Table 2.
Analysis of demographic data, clinical features, concomitant diseases and outcome among 134 patients with primary pyogenic liver abscess
| |
Survivor |
Mortality |
Total |
|
Univariate logistic regression analysis |
|
|
|---|---|---|---|---|---|---|---|
| N = 128 (%) | N = 6 (%) | N = 134(%) | p value | Odds ratio | 95% confidence interval | P-value | |
| Demographic data |
|
|
|
|
|
|
|
| Gender, male (%) |
34 (26.6%) |
5 (83.3%) |
39 (29.1%) |
<0.001 |
1.879 |
2.284–11.130 |
0.006 |
| Age, mean ± SD*1 (years) |
53.6 ± 18.9 |
67.5 ± 7.4 |
59.4 ± 16.3 |
0.705 |
|
|
|
| Length of hospitalization, mean ± SD (days) |
10.2 ± 8.3 |
17.2 ± 6.3 |
14.2 ± 7.3 |
0.612 |
|
|
|
| Underlying diseases & co-morbidity |
|
|
|
|
|
|
|
| Category C of disease severity on admission a*2, mean ± SD |
15 (11.7%) |
2 (33.3%) |
17 (10.4%) |
0.025 |
|
|
|
| Coexisting diseases, no. (%) |
|
|
|
|
|
|
|
| Diabetes mellitus |
84 (65.6%) |
2 (33.3%) |
86 (64.2%) |
0.055 |
|
|
|
| Biliary disorders*3 |
44 (34.4%) |
4 (66. 7%) |
48 (35.8%) |
0.055 |
|
|
|
| Alcoholism |
45 (35.2%) |
2 (33.3%) |
47 (35.1%) |
1.000 |
|
|
|
| Liver cirrhosis |
46 (35.9%) |
3 (50%) |
49 (36.6%) |
0.530 |
|
|
|
| Malignancy*4 |
37 (28.9%) |
4 (66. 7%) |
41 (30.6%) |
<0.001 |
2.067 |
1.174–13.130 |
0.004 |
| Uremia |
49 (38.3%) |
3 (50%) |
52 (37.6%) |
0.750 |
|
|
|
| Delay issue |
|
|
|
|
|
|
|
| Patient delay (days), mean (range) |
10 (1–124) |
9 (1–91) |
|
0.569 |
|
|
|
| Total delay (days), mean (range) |
19 (1–124) |
17 (1–91) |
|
0.459 |
|
|
|
| Symptoms and signs on admission, no. (%) |
|
|
|
|
|
|
|
| Fever/chills |
118 (92.2%) |
4 (66.7%) |
122 (91.0%) |
0.069 |
|
|
|
| Abdominal pain |
117 (91.4%) |
5 (83.3%) |
122 (91.0%) |
0.256 |
|
|
|
| Anorexia |
12 (9.4%) |
2 (33.3%) |
14 (10.5%) |
0.056 |
|
|
|
| Malaise |
115 (89.9%) |
5 (83.3%) |
120 (89.6%) |
0.322 |
|
|
|
| Nausea/emesis |
114 (89.1%) |
4 (66.7%) |
118 (12.7%) |
0.057 |
|
|
|
| Respiratory distress*5 |
15 (11.7%) |
3 (50%) |
18 (13.4%) |
0.007 |
1.667 |
1.164–14.210 |
0.006 |
| Signs on admission, no. (%) |
|
|
|
|
|
|
|
| Body temperature > 38.3°C |
111 (86.7%) |
6 (100%) |
117 (87.3%) |
0.358 |
|
|
|
| Blood pressure < 90/60 mmHg |
38 (29.7%) |
2 (33.3%) |
40 (29.8%) |
0.001 |
2.167 |
2.104–13.150 |
0.003 |
| Right upper quadrant tenderness |
109 (85.2%) |
3 (50%) |
112 (83.6%) |
0.701 |
|
|
|
| Jaundice |
20 (15.6%) |
5 (83.3%) |
25 (18.7%) |
<0.001 |
1.900 |
1.246–3.297 |
0.008 |
| Murphy's sign*6 |
21 (16.4%) |
1 (16.7%) |
22 (16.4%) |
0.869 |
|
|
|
| Hepatomegaly |
22 (17.2%) |
0 (0%) |
22 (16.4%) |
0.125 |
|
|
|
| Disturbance of consciousness |
23 (17.8%) |
1 (16.7%) |
24 (17.9%) |
0.980 |
|
|
|
| Ascites |
24 (18.8%) |
1 (16.7%) |
25 (18.7%) |
1.000 |
|
|
|
| Source of infection, no. (%) |
|
|
|
|
|
|
|
| Biliary origin*7 |
32 (25%) |
4 (66.7%) |
36 (26.9%) |
0.069 |
|
|
|
| Cryptogenic origin |
33 (25.8%) |
1 (16.7%) |
34 (25.4%) |
0.729 |
|
|
|
| Sonographic findings at first examination, no (%) |
|
|
|
|
|
|
|
| Negative findings and equivocal |
5 (83.3%) |
1 (16.7%) |
6 (4.5%) |
0.077 |
|
|
|
| Single abscesss (77%) |
101 (98.1%) |
2 (1.9%) |
103 (77%) |
0.063 |
|
|
|
| Right lobe (72.3%) |
95 (97.9%) |
2 (2.1%) |
97 (72.3%) |
0.071 |
|
|
|
| Multiple abscesses (23%) |
30 (96.8%) |
1 (3.2%) |
31(23%) |
1.000 |
|
|
|
| Gas formation |
27 (96.4%) |
1 (3.6%) |
28 (20.9%) |
1.000 |
|
|
|
| Difficulty at initial aspiration |
8 (88.9%) |
1 (11.1%) |
9 (6.7%) |
0.161 |
|
|
|
| Microbiology |
|
|
|
0.028 |
|
|
|
|
Klebsiella pneumonia |
93 (97.9%) |
2 (2.1%) |
95 (70.8%) |
|
|
|
|
| Non- Klebsiella GNB |
28 (90.3%) |
3 (9.7% ) |
31 (23.1%) |
|
|
|
|
| Aerobic GPC |
4 (80%) |
1 (20%) |
5 (3.7%) |
|
|
|
|
| Anaerobes |
1 (100%) |
0 |
1 (0.4%) |
|
|
|
|
| Mixed infection |
2 (100%) |
0 |
2 (1.4%) |
|
|
|
|
| Treatment |
|
|
|
|
|
|
|
| Doctor delay of effective antibiotics therapy (days), mean (range) |
8 (0–33) |
4 (0–37) |
|
0.101 |
|
|
|
| Prolonged doctor delay of effective antibiotics therapy (>8 days) |
78 (61.5%) |
2 (33.3%) |
|
0.118 |
|
|
|
| Delay of aspiration/drainage (days), mean (range) |
9 (0–33) |
7 (0–27) |
|
0.201 |
|
|
|
| Prolonged delay of aspiration/drainage therapy (>9 days) |
78 (61.5%) |
1 (16.7%) |
|
0.008 |
|
|
|
| Complications, no. (%) |
|
|
|
|
|
|
|
| Rupture of liver abscess |
0 (0%) |
2 (33.3%) |
2 (1.5%) |
<0.001 |
5.167 |
2.194–23.150 |
0.003 |
| Endophthalmitis, related to PPLA |
7 (5.6%) |
2 (33.3%) |
9 (6.7%) |
0.003 |
2.167 |
1.234–13.140 |
0.005 |
| Multiple organ failure, related to PPLA | 4 (3.1%) | 6 (100%) | 10 (7.5%) | <0.001 | 3.067 | 1.184–15.150 | 0.001 |
P-value by Chi-square test or Fisher's exact test when appropriated.
Abbreviation: GNB Gram negative bacilli, GPC Gram positive cocci.
Notes:*1SD standard deviation, *2Disease severity was categorized according to McCabe & Jackson criteria, and Category C meant the rapid fatal group; *3Biliary disorders including biliary stone diseases (cholelithiasis, choledocholithiasis, or hepatolithiasis) and prior hepatobiliary; surgery; *4Malignancy including lung cancer, pancreatic cancer, breast cancer, esophagus cancer, stomach cancer, colon cancer, lymphoma, prostate cancer, hematological malignancy, oral cancer, solid tumor and large intestines. Non-digestive system cancer; *5Respiratory distress including shortness of breath, dyspnea, chest distress, hypoxemia (saturation of oxygen is less than 95%); *6Murphy’s sign: deep inspiration or cough during subcostal palpation of RUQ producing increased pain and inspiratory arrest; *7Biliary origin of liver abscess including suppurative cholangitis and acute cholecystitis.