Abstract
Background: Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED. Methods: Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,—i.e., 80 patients with LA. Results: Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148–1.449, p < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups. Conclusion: Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.
Highlights
Pyogenic liver abscess (LA) is more common in Asian countries than in Western countries [1], the incidence of LA is increasing in the United States due to the aging of the population, diabetes, hepatobiliary disease, instrumental usage of the biliary tract, and liver transplantation [2]
Since both intrahepatic mass-forming cholangiocarcinoma (IMCC) and LA share the features of chronic biliary inflammation and ascending cholangitis [6,7], differentiating between these two diseases can be challenging in the emergency department (ED)
On multivariable logistic regression analysis, serum C-reactive protein (CRP) was the only significant predictor among all inflammatory markers for differentiation between the LA and IMCC groups
Summary
Pyogenic liver abscess (LA) is more common in Asian countries than in Western countries [1], the incidence of LA is increasing in the United States due to the aging of the population, diabetes, hepatobiliary disease, instrumental usage of the biliary tract, and liver transplantation [2]. IMCC accounts for most intrahepatic cholangiocarcinoma [5]. Since both IMCC and LA share the features of chronic biliary inflammation and ascending cholangitis [6,7], differentiating between these two diseases can be challenging in the emergency department (ED). It is important to identify simple, accurate, and cost-effective biomarkers for differentiating LA from IMCC that can be used in the ED to triage patients effectively. White blood cell (WBC) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) levels are the commonly used inflammatory markers for differential diagnoses of infection in the ED.
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