Pyogenic liver abscesses: a comparison of older and younger patients

Smoger, Steven H.; Mitchell, Charlene K.; McClave, Stephen A.

doi:10.1093/ageing/27.4.443

Cited by 25 publications

(31 citation statements)

References 19 publications

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“…Moreover, this study revealed that presenting RUQ tenderness in older patients occurred less frequently than in the young despite the higher frequency of biliary aetiology/ disorders in older patients. However, our data did not support the postulation by Smoker et al [8], as this subtle feature in older patients may contribute to a delay in PLA diagnosis. The mean duration of symptoms prior to admission was 5.3 days and the mean time until diagnosis of PLA was made after admission was 1.4 days in older patients, which is shorter than the corresponding times reported in previous studies [8,12,13].…”

Section: Discussioncontrasting

confidence: 99%

“…First, some discrepancies in clinical features existed between the older and younger PLA patients. As described in the literature [8,12,13], older PLA patients are more likely to have a biliary abnormality/aetiology or underlying malignancy, whereas younger PLA patients are more likely to be males, to have RUQ tenderness, alcoholism and a cryptogenic aetiology. Polymicrobial or anaerobic infections with MDR organisms, a pleural effusion, inappropriate initial antibiotic selection and a greater severity of illness on admission occur more frequently in older PLA patients than younger patients.…”

Section: Discussionmentioning

confidence: 95%

“…Interestingly, older PLA patients with a positive culture for K. pneumoniae had a better prognosis than older patients without K. pneumoniae. The published studies [8,12,13] regarding older PLA patients have several limitations, primarily related to small sample sizes. Each of the three studies included <20 patients, and these studies lack an analysis of bacterial characteristics, detailed information regarding outcome or a comparison group of younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators have hypothesised that advanced age might be one of the prognostic factors for mortality in PLA patients [4]. While several groups have attempted to explore the discrepancies in clinical features and prognosis between younger and older patients [8,12,13], there was either lack of an appropriate comparison group or a small sample size in these reports. In addition, the effectiveness of percutaneous catheter drainage (PCD)/percutaneous needle aspiration (PNA), the current first-line treatment for PLA, remains unclear in older patients.…”

Section: Introductionmentioning

confidence: 99%

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Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors

et al. 2008

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Background: pyogenic liver abscess (PLA) is a potentially life-threatening disease in middle-to-old aged persons. Objective: to compare the differences in clinical features and outcomes between older and younger PLA patients, and to identify predictors of outcomes in older patients. Design: retrospective chart review of all PLA patients between July 1999 and June 2007. Setting: a 1,600-bed primary and tertiary care centre. Subjects: in total, 339 patients were enrolled and included 118 ≥65 years of age (the elderly group) and 221 patients <65 years of age (the non-elderly group). Methods: clinical features, laboratory, imaging and microbiologic findings, treatment and outcomes for each of the included patients were collected. The predictor of outcome was determined using logistic regression and purposeful selection of covariates. Results: the elderly group had a higher APACHE II score on admission, a biliary abnormality, a malignancy, a pleural effusion, polymicrobial, anaerobic or multi-drug-resistant isolates, inappropriate initial antibiotics, a longer hospitalisation and a longer parenteral antibiotic treatment period than the non-elderly group, whereas the non-elderly group was more likely to be alcoholic men with cryptogenic origin of abscess and Klebsiella pneumoniae infection. There was no difference in case fatality between the elderly (13.6%) and non-elderly (8.6%) groups despite the elderly group having a poorer host status on admission. In multivariate analysis, age (P = 0.028) and APACHE II score at admission ≥15 (P = 0.001) were risk factors, but K. pneumoniae infection (P = 0.012) was a protective factor for fatality in older PLA patients. Conclusions: these data suggest that older PLA patients wound have a fair outcome compared to younger patients, but require longer hospitalisations.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors

et al. 2008

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“…1 This parallels the increased incidence of biliary tract disease in older populations. 3,4 Risk factors for pyogenic liver abscess include male sex, advanced age, biliary tract disease, diabetes mellitus, liver transplantation, malignancy and percutaneous treatments for hepatocellular carcinoma, including radiofrequency ablation. 1,5 The most common clinical features include fever (73%), chills (45%) and right upper quadrant pain (38%).…”

Section: Discussionmentioning

confidence: 99%

Persistent epigastric pain in an 80-year-old man

MacFadden¹,

Penner²,

Gold³

2011

Canadian Medical Association Journal

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A n 80-year-old man presented with a one-week history of constant epigastric pain and left-sided exertional chest pain. On the day of presentation, he had experienced four episodes of nonbilious vomiting, but had no other gastrointestinal symptoms. He did not report fever, chills or sweats. There was no history of recent travel or contact with an ill person. His medical history included hypertension, type 2 diabetes mellitus, dyslipidemia, prior myocardial infarction with left ventricular dysfunction, and a left hemicolectomy for adenocarcinoma of the colon, which was in remission.He was afebrile, his heart rate was 112 beats/ min and his blood pressure was 123/71 mm Hg. Except for mild tenderness in the upper abdominal quadrants, his physical examination was normal. The results of laboratory investigations are summarized in Table 1. Electrocardiography showed a first-degree atrioventricular block with sinus bradycardia.The patient was admitted with a diagnosis of non-ST-segment elevation myocardial infarction and received evidence-based therapies. His chest pain resolved; however, his epigastric pain persisted.What is the next step in investigating his persistent epigastric pain? a. Abdominal ultrasonography b. Contrast-enhanced computed tomography (CT) of the abdomen c. Plain radiography of the abdomen d. Exploratory laparotomy or laparoscopy e. EsophagogastroduodenoscopyTo further investigate his epigastric pain, in association with newly elevated liver enzymes, (a) abdominal ultrasonography was first performed followed by (b) contrast-enhanced CT of the abdomen. Ultrasonography showed two hypoechoic lesions in the liver, the largest measuring 3.0 × 3.1 × 3.3 cm; one of the lesions had a cystic component. The biliary tract was normal. The contrast-enhanced CT scan of the abdomen showed two rim-enhancing lesions, the largest measuring 5.9 × 3.7 cm. A curved, calcified foreign body was identified, spanning between the gastric antrum and one of the liver lesions (Figure 1)

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