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Large retrospective study analysing predictive factors of primary treatment failure, recurrence and death in pyogenic liver abscesses

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Abstract

Purpose

Pyogenic liver abscess (PLA) is a severe disease, which unfavourable evolution remains frequent. Our objective was to assess predictive factors of unfavourable outcome in patients with PLA.

Methods

We conducted a retrospective study in a French tertiary care centre. All patients admitted for PLA between 2010 and 2018 were included. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence of PLA after an initial cure, or death within 3 months after diagnosis. Hazard ratios (95% CI) were calculated with multivariable Cox proportional hazard models.

Results

302 patients were included among which 91 (30.1%) patients had an unfavourable outcome because of PTF, recurrence or death in 55 (18.2%), 28 (9.2%) and 32 (10.6%) patients, respectively. Hepatic metastases (HR 2.08; 95% CI 1.04–4.15), a nosocomial infection (2.25; 1.14–4.42), portal thrombosis (2.12; 1.14–3.93), and the isolation of Enterococcus spp. (2.18; 1.22– 3.90) were independently associated with PTF. Ischemic cholangitis (6.30; 2.70–14.70) and the isolation of Streptococcus spp. (3.72; 1.36–10.16) were associated with the risk of recurrence. Charlson comorbidity index (HR 1.30 per one point; 95% CI 1.15–1.46; p < 0.001), portal thrombosis (3.53; 1.65–7.56) and the presence of multi-drug-resistant organisms (3.81; 1.73–8.40) were associated with mortality within 3 months following PLA diagnosis. PLA drainage was the only factor associated with a lower mortality (0.14; 0.06–0.34).

Conclusion

Identification of specific risk factors may help to improve the management of PLA and to elaborate targeted recommendations according to patient’s and disease’s characteristics.

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Acknowledgements

We thank Roza Rahli for her contribution to data entry, and Victoire de Lastours for reviewing the English text.

Funding

No external funding was received.

Author information

Authors and Affiliations

  1. Service de Médecine Interne, Hôpital Beaujon, Assistance Publique—Hôpitaux de Paris, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Geoffrey Rossi, Yann Nguyen, Emmanuel Lafont, Benjamin Rossi, Etienne Canouï, Bruno Fantin & Agnès Lefort

  2. Service d’Hépatologie, Hôpital Beaujon, Assistance Publique—Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Olivier Roux

  3. Service de Chirurgie Viscérale Et Digestive, Hôpital Beaujon, Assistance Publique—Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Safi Dokmak

  4. Service de Microbiologie, Hôpital Beaujon, Assistance Publique—Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Frédéric Bert

  5. Service de Médecine Interne, Hôpital Robert Ballanger, 93600, Aulnay-sous-bois, France

    Benjamin Rossi & Bruno Fantin

  6. IAME, UMR1137, Université de Paris and INSERM, Paris, France

    Agnès Lefort

Authors
  1. Geoffrey Rossi
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  2. Yann Nguyen
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  3. Emmanuel Lafont
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  4. Benjamin Rossi
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  5. Etienne Canouï
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  6. Olivier Roux
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  7. Safi Dokmak
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  8. Frédéric Bert
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  9. Bruno Fantin
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  10. Agnès Lefort
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Contributions

Study conception and design: RG, LA. Acquisition of data: RG, LE, CE, RB, RO, DS, BF, LA, FB Analysis and interpretation of data: RG, NY, LA Drafting and writing of the manuscript: RG, LA All authors were involved in revising the manuscript, and all authors approved the final version to be published. AL and GR have full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analyses.

Corresponding authors

Correspondence to Geoffrey Rossi or Agnès Lefort.

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Conflict of interests

All authors have declared no conflicts of interest related to this work.

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Rossi, G., Nguyen, Y., Lafont, E. et al. Large retrospective study analysing predictive factors of primary treatment failure, recurrence and death in pyogenic liver abscesses. Infection 50, 1205–1215 (2022). https://doi.org/10.1007/s15010-022-01793-z

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  • DOI: https://doi.org/10.1007/s15010-022-01793-z

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