Abstract
Pyogenic liver abscess (PLA) is a major life-threatening disease with varied clinical features. This study aimed to determine predictors of mortality in patients with PLA using criteria determined upon admission. We retrospectively examined the data of 324 hospitalized adults in whom liver abscesses were confirmed using abdominal ultrasound and/or computed tomography. The relationship between various risk factors was assessed using multivariate analysis. A total of 109 (33.6%) patients were admitted to the intensive care unit (ICU). The overall mortality rate was 7.4% and was higher among ICU patients than non-ICU patients (21.1% vs. 0.5%, p < 0.001). PLA patients with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥18 had a 19.31-fold increased risk, and those with concomitant infections had a 34.33-fold increased risk of 30-day mortality according to multivariate analysis. The estimated area under the receiver operating characteristic curve for predicting 30-day mortality revealed that APACHE II score ≥18 (sensitivity of 75% and specificity of 84%, p < 0.0001) had better discriminative power than Sequential Organ Failure Assessment (SOFA) ≥6 (sensitivity of 81% and specificity of 66%, p < 0.0001). APACHE II has shown better discrimination ability than SOFA in predicting mortality in PLA patients. To improve outcomes in patients with PLA, future management strategies should focus on high-risk patients.
Highlights
The incidence of pyogenic liver abscess (PLA), a major life-threatening disease with varied clinical features, is increasing worldwide
The significant factors for predicting mortality included the following: high Acute Physiology and Chronic Health Evaluation (APACHE) II score and concomitant infections
Our finding of a high APACHE II score is consistent with previous studies, this study provided additional information concerning its use as a predictor of mortality in patients with PLA on admission [2,16,17]
Summary
The incidence of pyogenic liver abscess (PLA), a major life-threatening disease with varied clinical features, is increasing worldwide. Despite continuous advancements in medical technology enabling physicians to better diagnose and treat patients with PLA [11], the mortality rate due to PLA varies from 2% to 28% [2,3,4,5,12,13,14,15,16,17]. This is of particular concern in critically ill patients admitted to the intensive care unit (ICU) as they have more adverse outcomes and a high risk of mortality [3,6,16]
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