Abstract
Background
Acute kidney injury (AKI) can occur in various infectious conditions. Liver abscess is relatively rare, but can lead to sepsis and/or other severe complications. Few studies of AKI in patients with a liver abscess have been conducted. Therefore, we analyzed the clinical and laboratory data of AKI in patients with a liver abscess.
Methods
We retrospectively reviewed the medical records of patients who were diagnosed with a liver abscess from January 2000 to March 2013. The study included 404 patients with a liver abscess confirmed by clinical presentation and computed tomography.
Results
AKI occurred in 137 patients (34 %). As per RIFLE classification, renal injury was graded as either at risk of renal dysfunction (35.8 %), renal injury (47.4 %), and renal failure (16.5 %). AKI occurred more frequently in males and patients with liver cirrhosis (P < 0.001 and P = 0.005). Patients with AKI had lower serum albumin and higher AST and ALT levels than did patients without AKI. Bacteria were frequently isolated in AKI patients from blood culture and liver abscess aspirates (P < 0.001 and P = 0.007). The occurrence of septic shock was positively correlated with AKI (P = 0.002) and AKI was more frequent in patients with chronic kidney disease (P = 0.04). Higher mortality was observed in CKD patients accompanied by AKI (P < 0.001). Three patients with AKI underwent hemodialysis; two patients who had initially normal renal function completely recovered whereas one CKD patient progressed to ESRD, requiring maintenance hemodialysis.
Conclusion
AKI is relatively common in patients with liver abscess. Physicians should therefore attempt to prevent, detect, and manage AKI early in patients with liver abscess.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs10157-014-1016-8/MediaObjects/10157_2014_1016_Fig1_HTML.gif)
Similar content being viewed by others
References
Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol. 2004;2:1032–8.
Chen W, Chen CH, Chiu KL, et al. Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care. Crit Care Med. 2008;36:1184–8.
Jepsen P, Vilstrup H, Schonheyder HC, et al. A nationwide study of the incidence and 30-day mortality rate of pyogenic liver abscess in Denmark, 1977–2002. Aliment Pharmacol Ther. 2005;21:1185–8.
Meddings L, Myers RP, Hubbard J, et al. A population-based study of pyogenic liver abscesses in the United States: Incidence, mortality, and temporal trends. Am J Gastroenterol. 2010;105:117–24.
Tsai FC, Huang YT, Chang LY, et al. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis. 2008;14:1592–600.
Wang JH, Liu YC, Lee SS, et al. Primary liver abscess due to klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26:1434–8.
Keynan Y, Rubinstein E. Diabetes mellitus and pyogenic liver abscess: Risk and prognosis. Clin Infect Dis. 2007;45:801.
Wong WM, Wong BC, Hui CK, et al. Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period. J Gastroenterol Hepatol. 2002;17:1001–7.
Mischinger HJ, Hauser H, Rabl H, et al. Pyogenic liver abscess: Studies of therapy and analysis of risk factors. World J Surg. 1994;18:852–7 discussion 858.
Alvarez Perez JA, Gonzalez JJ, Baldonedo RF, et al. Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess. Am J Surg. 2001;181:177–86.
Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: Recent trends in etiology and mortality. Clin Infect Dis. 2004;39:1654–9.
Ruiz-Hernandez JJ, Leon-Mazorra M, Conde-Martel A, Marchena-Gomez J, Hemmersbach-Miller M, Betancor-Leon P. Pyogenic liver abscesses: mortality-related factors. Eur J Gastroenterol Hepatol. 2007;19:853–8.
Molle I, Thulstrup AM, Vilstrup H, Sorensen HT. Increased risk and case fatality rate of pyogenic liver abscess in patients with liver cirrhosis: a nationwide study in Denmark. Gut. 2001;48:260–3.
Akram AR, Singanayagam A, Choudhury G, Mandal P, Chalmers JD, Hill AT. Incidence and prognostic implications of acute kidney injury on admission in patients with community-acquired pneumonia. Chest. 2010;138:825–32.
Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care. 2006;10:R73.
Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med. 2007;35:1837–43 quiz 1852.
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.
Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: Results of the SOAP study. Crit Care Med. 2006;34:344–53.
Guerin C, Girard R, Selli JM, Perdrix JP, Ayzac L. Initial versus delayed acute renal failure in the intensive care unit. A multicenter prospective epidemiological study. Rhone-alpes area study group on acute renal failure. Am J Respir Crit Care Med. 2000;161:872–9.
Hoste EA, Lameire NH, Vanholder RC, Benoit DD, Decruyenaere JM, Colardyn FA. Acute renal failure in patients with sepsis in a surgical ICU: predictive factors, incidence, comorbidity, and outcome. J Am Soc Nephrol. 2003;14:1022–30.
Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow GM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol. 2002;13:1350–7.
Yegenaga I, Hoste E, Van Biesen W, et al. Clinical characteristics of patients developing ARF due to sepsis/systemic inflammatory response syndrome: results of a prospective study. Am J Kidney Dis. 2004;43:817–24.
Sriramnaveen P, Sridhar A, Sandeep Y, et al. Acute kidney injury in patients with pyogenic liver abscess. Ren Fail. 2011;33:551–2.
Lopes JA, Jorge S, Resina C, et al. Acute renal failure in patients with sepsis. Crit Care. 2007;11:411.
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995;273:117–23.
Plataki M, Kashani K, Cabello-Garza J, et al. Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clin J Am Soc Nephrol. 2011;6:1744–51.
Bagshaw SM, Lapinsky S, Dial S, et al. Acute kidney injury in septic shock: clinical outcomes and impact of duration of hypotension prior to initiation of antimicrobial therapy. Intensive Care Med. 2009;35:871–81.
Suh SH, Kim CS, Choi JS, Bae EH, Ma SK, Kim SW. Acute kidney injury in patients with sepsis and septic shock: risk factors and clinical outcomes. Yonsei Med J. 2013;54:965–72.
Treska V, Skalicky T, Liska V, Mirka H, Smid D, Vachtova M. Pyogenic abscesses of the liver. Rozhl Chir. 2007;86:284–7.
Lee KT, Sheen PC, Chen JS, Ker CG. Pyogenic liver abscess: multivariate analysis of risk factors. World J Surg. 1991;15:372–6.
Heras M, Fernandez-Reyes MJ, Guerrero MT, et al. Acute renal failure predictors in elderly patients with chronic kidney disease. Nefrologia. 2012;32:819–23.
Chawla LS, Amdur RL, Amodeo S, Kimmel PL, Palant CE. The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int. 2011;79:1361–9.
Ishani A, Nelson D, Clothier B, et al. The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease, and death. Arch Intern Med. 2011;171:226–33.
Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int. 2012;82:516–24.
McCullough PA. Radiocontrast-induced acute kidney injury. Nephron Physiol. 2008;109:61–72.
Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis. 2009;53:961–73.
Jones J, Holmen J, De Graauw J, Jovanovich A, Thornton S, Chonchol M. Association of complete recovery from acute kidney injury with incident CKD stage 3 and all-cause mortality. Am J Kidney Dis. 2012;3:402–8.
Mammen C, Al Abbas A, Skippen P, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis. 2012;59:523–30.
Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007;18:1292–8.
Zhou Q, Zhao C, Xie D, et al. Acute and acute-on-chronic kidney injury of patients with decompensated heart failure: Impact on outcomes. BMC Nephrol. 2012;13:51.
Chertow GM, Burdick E, Honour M, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16:3365–70.
Nisula S, Kaukonen KM, Vaara ST, FINNAKI Study Group, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: The FINNAKI study. Intensive Care Med. 2013;39:420–8.
Joannidis M, Metnitz B, Bauer P, et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35:1692–702.
Barrantes F, Tian J, Vazquez R, et al. Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med. 2008;36:1397–403.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yun, S.E., Jeon, DH., Kim, M.J. et al. The incidence, risk factors, and outcomes of acute kidney injury in patients with pyogenic liver abscesses. Clin Exp Nephrol 19, 458–464 (2015). https://doi.org/10.1007/s10157-014-1016-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-014-1016-8