Factors related to complications and mortality in pyogenic liver abscesses

Abstract

Background: Pyogenic liver abscess (PLA) is the most common type of visceral abscess. We recorded multiple variables of the disease and assessed those associated with disease severity and mortality. Methods: The medical records of 33 patients were reviewed. Results: Source of infection was identified in 27.8% of cases. The majority of PLA were located in the right lobe. The most common isolated microorganism was Escherichia coli. Complications including basilar infiltrates, pleural effusions, pylephlebitis and septic shock developed in 12 cases (36.4%). Factors associated with complications on univariate analysis were the large size of the abscess (p < 0.05, OD 1.8, 95% CI 1.7-2.1), a urea level more than 55 mg/dl at presentation (p < 0.05, OD 1.7, 95% CI 1.5-1.9) and delay in diagnosis (p < 0.05, OD 1.3, 95% CI 0.9-1.6). Two deaths (6%) from sepsis were recorded. Factors associated with mortality on univariate analysis were bilirubin > 2 mg/dl (p < 0.05, OD 1.0, 95% CI 0.9-1.1), antibiotics alone without prompt drainage (p < 0.05, OD 1.3, 95% CI 1.1-1.5), bilobar involvement (p < 0.05, OD 1.3, 95% CI 1.1-1.5) and occurrence of complications (p = 0.05, OD 1.0, 95% CI 0.9-1.1). Conclusions: Our results suggest that the prognosis in PLA is related to severity of medical condition and early diagnosis and management. PLA still remains a clinical entity with high morbidity and mortality.