Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses

Abstract

Background Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST. Methods We reviewed the medical charts of all of our institution’s adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST ( n = 41 patients) and non-ST ( n = 255). A comparison between groups was performed. Results The overall median age was 68 years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10 days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group ( p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST ( p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10 days on presentation comprised the risk factors that indicated the need to perform ST. Conclusions There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10 days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD.

Demographics and prognosis of patients with pyogenic liver abscess due to Klebsiella pneumonia or other species

“…The prevalence of KPPLA has increased significantly worldwide [ 14 , 15 ], and KP was previously reported as the most common pathogen in Chinese patients with PLA [ 4 , 6 ], consistent with our results. However, we found a lower overall mortality rate (2.9 %) than reported by Yu et al (7.8 %, 5/64) [ 1 ], and in other previous studies [ 8 ].…”

Current Management of Liver Abscess: A Narrative Review

“…Liver abscess that is due to biliary disease or tumors, duration of symptoms that are more than 10 days are risk factors that favor surgical drainage. In patients who present with large multiloculated liver abscess and those who have underlying sepsis, surgical drainage should be the treatment of choice [42,43].…”