Management practices and predictors of outcome of Liver abscess in adults: a series of 1630 patients from a liver unit
2020
Abstract Background The management practices of liver abscess (LA) have evolved over time. The precise diagnosis of etiology and complications is pivotal for appropriate management. Methods Descriptive analyses of consecutive patients treated for LA using electronic medical records at a liver unit between years 2010-2020 and investigate relationships between clinical, imaging, laboratory and microbiological findings, treatment strategies and mortality. Results Of 1630 LA patients, the most common etiologies were amoebic liver abscess (ALA;81%) and pyogenic liver abscess(PLA;10.3%, mainly related to biliary disease and/or obstruction). Abdominal pain(86%) and fever (85.3%) were the commonest presenting symptoms (median duration-10 days). Almost 10% had jaundice at presentation, 31.1% were diabetic, 35.5% had chronic alcohol use and 3.3% had liver cirrhosis. Nearly 54% LA were solitary, 77.7% localized to right liver lobe (most commonly segment VII/VIII). Patients with large LA (>10cm,11.9%) had more frequent jaundice and abscess rupture (p-0.01). Compared to ALA, patients with PLA were older, more often had multiple and bilobar abscesses with local complications. Over four-fifth of patients received percutaneous interventions [catheter drainage(PCD;36.1%) alone and needle aspiration(PNA) plus PCD(34.1%) as most common]. 58 patients underwent endoscopic retrograde cholangiography for intrabiliary abscess rupture(n=36) or cholangitic abscess(n=22). The median duration of hospital stay and PCD were 7(4 to 10) days and 5(4 to 8 days) respectively. The overall in-hospital mortality was 1.1%. Presence of septic encephalopathy (HR: 20.8; 95% CI: 1.9-220.7; p-0.012), liver cirrhosis (HR: 20.1; 95% CI: 2.7-146.9; p-0.003) and jaundice (HR: 7.6; 95% CI:1.7-33.1; p-0.006) were independent predictors of mortality. Conclusions The commonest presentation was middle age male with right lobe solitary ALA. Patients with large, bilobar and/or pyogenic abscess had more complications. Nearly 70% patients require percutaneous interventions, which if given early improve treatment outcomes. Presence of jaundice, liver cirrhosis and septic encephalopathy were independent predictors of mortality.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
23
References
3
Citations
NaN
KQI