Background
Methods
Study subjects
Data collection and definitions
Treatments
Statistical analysis
Results
Demographic and baseline clinical characteristics of the study population
Characteristics | Total (n = 648) | Maximal size of abscess | P value | ||
---|---|---|---|---|---|
< 5 cm (n = 293) | 5 ~ 10 cm (n = 312) | ≥ 10 cm (n = 43) | |||
Age, years | 65.7 ± 14.6 | 65.5 ± 14.9 | 66.4 ± 14.3 | 62.2 ± 14.7 | 0.658 |
Male sex | 406 (62.7) | 188 (64.2) | 190 (60.9) | 28 (65.1) | 0.668 |
BMI, kg/m2 | 23.8 ± 3.5 | 23.7 ± 3.4 | 24.0 ± 3.5 | 23.1 ± 3.7 | 0.850 |
Significant alcohol drinking | 58 (9.0) | 29 (9.9) | 25 (8.0) | 4 (9.3) | 0.717 |
Underlying disease | |||||
Malignancy | 95 (14.7) | 48 (16.4) | 41 (13.1) | 6 (14.0) | 0.525 |
Biliary disease | 170 (26.2) | 81 (27.6) | 81 (26.0) | 8 (18.6) | 0.448 |
Diabetes mellitus | 183 (28.2) | 85 (29.0) | 82 (26.3) | 16 (37.2) | 0.304 |
Hypertension | 212 (32.7) | 101 (34.5) | 102 (32.7) | 9 (20.9) | 0.210 |
Chronic liver disease | 32 (4.9) | 15 (5.1) | 14 (4.5) | 3 (7.0) | 0.765 |
Previous liver abscess | 10 (1.5) | 5 (1.7) | 5 (1.6) | 0 (0.0) | 0.693 |
Vital sign at admission | |||||
Decreased mentality | 16 (2.6) | 8 (2.9) | 8 (2.7) | 0 (0.0) | 0.560 |
Systolic BP, mmHg | 117.4 ± 22.5 | 118.6 ± 23.1 | 116.2 ± 21.8 | 117.5 ± 23.0 | 0.314 |
Diastolic BP, mmHg | 71.5 ± 13.0 | 72.2 ± 13.1 | 70.7 ± 13.1 | 72.4 ± 12.4 | 0.391 |
Body temperature, °C | 37.3 ± 1.0 | 37.4 ± 1.1 | 37.2 ± 0.9 | 37.2 ± 0.9 | 0.003 |
Heart rates, /min | 88.2 ± 16.2 | 88.3 ± 16.1 | 87.7 ± 16.2 | 91.5 ± 16.7 | 0.647 |
Respiratory rates, /min | 19.3 ± 2.0 | 19.3 ± 2.0 | 19.2 ± 2.1 | 19.6 ± 2.0 | 0.799 |
Laboratory findings | |||||
WBC, /mm3 | 13.8 ± 6.9 | 13.0 ± 7.3 | 14.0 ± 6.3 | 16.7 ± 6.9 | 0.001 |
Hemoglobin, g/dL | 12.0 ± 2.0 | 12.2 ± 2.0 | 11.9 ± 1.9 | 11.0 ± 2.0 | 0.001 |
Platelet, × 1000/mm3 | 273.3 ± 221.8 | 239.6 ± 140.4 | 303.4 ± 283.5 | 285.1 ± 134.4 | 0.009 |
ESR, mm/hr | 65.9 ± 31.7 | 59.2 ± 31.2 | 70.4 ± 30.4 | 77.1 ± 35.6 | < 0.001 |
PT, INR | 1.2 ± 0.2 | 1.2 ± 0.2 | 1.2 ± 0.2 | 1.3 ± 0.1 | 0.001 |
Na, mmol/L | 135.7 ± 4.6 | 135.7 ± 4.6 | 135.8 ± 4.6 | 134.6 ± 4.7 | 0.542 |
AST, IU/L | 94.8 ± 152.0 | 87.6 ± 147.6 | 93.0 ± 148.0 | 157.8 ± 194.6 | 0.040 |
ALT, IU/L | 83.8 ± 105.3 | 80.0 ± 109.5 | 80.3 ± 88.2 | 134.2 ± 163.8 | 0.045 |
Total bilirubin, mg/dL | 1.4 ± 1.6 | 1.6 ± 1.9 | 1.3 ± 1.3 | 1.2 ± 1.0 | 0.029 |
Albumin, g/dL | 3.4 ± 0.5 | 3.5 ± 0.5 | 3.3 ± 0.5 | 3.0 ± 0.4 | < 0.001 |
Creatinine, mg/dL | 1.0 ± 0.9 | 1.0 ± 0.8 | 1.0 ± 0.9 | 1.0 ± 1.2 | 0.637 |
LD, IU/L | 582.0 ± 297.9 | 569.8 ± 303.3 | 576.7 ± 298.3 | 694.4 ± 240.5 | 0.110 |
hs-CRP, mg/L | 160.3 ± 84.6 | 139.8 ± 85.3 | 174.9 ± 81.0 | 193.3 ± 75.2 | < 0.001 |
PCT, ng/mL | 17.4 ± 28.6 | 19.9 ± 30.2 | 17.3 ± 28.8 | 4.6 ± 9.3 | 0.042 |
CT findings | |||||
Non-single lesion | 166 (25.6) | 88 (30.0) | 73 (23.4) | 5 (11.6) | 0.016 |
Cystic appearance | 334 (51.5) | 99 (33.8) | 198 (63.5) | 37 (86.0) | < 0.001 |
Multiloculated abscess | 391 (60.3) | 119 (40.6) | 239 (76.6) | 33 (76.7) | < 0.001 |
Characteristics of pyogenic liver abscess and clinical outcomes
Characteristics | Total (n = 648) | Maximal size of abscess | P value | ||
---|---|---|---|---|---|
< 5 cm (n = 293) | 5 ~ 10 cm (n = 312) | ≥ 10 cm (n = 43) | |||
Complications | |||||
Rupture | 18 (2.8) | 6 (2.0) | 8 (2.6) | 4 (9.3) | 0.025 |
Hematoma | 10 (1.5) | 2 (0.7) | 6 (1.9) | 2 (4.7) | 0.108 |
Biloma | 13 (2.0) | 5 (1.7) | 5 (1.6) | 3 (7.0) | 0.055 |
Venous thrombosis | 22 (7.5) | 21 (6.7) | 4 (9.3) | 47 (7.3) | 0.809 |
Extrahepatic manifestations | |||||
Pulmonary edema | 88 (13.6) | 31 (10.6) | 49 (15.7) | 8 (18.6) | 0.112 |
Pleural effusion | 207 (31.9) | 73 (24.9) | 110 (35.3) | 24 (55.8) | < 0.001 |
Ascites | 116 (17.9) | 40 (13.7) | 60 (19.2) | 16 (37.2) | 0.001 |
Invasive syndrome | 13 (2.0) | 6 (2.0) | 4 (1.3) | 3 (7.0) | 0.044 |
Antibiotic treatment only | 270 (41.7) | 148 (50.5) | 111 (35.6) | 11 (25.6) | < 0.001 |
Invasive procedure | |||||
Needle aspiration alone | 12 (1.9) | 12 (4.1) | 0 (0.0) | 0 (0.0) | < 0.001 |
PCD insertion | 366 (56.5) | 133 (45.4) | 201 (64.4) | 32 (74.4) | < 0.001 |
PCD insertion within 3 days | 269 (41.5) | 91 (31.1) | 149 (47.8) | 29 (67.4) | 0.037 |
Multiple PCD drainage | 78 (12.0) | 28 (9.6) | 36 (11.5) | 14 (32.5) | < 0.001 |
Salvage procedure | 235 (36.3) | 65 (22.2) | 143 (45.8) | 27 (62.8) | < 0.001 |
Duration of drainage, days | 12.6 ± 8.4 | 10.7 ± 5.5 | 12.1 ± 7.3 | 20.6 ± 14.3 | < 0.001 |
Admission days, days | 19.0 ± 12.1 | 17.4 ± 11.6 | 19.7 ± 11.3 | 24.0 ± 18.0 | < 0.001 |
In-hospital expire | 14 (2.2) | 4 (1.4) | 5 (1.6) | 5 (11.6) | < 0.001 |
Profiles of isolated microorganisms
Characteristics | Total (n = 648) | Maximal size of abscess | P value | ||
---|---|---|---|---|---|
< 5 cm (n = 293) | 5 ~ 10 cm (n = 312) | ≥ 10 cm (n = 43) | |||
Positive culture results | 326 (50.4) | 147 (50.2%) | 158 (50.8%) | 21 (48.8%) | 0.966 |
Monomicrobial | 290 (44.8) | 131 (44.7) | 139 (44.6) | 20 (46.5) | 0.971 |
Polymicrobial | 36 (5.6) | 16 (5.5) | 19 (6.1) | 1 (2.3) | 0.598 |
Isolated microorganisms | |||||
Gram (−) organisms | |||||
Klebsiella pneumoniae | 236 (36.4) | 106 (36.2) | 118 (37.8) | 12 (27.9) | 0.445 |
Escherichia coli | 34 (5.2) | 16 (5.5) | 16 (5.1) | 2 (4.7) | 0.967 |
Aeromonas species | 2 (0.3) | 1 (0.3) | 1 (0.3) | 0 (0.0) | 0.930 |
Enterobacter species | 15 (2.3) | 8 (2.7) | 6 (1.9) | 1 (2.3) | 0.804 |
Acinetobacter species | 2 (0.3) | 0 (0.0) | 2 (0.6) | 0 (0.0) | 0.340 |
Pseudomonas species | 9 (1.4) | 4 (1.4) | 5 (1.6) | 0 (0.0) | 0.701 |
Citrobacter species | 2 (0.3) | 0 (0.0) | 2 (0.6) | 0 (0.0) | 0.340 |
Others | 6 (0.9) | 3 (1.0) | 2 (0.6) | 1 (2.3) | 0.542 |
Gram (+) organisms | |||||
Streptococcus species | 30 (4.6) | 13 (4.4) | 14 (4.5) | 3 (7.0) | 0.750 |
Staphylococcus species | 20 (3.1) | 8 (2.7) | 9 (2.9) | 3 (7.0) | 0.310 |
Enterococcus species | 7 (1.1) | 2 (0.7) | 5 (1.6) | 0 (0.0) | 0.427 |
Clostridium species | 1 (0.2) | 1 (0.3) | 0 (0.0) | 0 (0.0) | 0.545 |
Others | 3 (0.5) | 2 (0.7) | 1 (0.3) | 0 (0.0) | 0.725 |
Fungus | 1 (0.2) | 0 (0.0) | 1 (0.3) | 0 (0.0) | – |
Findings of colonoscopic examination
Factors associated with prolonged hospitalization
Univariate analysis | Multivariate analysis | |||||||
---|---|---|---|---|---|---|---|---|
P value | OR | Lower CI | Upper CI | P value | OR | Lower CI | Upper CI | |
Age ≥ 65 years, vs < 65 | 0.208 | 1.24 | 0.89 | 1.72 | ||||
Male sex | 0.023 | 0.68 | 0.49 | 0.95 | 0.762 | 0.912 | 0.501 | 1.659 |
Malignancy | 0.006 | 1.88 | 1.19 | 2.96 | 0.139 | 1.784 | 0.829 | 3.835 |
Biliary disease | 0.884 | 1.03 | 0.71 | 1.49 | ||||
DM | 0.005 | 1.67 | 1.17 | 2.38 | 0.019 | 2.018 | 1.120 | 3.634 |
HTN | 0.032 | 1.45 | 1.03 | 2.05 | 0.478 | 1.234 | 0.690 | 2.207 |
Significant alcohol consumption | 0.667 | 0.88 | 0.49 | 1.55 | ||||
Decreased mentality at admission | 0.993 | 1.00 | 0.31 | 2.95 | ||||
Shock at admission | 0.285 | 1.51 | 0.70 | 3.19 | ||||
WBC ≥ 12,000 /mm3, at baseline | 0.129 | 1.29 | 0.93 | 1.80 | ||||
Hb < 10 mg/dL, at baseline | 0.196 | 1.35 | 0.85 | 2.11 | ||||
Na < 130 mmol/L, at baseline | 0.534 | 1.16 | 0.72 | 1.85 | ||||
ALT ≥ 200 IU/L, at baseline | 0.012 | 2.23 | 1.20 | 4.19 | 0.459 | 1.493 | 0.517 | 4.315 |
Albumin < 3 g/dL | 0.002 | 1.875 | 1.253 | 2.805 | 0.048 | 2.009 | 1.007 | 4.009 |
hs-CRP ≥ 200 mg/L, at baseline | < 0.001 | 1.91 | 1.35 | 2.70 | 0.024 | 2.008 | 1.094 | 3.684 |
PCT ≥ 5 ng/mL, at baseline | 0.009 | 1.99 | 1.19 | 3.34 | 0.041 | 1.946 | 1.029 | 3.680 |
Non-single abscess lesion | 0.134 | 1.33 | 0.91 | 1.92 | ||||
Maximal abscess diameter (< 5 cm, 5 ~ 10 cm, ≥10 cm) | < 0.001 | 1.84 | 1.40 | 2.44 | 0.007 | 1.962 | 1.206 | 3.191 |
PCD insertion during admission | < 0.001 | 1.82 | 1.30 | 2.56 | 0.093 | 1.835 | 0.903 | 3.732 |
PCD insertion within 3 days of admission | 0.114 | 0.68 | 0.43 | 1.10 | ||||
Culture positive (blood or pus) | 0.001 | 1.75 | 1.26 | 2.44 | 0.310 | 1.355 | 0.754 | 2.437 |
Klebsiella pneumoniae isolation | 0.068 | 1.364 | 0.978 | 1.902 | ||||
SIRS criteria at admission | 0.065 | 1.16 | 0.99 | 1.36 | ||||
qSOFA score ≥ 2 at admission | 0.756 | 1.22 | 0.31 | 4.33 | ||||
AKI at admission | 0.011 | 1.760 | 1.141 | 2.714 | 0.363 | 0.708 | 0.337 | 1.490 |
Factors associated with in-hospital mortality
Univariate analysis | Multivariate analysis | |||||||
---|---|---|---|---|---|---|---|---|
P value | OR | Lower CI | Upper CI | P value | OR | Lower CI | Upper CI | |
Age ≥ 65 years, vs < 65 | 0.046 | 1.63 | 1.25 | 29.88 | 0.969 | 0.963 | 0.146 | 6.341 |
Male sex | 0.889 | 1.07 | 0.37 | 3.53 | ||||
Malignancy | 0.006 | 4.59 | 1.48 | 13.52 | 0.120 | 3.581 | 0.717 | 17.892 |
Biliary disease | 0.013 | 3.88 | 1.33 | 11.96 | 0.133 | 0.294 | 0.060 | 1.450 |
DM | 0.569 | 0.69 | 0.15 | 2.23 | ||||
HTN | 0.369 | 0.55 | 0.12 | 1.80 | ||||
Decreased mentality at admission | 0.016 | 6.99 | 1.03 | 28.97 | 0.285 | 0.126 | 0.003 | 5.621 |
Shock at admission | 0.131 | 3.28 | 0.50 | 12.78 | ||||
WBC ≥ 12,000 /mm3, at baseline | 0.035 | 5.03 | 1.36 | 32.47 | 0.743 | 0.747 | 0.131 | 4.271 |
Hb < 10 mg/dL, at baseline | 0.009 | 4.88 | 1.30 | 15.21 | 0.221 | 0.370 | 0.075 | 1.822 |
Na < 130 mmol/L, at baseline | 0.405 | 1.73 | 0.39 | 5.69 | ||||
ALT ≥200 IU/L, at baseline | 0.005 | 5.50 | 1.46 | 17.20 | 0.095 | 4.582 | 0.766 | 27.406 |
Albumin < 3 g/dL | 0.002 | 5.700 | 1.942 | 16.734 | 0.061 | 4.284 | 0.937 | 19.591 |
hs-CRP ≥ 200 mg/L, at baseline | 0.029 | 3.53 | 1.16 | 11.82 | 0.055 | 4.776 | 0.969 | 23.543 |
PCT ≥ 10 ng/mL, at baseline | 0.069 | 7.73 | 1.12 | 152.44 | ||||
Non-single abscess lesion | 0.044 | 2.99 | 1.01 | 8.85 | 0.109 | 0.293 | 0.065 | 1.312 |
Maximal abscess diameter (< 5 cm, 5 ~ 10 cm, ≥10 cm) | 0.006 | 3.221 | 1.397 | 7.423 | 0.037 | 3.399 | 1.075 | 10.741 |
PCD insertion during admission | 0.304 | 0.57 | 0.19 | 1.66 | ||||
PCD insertion within 3 days of admission | 0.587 | 1.82 | 0.29 | 35.07 | ||||
Culture positive (blood or pus) | 0.111 | 0.386 | 0.120 | 1.245 | ||||
Klebsiella pneumoniae isolation | 0.254 | 0.473 | 0.131 | 1.711 | ||||
SIRS criteria at admission | 0.078 | 1.54 | 0.94 | 2.50 | ||||
qSOFA score ≥ 2 at admission | 0.005 | 10.40 | 1.50 | 45.28 | 0.566 | 0.358 | 0.011 | 11.968 |
AKI at admission | < 0.001 | 22.708 | 6.212 | 83.016 | 0.001 | 12.023 | 2.639 | 54.786 |