess (PLA) Are Comparable to Non-Gas-Forming PLA in the Era of Multimodal Care: A Propensity Score Matched Study

Abstract

Gas-forming pyogenic liver abscess (GFPLA) occurs in 7-24% of all pyogenic liver abscess (PLA) and has been traditionally associated with high mortality. Studies suggest that use of a proactive approach of prompt resuscitation, parenteral antibiotics, percutaneous drainage and a dedicated multidisciplinary team may improve clinical outcomes. Hence, we aim to investigate if the clinical outcomes of PLA are determined by gas formation. This is a retrospective study of patients with PLA from 2007 to 2011. A 1:2 propensity score matching (PSM) analysis was performed using age, co-morbid diabetes, presence of septic shock, haemoglobin levels, international normalized ratio, creatinine, total bilirubin, positive blood culture and pus culture, and the size of abscess. Demographics, clinical profile and perioperative data were compared. 213 patients had PLA: 41(19.2%) patients had GFPLA and 172(80.8%) patients had non-GFPLA. 1:2 PSM resulted in a total of 108 patients (36 GFPLA and 72 non-GFPLA). Clinical profile and microbiology are shown in Table 1. Median duration of parenteral antibiotics was significantly lower in the GFPLA group (9.5 days vs 14 days, p=0.044), but median total duration of antibiotics use was comparable (GFPLA 39 days vs non-GFPLA 37 days, p=0.634). Median length of stay (days) did not differ significantly between GFPLA and non-GFPLA (14 vs 15, p=0.299). There were no statistically significant differences between GFLPA and non-GFLPA in the need for percutaneous drainage (26/36(72.2%) vs 47/72(65.3%) respectively, p=0.467) and in-hospital all-cause mortality (4/36(11.1%) vs 7/72(9.7%), p=0.822). Outcomes of GFPLA are comparable to non-GFPLA in the era of multimodal care.Table 1Clinical profile and microbiology of patients with gas-forming pyogenic liver abscess (GFPLA) and non-GFPLA before and after matchingOverall cohort (n=213)Matched cohort (n=108)GFPLA (n=41)Non-GFPLA (n=172)p-valueSMD (standardised mean difference)GFPLA (n=36)Non-GFPLA (n=72)p-valueSMDAge (interquartile range)61 (53 - 69)62 (51 - 74)0.7870.01061.5 (52.3 - 68.8)62.5 (53.3 - 73.8)0.6460.047Gender, male (%)27 (65.9)104 (60.5)0.524-24 (66.7)45 (62.5)0.671-Diabetes mellitus, yes (%)18 (43.9)56 (32.6)0.1700.23313 (36.1)24 (33.3)0.7740.058Pus culture, yes (%)21 (70)61 (66.3)0.7080.30717 (65.4)37 (78.7)0.2140.083Klebsiella pneumoniae (%)17 (81)51 (82.3)13 (76.5)33 (89.2)Clostridium perfringes (%)1 (4.8)1 (1.6)1 (5.9)1 (2.7)Others (%)3 (14.3)9 (14.8)3 (17.6)3 (8.1)Size of largest abscess (cm)6.6 (4.9 - 8.3)5.4 (3.6 - 7.0)0.0050.4886.3 (4.5 - 7.5)6.1 (5.0 - 7.6)0.6690.131 Open table in a new tab