For patients with pyogenic liver abscess, large maximal diameter of the abscess at admission indicated prolonged hospitalization and poor prognosis, according to study data presented at The American Association for the Study of Liver Diseases’ The Liver Meeting, held November 8 to 12, 2019 in Boston, Massachusetts.

Investigators retrospectively reviewed data from 482 patients with pyogenic liver abscess admitted to Chonbuk University Hospital in South Korea from 2005 to 2018. Patients’ mean age was 64.6 years ± 14.6 years, and roughly one-fourth had underlying diabetes mellitus, hypertension, or biliary disease.

The mean maximal diameter of hepatic abscess was 5.6± 2.6 cm, and 74.5% were cases of single abscess. The culture-positive rate of microorganism isolation from blood and purulent material was 40.5%. Klebsiella pneumoniae accounted for 71.9% of isolated microorganisms.

Evaluation of the extension of the liver abscess found 28 cases of portal vein thrombosis, 7 cases of biloma, 52 of pulmonary edema, 79 of pleural effusion, and 7 of liver rupture. Colonoscopy examinations were performed for 75 patients at admission, with 2 cases of colon cancer, 37 of colon polyps, and 7 of colonic diverticula detected.

Patients were divided into 3 groups based on maximal diameter of the abscess (<5 cm, 5-10 cm, and ≥10 cm), and clinical parameters were compared. No differences were observed between groups in regards to underlying disease or vital signs at admission but laboratory parameters indicated more severe inflammation states with increasing abscess size. Among patients with larger abscess diameters, results showed a higher white blood cell counts, C-reactive protein and prothrombin levels as well as lower albumin and hemoglobin levels with statistical significance. A longer duration of hospitalization (> 14 days) and a higher risk for in-hospital mortality also were documented in patients with large abscesses.

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Multivariate analysis of factors related to long-term hospitalization showed that high baseline levels of high‐sensitivity C‐reactive protein and procalcitonin as well as large maximal abscess diameter were independent factors associated with prolonged hospital stays.

Eleven disease-related deaths occurred during the study, amounting to a 30-day mortality rate of 3.1%. In addition to maximal abscess diameter, decreased mental status and grade of acute kidney injury at admission were independent factors associated with mortality risk.

The investigators concluded that, “more aggressive treatment strategies with careful monitoring may be required in patients with large hepatic abscesses.” Poor prognosis and prolonged hospital stay are also indicated by large maximal diameter of liver abscess at admission.

Reference

Lee CH, Kim IH, Yang HC, et al. Maximal diameter of hepatic abscess independently predicts prolonged hospitalization and poor prognosis in patients with pyogenic liver abscess. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 1042.