Background
Methods
Patients
Data collection
Statistical analysis
Results
Demographic data and comorbidities
Total N = 332 | Under 65 N = 250 | Over 65 N = 82 | P value | |
---|---|---|---|---|
Age (years; median, range) | 57(18–89) | 53(18–60) | 72(65–89) | |
Gender (Male/Female) | 187/145 | 148/102 | 39/43 | 0.065 |
Etiologies (n, %) | ||||
Biliary source | 107(32.2%) | 71(28.4%) | 36(43.9%) | 0.009 |
Portal vein seeding, bowel and/or pelvic pathology | 29(8.7%) | 24(9.6%) | 5(6.1%) | 0.330 |
Hepatic artery seeding | 19(5.7%) | 16(6.4%) | 3(3.7%) | 0.513 |
Direct extension | 39(11.7%) | 25(10.0%) | 14(17.1%) | 0.084 |
Trauma to the liver | 12(3.6%) | 10(4.0%) | 2(2.4%) | 0.752 |
Cryptogenic infection | 126(38.0%) | 104(41.6%) | 22(26.8%) | 0.017 |
Comorbidities (n, %) | ||||
Smoking | 90(27.1%) | 77(30.8%) | 13(15.9%) | 0.008 |
Drinking | 56(16.9%) | 46(18.4%) | 10(12.2%) | 0.193 |
Hypertension | 69(20.8%) | 36(14.4%) | 33(40.2%) | < 0.001 |
Diabetes mellitus | 106(31.9%) | 72(28.8%) | 34(41.5%) | 0.033 |
Hepatobiliary malignant diseases | 40(12.1%) | 32(12.8%) | 8(9.8%) | 0.462 |
Cholelithiasis | 123(37.1%) | 82(32.8%) | 41(50.0%) | 0.005 |
Cirrhosis | 14(4.2%) | 11(4.4%) | 3(3.7%) | 1 |
Viral hepatitis | 23(6.9%) | 19(7.6%) | 4(4.9%) | 0.400 |
Coronary artery disease | 15(4.5%) | 5(2.0%) | 10(12.2%) | < 0.001 |
Surgery history | ||||
Abdominal surgery history | 155(46.7%) | 115(46.0%) | 40(48.8%) | 0.661 |
Hepatobiliary surgery | 129(38.9%) | 94(37.6%) | 35(42.7%) | 0.413 |
Other surgery | 26(7.8%) | 21(8.4%) | 5(6.1%) | 0.501 |
No surgery | 177(53.3%) | 135(54.0%) | 42(51.2%) | 0.661 |
Clinical features, laboratory results and imaging findings
Total N = 332 | Under 65 N = 250 | Over 65 N = 82 | P value | |
---|---|---|---|---|
Symptoms and signs (n, % or mean ± S.D.) | ||||
Fever | 292(88.0%) | 221(88.4%) | 71(86.6%) | 0.661 |
Chills | 170(51.2%) | 131(52.4%) | 39(47.6%) | 0.447 |
Abdominal pain | 144(43.4%) | 105(42.0%) | 39(47.6%) | 0.378 |
Nausea | 77(23.2%) | 50(20.0%) | 27(32.9%) | 0.016 |
Vomit | 50(15.1%) | 30(12.0%) | 20(24.4%) | 0.006 |
Fatigue | 55(16.6%) | 44(17.6%) | 11(13.4%) | 0.376 |
Temperature (°C) | 37.3 ± 1.1 | 37.3 ± 1.1 | 37.1 ± 1.0 | 0.062 |
Respiratory rate | 19.8 ± 1.8 | 19.8 ± 1.8 | 19.5 ± 1.7 | 0.149 |
Heart rate | 85.3 ± 13.3 | 86.1 ± 13.5 | 82.7 ± 12.5 | 0.042 |
Mean arterial pressure (mmHg) | 89.8 ± 25.2 | 88.6 ± 25.5 | 93.6 ± 24.1 | 0.116 |
Laboratory results (mean ± S.D.) | ||||
Leucocytes (× 109/L) | 11.1 ± 5.7 | 10.8 ± 5.0 | 12.2 ± 7.4 | 0.123 |
Neutrophils (×109/L) | 9.0 ± 5.5 | 8.7 ± 4.8 | 10.0 ± 7.1 | 0.136 |
Hemoglobin (g/L) | 112.1 ± 19.7 | 112.4 ± 19.8 | 111.1 ± 19.7 | 0.624 |
Platelet count (× 109/L) | 227.6 ± 127.4 | 231.5 ± 133.1 | 215.9 ± 108.4 | 0.342 |
ALT (U/L) | 64.1 ± 103.8 | 62.3 ± 91.3 | 69.8 ± 135.5 | 0.569 |
AST (U/L) | 55.2 ± 139.3 | 50.6 ± 93.8 | 69.2 ± 227.7 | 0.295 |
ALP (U/L) | 195.0 ± 136.2 | 197.2 ± 137.3 | 188.1 ± 133.4 | 0.600 |
GGT (U/L) | 165.0 ± 158.3 | 159.2 ± 148.6 | 182.5 ± 184.3 | 0.248 |
TBIL (μmol/L) | 20.7 ± 25.1 | 21.6 ± 27.8 | 18.1 ± 14.3 | 0.277 |
DBIL (μmol/L) | 11.0 ± 17.4 | 11.7 ± 19.4 | 9.0 ± 8.2 | 0.210 |
ALB (g/L) | 30.6 ± 5.9 | 30.8 ± 5.8 | 29.9 ± 5.9 | 0.200 |
Cr (umol/L) | 65.9 ± 49.8 | 65.4 ± 49.8 | 67.1 ± 50.1 | 0.780 |
BUN (mmol/L) | 5.1 ± 3.0 | 4.9 ± 3.1 | 5.6 ± 2.7 | 0.088 |
PT (s) | 14.6 ± 1.8 | 14.5 ± 1.5 | 15.0 ± 2.5 | 0.127 |
APTT (s) | 38.7 ± 5.7 | 38.6 ± 5.5 | 38.9 ± 6.2 | 0.700 |
INR | 1.2 ± 0.2 | 1.2 ± 0.1 | 1.2 ± 0.3 | 0.106 |
FIB (g/L) | 6.0 ± 1.9 | 6.1 ± 1.9 | 5.8 ± 1.8 | 0.198 |
Imaging findings (n, % or mean ± S.D.) | ||||
Single lesion | 244(73.5%) | 184(73.6%) | 60(73.1%) | 0.939 |
Multiple lesions | 88(26.5%) | 66(26.4%) | 22(26.8%) | |
Maximal diameter of abscess (cm) | 6.6 ± 2.8 | 6.6 ± 2.8 | 6.9 ± 2.8 | 0.406 |
Gas formation | 56(16.9%) | 40(16.0%) | 16(19.5%) | 0.461 |
Abscess location | N = 297 | N = 229 | N = 68 | |
Left lobe | 45(15.2%) | 34(14.9%) | 11(16.2%) | 0.307 |
Right lobe | 211(71.0%) | 167(72.9%) | 44(64.7%) | |
Both-lobes | 41(13.8%) | 28(12.2%) | 13(19.1%) |
Microbiological characteristics
Total | Under 65 | Over 65 | P value | |
---|---|---|---|---|
Pus culture (n, %) | N = 202 | N = 155 | N = 47 | |
Klebsiella spp | 77(38.1%) | 62(40.0%) | 15(31.9%) | 0.317 |
Escherichia coli | 19(9.4%) | 14(9.0%) | 5(10.6%) | 0.777 |
Enterococcus | 7(3.5%) | 4(2.6%) | 3(6.4%) | 0.357 |
Streptococcus | 8(4.0%) | 8(5.2%) | 0(0) | 0.202 |
Staphylococcus | 3(1.5%) | 2(1.3%) | 1(2.1%) | 0.550 |
Clostridium perfringens | 1(0.5%) | 1(0.7%) | 0(0) | 1 |
Other | 10(5.0%) | 7(4.5%) | 3(6.4%) | 0.701 |
Multiple bacteria | 17(8.4%) | 13(8.4%) | 4(8.5%) | 1 |
No growth | 60(29.7%) | 44(28.4%) | 16(34.0%) | 0.457 |
Blood culture (n, %) | N = 151 | N = 111 | N = 40 | |
Klebsiella spp | 13(8.6%) | 12(10.8%) | 1(2.5%) | 0.186 |
Escherichia coli | 8(5.3%) | 5(4.5%) | 3(7.5%) | 0.437 |
Enterococcus | 2(1.3%) | 1(0.9%) | 1(2.5%) | 0.461 |
Streptococcus | 4(2.7%) | 3(2.7%) | 1(2.5%) | 1 |
Staphylococcus | 4(2.7%) | 3(2.7%) | 1(2.5%) | 1 |
Clostridium perfringens | 1(0.7%) | 1(0.9%) | 0(0) | 1 |
Other | 3(2.0%) | 3(2.7%) | 0(0) | 0.566 |
Multiple bacteria | 5(3.3%) | 5(4.5%) | 0(0) | 0.326 |
No growth | 111(73.5%) | 78(70.3%) | 33(82.5%) | 0.133 |
Treatment and outcomes
Total N = 332 | Under 65 N = 250 | Over 65 N = 82 | P value | |
---|---|---|---|---|
Treatments (n, %) | ||||
Empirical antibiotic treatment | 170(51.2%) | 135(54.0%) | 35(42.7%) | 0.075 |
Antibiotics alone | 96(28.9%) | 65(26.0%) | 31(37.8%) | 0.120 |
Percutaneous drainage | 188(56.6%) | 148(59.2%) | 40(48.8%) | |
Surgical drainage | 48(14.5%) | 37(14.8%) | 11(13.4%) | |
Complications (n, %) | ||||
Sepsis | 151(45.5%) | 111(44.4%) | 40(48.8%) | 0.489 |
Septic shock | 3(0.9%) | 2(0.8%) | 1(1.2%) | 0.574 |
Acute Respiratory Distress Syndrome | 3(0.9%) | 3(1.2%) | 0(0) | 1 |
Acute kidney injury | 1(0.3%) | 1(0.4%) | 0(0) | 1 |
Spontaneous rupture of abscess | 2(0.6%) | 1(0.4%) | 1(1.2%) | 0.434 |
Pleural effusion | 117(35.2%) | 87(34.8%) | 30(36.6%) | 0.769 |
Portal venous thrombosis | 2(0.6%) | 2(0.8%) | 0(0) | 1 |
Metastatic complications | 8(2.4%) | 7(2.8%) | 1(1.2%) | 0.693 |
Outcomes (% or mean ± S.D.) | ||||
Length of antibiotics required (days) | 8.4 ± 5.3 | 8.3 ± 5.4 | 8.7 ± 4.9 | 0.535 |
Time taken for temperature normalization (days) | 7.0 ± 6.1 | 7.4 ± 6.3 | 5.8 ± 5.3 | 0.040 |
Length of hospital stay (days) | 15.6 ± 8.3 | 15.9 ± 8.3 | 14.7 ± 8.4 | 0.258 |
Received antibiotic therapy in the preceding 3 months | 62(18.7%) | 43(17.2%) | 19(23.2%) | 0.229 |
Re-operated | 12(3.6%) | 12(4.8%) | 0(0) | 0.093 |
In-hospital mortality | 0 | 0 | 0 |
Prognostic factors associated with the development of sepsis in PLA patients
Variable (N = 332) | Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|---|
Yes N = 154 | No N = 178 | P value | OR (95% CI) | P value | |
Age (years; median, range) | 56(18–85) | 59(20–89) | 0.290 | ||
Gender (Male/Female) | 88/66 | 99/79 | 0.780 | ||
Etiologies (n, %) | |||||
Biliary source | 53(34.1%) | 54(30.3%) | 0.428 | ||
Portal vein seeding, bowel and/or pelvic pathology | 17(11.0%) | 12(6.7%) | 0.167 | ||
Hepatic artery seeding | 17(11.0%) | 2(1.1%) | < 0.001 | 0.105(0.023–0.486) | 0.004 |
Direct extension | 17(11.0%) | 22(12.4%) | 0.709 | ||
Trauma to the liver | 5(3.2%) | 7(3.9%) | 0.738 | ||
Cryptogenic infection | 45(29.2%) | 81(45.5%) | 0.002 | 1.406(0.824–2.397) | 0.211 |
Comorbidities (n, %) | |||||
Smoking | 49(31.8%) | 41(23.0%) | 0.073 | ||
Drinking | 33(21.4%) | 23(12.9%) | 0.039 | 0.617(0.329–1.154) | 0.131 |
Hypertension | 28(18.2%) | 41(23.0%) | 0.277 | ||
Diabetes mellitus | 56(36.4%) | 50(28.1%) | 0.107 | ||
Hepatobiliary malignant diseases | 20(13.0%) | 20(11.2%) | 0.625 | ||
Cholelithiasis | 58(37.7%) | 65(36.5%) | 0.829 | ||
Cirrhosis | 4(2.6%) | 10(5.6%) | 0.170 | ||
Viral hepatitis | 8(5.2%) | 15(8.4%) | 0.886 | ||
Coronary artery disease | 5(3.2%) | 10(5.6%) | 0.413 | ||
Surgery history | |||||
Abdominal surgery history | 81(52.6%) | 74(41.6%) | 0.045 | 0.617(0.368–1.035) | 0.067 |
Hepatobiliary surgery | 67(43.5%) | 62(34.8%) | 0.106 | ||
Other surgery | 14(9.1%) | 12(6.7%) | 0.427 |
Prognostic factors associated with prolonged time (≥7 days) taken for temperature normalization in PLA patients
Variable (N = 332) | Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|---|
< 7 days N = 174 | ≥ 7 days N = 158 | P value | OR (95% CI) | P value | |
Age (years; median, range) | 57(20–89) | 59(18–84) | 0.385 | ||
Gender (Male/Female) | 108/66 | 79/79 | 0.027 | 1.767(1.017–3.070) | 0.012 |
Etiologies (n, %) | |||||
Biliary source | 64(36.8%) | 43(27.2%) | 0.063 | ||
Portal vein seeding, bowel and/or pelvic pathology | 13(7.5%) | 16(10.1%) | 0.392 | ||
Hepatic artery seeding | 6(3.4%) | 12(7.6%) | 0.162 | ||
Direct extension | 18(10.3%) | 21(13.3%) | 0.405 | ||
Trauma to the liver | 7(4.0%) | 5(3.2%) | 0.676 | ||
Cryptogenic infection | 65(37.4%) | 61(38.6%) | 0.814 | ||
Comorbidities (n, %) | |||||
Smoking | 52(29.9%) | 38(24.1%) | 0.232 | ||
Drinking | 38(21.8%) | 18(11.4%) | 0.011 | 2.849(1.262–6.430) | 0.012 |
Hypertension | 40(23.0%) | 29(18.4%) | 0.299 | ||
Diabetes mellitus | 58(33.3%) | 48(30.4%) | 0.564 | ||
Hepatobiliary malignant diseases | 19(10.9%) | 21(13.3%) | 0.507 | ||
Cholelithiasis | 74(42.5%) | 49(31.0%) | 0.052 | ||
Cirrhosis | 10(5.7%) | 4(2.5%) | 0.145 | ||
Viral hepatitis | 14(8.0%) | 9(5.7%) | 0.400 | ||
Surgery history | |||||
Abdominal surgery history | 87(50.0%) | 68(43.0%) | 0.204 | ||
Hepatobiliary surgery | 74(42.5%) | 55(34.8%) | 0.150 | ||
Other surgery | 13(8.5%) | 13(8.2%) | 0.798 |