Predictors of Mortality in Patients with Pyogenic Liver Abscess Requiring Intensive Care

Abstract

Background: Despite progress in the diagnosis and management of pyogenic liver abscess, the mortality rate remains high in critically ill patients. There have been limited studies on patients with pyogenic liver abscess requiring intensive care. The aim of this study was to assess the risk factors of mortality among patients with pyogenic liver abscess treated in intensive care unit (ICU). Methods: Thirty-five patients with pyogenic liver abscess admitted to ICU, between January 2003 and June 2009, were studied retrospectively. Parameters including general characteristics, clinical presentations, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores, features of liver abscess and laboratory data were reviewed. The main outcome measure was survival. Univariate and subsequent multivariate logistic regression analyses were performed to assess the risk factors for mortality. The best cut-off for each identified independent risk factor for mortality was then investigated. Results: Univariate analysis implicated APACHE Ⅱ scores on admission, abscess size and gas formation as prognostic factors of mortality. Multivariate analysis showed higher APACHE Ⅱ scores on ICU admission (OR=1.387; 95% CI=1.106-1.739) and size of the liver abscess (OR=2.986; 95% CI=1.060-3.723) as independent prognostic factors for mortality. Finally, APACHE Ⅱ scores≥17 and the diameter of liver abscess≥5 cm were found to be relatively more accurate in predicting mortality in the study population. Conclusion: In patients with pyogenic liver abscess requiring intensive care, APACHE Ⅱ scores≥17 and the diameter of liver abscess≥5 cm were accurate predictors of mortality.