Abstract
ObjectivesLittle is known about the risk of pyogenic liver abscess in patients with splenectomy. We explored the relationship between splenectomy and pyogenic liver abscess in Taiwan.MethodsWe conducted a nationwide cohort analysis using the hospitalization dataset of the Taiwan National Health Insurance Program. We included 17 779 subjects aged 20–84 years who underwent splenectomy in 1998 to 2010 (splenectomy group) and 70 855 randomly selected subjects without splenectomy (non-splenectomy group). Both groups were matched by sex, age, other comorbidities, and hospitalization year of receiving splenectomy. The incidence of pyogenic liver abscess at the end of 2011 was measured. The multivariable Cox proportional hazard regression model was used to estimate the hazard ratios and 95% confidence intervals for pyogenic liver abscess associated with splenectomy and other comorbidities.ResultsThe overall incidence rate was 3.75-fold higher in the splenectomy group than that in the non-splenectomy group (2.15 vs 0.57 per 1000 person-years; 95% confidence interval, 3.57–3.94). After controlling for potential confounding factors, the adjusted hazard ratio of pyogenic liver abscess was 3.89 in subjects with splenectomy (95% confidence interval, 3.20–4.72) when compared with subjects without splenectomy. In further analysis, the hazard ratio markedly increased to 14.34 for those with splenectomy and having any of the assessed comorbidities, including alcoholism, biliary stone, chronic kidney disease, chronic liver diseases, and diabetes mellitus (95% confidence interval, 10.61–19.39).ConclusionsPatients with splenectomy are at an increased risk of developing pyogenic liver abscess, particularly when they have comorbid conditions.
Highlights
The human spleen mainly serves an immune function against invading microorganisms.[1,2] Patients with splenectomy are more likely than those without splenectomy to suffer severe life-threatening infections, which are recognized as overwhelming postsplenectomy infections with substantial morbidity and mortality.[3,4] Recently, there is growing evidence that patients with splenectomy are at increased risk of pulmonary tuberculosis and type II diabetes mellitus,[5,6] but risk of pyogenic liver abscess has not yet been examined.Pyogenic liver abscess is an infective disease of the liver, which can be caused by numerous microorganisms
An increasing amount of literature reveals that numerous risk factors, such as biliary tract disease, cirrhosis, diabetes mellitus, male sex, cancer, and renal disease, are associated with pyogenic liver abscess,[8,9,10,11,12] but splenectomy has not yet been evaluated
In this nationwide cohort study, we found that the incidence rate of pyogenic liver abscess among patients with splenectomy was slightly higher than that reported in Tsai et al’s study among patients in Taiwan with end-stage renal disease (21.5 vs 18.2 per 10 000 person-years)[11] but was significantly higher than that reported in Molle et al’s study among patients in Denmark with cirrhosis (215 vs 23.3 per 100 000 person-years).[9]
Summary
The human spleen mainly serves an immune function against invading microorganisms.[1,2] Patients with splenectomy are more likely than those without splenectomy to suffer severe life-threatening infections, which are recognized as overwhelming postsplenectomy infections with substantial morbidity and mortality.[3,4] Recently, there is growing evidence that patients with splenectomy are at increased risk of pulmonary tuberculosis and type II diabetes mellitus,[5,6] but risk of pyogenic liver abscess has not yet been examined.Pyogenic liver abscess is an infective disease of the liver, which can be caused by numerous microorganisms. The human spleen mainly serves an immune function against invading microorganisms.[1,2] Patients with splenectomy are more likely than those without splenectomy to suffer severe life-threatening infections, which are recognized as overwhelming postsplenectomy infections with substantial morbidity and mortality.[3,4] Recently, there is growing evidence that patients with splenectomy are at increased risk of pulmonary tuberculosis and type II diabetes mellitus,[5,6] but risk of pyogenic liver abscess has not yet been examined. The overall mortality rate of pyogenic liver abscess ranges from 10% to 25%, depending on the population studied.[7,8] An increasing amount of literature reveals that numerous risk factors, such as biliary tract disease, cirrhosis, diabetes mellitus, male sex, cancer, and renal disease, are associated with pyogenic liver abscess,[8,9,10,11,12] but splenectomy has not yet been evaluated
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