Abstract
Seventy-three patients with pyogenic liver abscess during the year 1978–1988 were studied in the Kaohsiung Medical College Hospital. The overall mortality rate was 19.2% in this study. By using univariate analysis, it was revealed that clinical jaundice, pleural effusion, bilobar abscess, profound hypoalbuminemia (<2.5 g/dl), hyperbilirubinemia (>2 mg/dl), elevated level of serum AST (>100 IU/L), alkaline phosphatase (>150 IU/L), and marked leukocytosis (>20,000 mm3) were associated with a higher mortality rate. Multivariate stepwise logistic regression analysis detected only 3 factors of marked leukocytosis (>20,000 mm3), profound hypoalbuminemia (<2.5 g/dl), and presence of pleural effusion with independent significance in predicting mortality. Meanwhile, it was also revealed that the laboratory data could not predict a risk factor to mortality unless they became markedly abnormal.
Résumé
Soixante-treize patients ayant un abcès pyogène du foie observé pendant les années 1978–1988 ont été étudiés à l'Hôpital de l'Ecole de Médecine Kaohsiung. La mortalité globale a été de 19.2%. En analyse monofactorielle, un plus fort taux de mortalité a été noté lorsqu'étaient associés ictère clinique, épanchement pleural, abcès dans les deux lobes, hypo-albuminémie (<2.5 g/dL), bilirubinémie (>2 mg/dL), sérum AST (>100 IU/L), phosphatases alcalines (>150 UI/L), et hyperleucocytose (>20,000 mm3). L'analyse multifactorielle pas à pas n'a détecté que 3 facteurs, hyperleucocytose, hyperleucocytose (>20,000 mm3), hypoalbuminémie (<2.5 g/dL), et l'existence d'un épanchement pleural, ayant une valeur significative dans la prédiction de mortalité. Il a été démontré qu'un seul facteur de risque n'avait de valeur prédictive que lorsque sa valeur était très anormale.
Resumen
Setenta y tres pacientes con absceso hepático piógeno manejados en el período 1978–1988 fueron estudiados en el Hospital del Colegio Médico de Kaohsiung. La mortalidad global fue de 19.2 por ciento. Mediante el análisis univariable, se encontró que la ictericia clínica, la efusión pleural, los abscesos bilobares, la hipoalbuminemia profunda (<2.5 g/dl), la hiperbilirrubinemia (>2 mg/dl), la elevación del nivel de la AST sérica (>100 IU/L), la elevación de la fosfatasa alcalina (>150 IU/L), y la leucocitosis pronunciada (>20,000 mm3) aparecieron como factores asociados con una alta tasa de mortalidad. El análisis multivariable de regresión logística détectó solo 3 factores con significatión independiente en cuanto a la predictión de mortalidad: leucocitosis pronunciada (>20,000 mm3), hipoalbunemia profunda (<2.5 g/dl), y efusión pleural. El estudio también reveló que los datos de laboratorio no tienen capacidad para predecir riesgo a menos que los valores se hagan notoriamente anormales.
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References
Rubinson, H.A., Isikoff, M.B., Hill, M.C.: Diagnostic imaging of hepatic abscesses: A retrospective analysis. Am. J. Roentgenol.135:735, 1980
Ferrucci, J.T., Von Sonnenberg, E.: Intraabdominal abscess: Radiological diagnosis and treatment. J. Am. Med. Assoc.246:2728, 1980
Gyorffy, E.J., Frey, C.F., Silva, J.R.J., McGahan, J.: Pyogenic liver abscess: Diagnostic and treatment strategies. Ann. Surg.206:699, 1987
Klatchko, B.A., Schwartz, S.I.: Diagnostic and therapeutic approaches to pyogenic abscess of the liver. Surg. Gynecol. Obstet.169:332, 1989
Kandel, G., Marcon, N.E.: Pyogenic liver abscess: New concepts of ah old disease. Am. J. Gastroenterol.79:65, 1984
Farges, O., Leese, T., Bismuth, H.: Pyogenic liver abscess: An improvement in prognosis. Br. J. Surg.75:862, 1988
Conter, R.L., Pitt, H.A., Tompkins, R.K.: Differentiation of pyogenic from amebic hepatic abscesses. Surg. Gynecol. Obstet.162:114, 1986
Heymann, A.D.: Clinical aspects of grave pyogenic abscesses of the liver. Surg. Gynecol. Obstet.149:209, 1979
Satiani, B., Davidson, E.D.: Hepatic abscesses: Improvement in mortality with early diagnosis and treatment. Am. J. Surg.135:647, 1978
Rubin, R.H., Schwartz, M.N., Malt, R.: Hepatic abscess: Changes in clinical, bacteriologie and therapeutic aspects. Am. J. Med.57:601, 1974
Greenstein, A.J., Lowenthal, D., Hammer, G.S., Schaffner, F., Aufses, Jr., A.H.: Continuing changing patterns of disease in pyogenic liver abscess: A study of 38 patients. Am. J. Gastroenterol.79:217, 1984
Pitt, H.A., Zuidema, G.D.: Factors influencing mortality in the treatment of pyogenic hepatic abscess. Surg. Gynecol. Obstet.140:228, 1975
Bansal, A.S., Prabhakar, P.: Clinical aspects of pyogenic liver abscess-the university hospital of the West Indies experience. J. Trop. Med. Hyg.91:87, 1988
McDonald, M.I., Corey, G.R., Gallis, H.A., Durack, D.T.: Single and multiple pyogenic liver abscess: Natural history, diagnosis and treatment with emphasis on percutaneous drainage. Medicine63: 291, 1984
Northover, J.M.A., Jones, B.J.M., Dawson, J.L., Williams, R.: Difficulties in the diagnosis and management of pyogenic liver abscess. Br. J. Surg.69:48, 1982
Takada, T.: Illustrated Manual of Percutaneous Transhepatic Cholangiography with Drainage, Tokyo, Igaku-shoin 1978, pp. 109–116
Barnes, P.F., DeCock, K.M., Reynolds, T.N., Ralls, P.W.: A comparison of amebic and pyogenic abscess of the liver. Medicine66:472, 1987
Greenstein, A.J., Barth, J., Dicker, A., Bottone, E.J., Aufses, Jr., A.H.: Amebic liver abscess: A study of 11 cases compared with a series of 38 patients with pyogenic liver abscess. Am. J. Gastroenterol.80:472, 1985
Young, A.E.: The clinical presentation of pyogenic liver abscess. Br. J. Surg.63:216, 1976
Barbour, G.L., Juniper, K.: A clinical comparison of amebic and pyogenic abscess of the liver in sixty-six patients. Am. J. Med.53:323, 1972
Lazarchick, J., DeSouza, E., Silva, N.A., Nidrols, D.R., Washington, II, J.A.: Pyogenic liver abscess. Mayo Clin. Proc.48:349, 1973
Berger, L.A., Osborne, D.R.: Treatment of pyogenic liver abscesses by percutaneous needle aspiration. Lancet2:132, 1982
Johnson, R.D., Mueller, P.R., Ferrucci, Jr., J.T.: Percutaneous drainage of pyogenic liver abscesses. Am. J. Roentgenol.144:463, 1985
Gerzof, S.G., Johnson, W.C., Robbins, A.H., Nabseth, D.C.: Intrahepatic pyogenic abscesses: Treatment by percutaneous drainage. Am. J. Surg.149:487, 1985
Bertel, C.K., van Heerden, J.A., Sheedy, II, P.G.: Treatment of pyogenic hepatic abscesses. Arch. Surg.121:554, 1986
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Lee, KT., Sheen, PC., Chen, JS. et al. Pyogenic liver abscess: Multivariate analysis of risk factors. World J. Surg. 15, 372–376 (1991). https://doi.org/10.1007/BF01658732
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DOI: https://doi.org/10.1007/BF01658732