A Population-Based Study of Unfavorable Prognostic Factors Associated With Pyogenic Liver Abscess

Abstract

Aim Pyogenic liver abscess (PLA) is a rare entity but, is associated with substantial mortality and morbidity. Our objective was to investigate variables associated with mortality and subsequent PLA in patients diagnosed with PLA in Southern Sweden. Methods We conducted a population-based observational study comprising all episodes of PLA that occurred between 2011 and 2020 in the county of Skåne, southern part of Sweden. The primary outcome was defined as all-cause 90-day mortality and the secondary outcome was defined as the occurrence of a subsequent PLA. Results A total of 452 episodes of PLA occurred in 360 patients during the study period. The 90-day mortality rate was 16% (n = 58) and the subsequent PLA rate was 20% (n = 92). In a multivariable logistic regression model, female sex (OR 2.0, 95% CI 1.1-3.9), malignancy (OR 3.7, 95% CI 1.9-7.1), liver failure (OR 6.3, 95% CI 2.7-14.5) and polymicrobial findings (OR 3.8, 95% CI 2.2-6.9) were associated with death within 90 days, p < 0.05. Male sex (OR 2.1, 95% CI 1.2-3.6), malignancy (OR 2.2, 95% CI 1.3-3.6), age (65-74 years) (OR, 2.2, 95% CI 1.2-4.1) and chronic liver disease (OR 3.0, 95% CI 1.4-6.4) were associated with the risk of subsequent PLA, p ≤ 0.01. Conclusions Identifying different clinical variables associated with an unfavourable outcome may improve the management and treatment of patients with PLA and thus prevent the risk of death and subsequent PLA.

Clinical management, pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital

“…Despite the use of antibiotics in almost all PLA patients, the majority required additional intervention sooner or later. This was also observed in other studies 18 , 35 – 37 , 40 , 46 . In contrast to ALA, antibiotic therapy alone is usually not sufficient to treat PLA.…”

“…This study also confirms some well-known PLA characteristics from the literature: the preponderance of males, “typical” symptoms (e.g. abdominal pain, fever) and the predominant involvement of the right liver lobe (Table 1 ) 19 , 35 – 38 , 40 , 41 , 45 , 46 . Biliary malignancies, cholelithiasis, and ischemic bile duct disease were the most frequent causes for PLA in our study.…”