A 10-Year Retrospective Analysis of Clinical Profi les, Laboratory Characteristics and Management of Pyogenic Liver Abscesses in a Chinese Hospital
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Pyogenic liver abscess (PLA) is a serious,life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The aim of this study was to collect demographic data and clinical,laboratory and microbiological characteristics of PLA patients treated between 2000 and 2010. We also aimed to collect information regarding our management experience of these cases. Methods: As a retrospective review, 47 patients with PLA in a tertiary referral center were examined to determine their demographic characteristics, clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. Results: Cryptogenic PLA was the most frequently identified type of PLA, while benign biliary tract disease was the most frequently identifi able cause of PLA (18/47 patients; 38.3%). Leukocytosis and elevated alanine transaminase were common laboratory findings and were observed in 35 (74.5%) and 22 (46.8%) patients,respectively. Increased fibrinogen was also detected in 11of 15 investigated cases (73.3%). Notably, infection-induced thrombocytopenia occurred in 8 patients (17%). Diabetes mellitus was associated with the occurrence of infection induced shock when compared to the non-diabetic group (p<0.05). Patients with two or more comorbid diseases had longer hospitalizations when compared to patients with one comorbid disease or those without comorbidities (p<0.001). The number of days needed to establish diagnosis was correlated with the length of hospitalization (p<0.001). The overall hospital mortality rate was 2.1% (1/47). Conclusions:Characteristics of PLA patients from the past 10 years are presented. The number of days needed to establish a PLA diagnosis was correlated with the length of the hospital stay. The hospital stay of PLA patients can be further improved by early diagnosis and effective treatments during the early stages of PLA progression.
Abstract
Background/Aims: Pyogenic liver abscess (PLA) is a serious,life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The aim of this study was to collect demographic data and clinical,laboratory and microbiological characteristics of PLA patients treated between 2000 and 2010. We also aimed to collect information regarding our management experience of these cases. Methods: As a retrospective review, 47 patients with PLA in a tertiary referral center were examined to determine their demographic characteristics, clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. Results: Cryptogenic PLA was the most frequently identified type of PLA, while benign biliary tract disease was the most frequently identifi able cause of PLA (18/47 patients; 38.3%). Leukocytosis and elevated alanine transaminase were common laboratory findings and were observed in 35 (74.5%) and 22 (46.8%) patients,respectively. Increased fibrinogen was also detected in 11of 15 investigated cases (73.3%). Notably, infection-induced thrombocytopenia occurred in 8 patients (17%). Diabetes mellitus was associated with the occurrence of infection induced shock when compared to the non-diabetic group (p<0.05). Patients with two or more comorbid diseases had longer hospitalizations when compared to patients with one comorbid disease or those without comorbidities (p<0.001). The number of days needed to establish diagnosis was correlated with the length of hospitalization (p<0.001). The overall hospital mortality rate was 2.1% (1/47). Conclusions:Characteristics of PLA patients from the past 10 years are presented. The number of days needed to establish a PLA diagnosis was correlated with the length of the hospital stay. The hospital stay of PLA patients can be further improved by early diagnosis and effective treatments during the early stages of PLA progression.
참고문헌 (26)
- Yu SC, "Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration", Hepatology, 39, pp.932~938 (2004)
- Alvarez Pérez JA, "Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess", Am J Surg, 181, pp.177~186 (2001)
- Lok KH, "Pyogenic liver abscess: clinical profile, microbiological characteristics, and management in a Hong Kong hospital", J Microbiol Immunol Infect, 41, pp.483~490 (2008)
- Wong WM, "Pyogenic liver abscess: retrospective analysis of 80 cases over a 10-year period", J Gastroenterol Hepatol, 17, pp.1001~1007 (2002)
- Miedema BW, "The diagnosis and treatment of pyogenic liver abscesses", Ann Surg, 200, pp.328~355 (1984)
- Huang CJ, "Pyogenic hepatic abscess. Changing trends over 42 years", Ann Surg, 223, pp.600~607 (1996)
- Johannsen EC, "Pyogenic liver abscesses", Infect Dis Clin North Am, 14, pp.547~563 (2000)
- Halvorsen RA Jr, "Hepatic abscess: sensitivity of imaging tests and clinical findings", Gastrointest Radiol, 13, pp.135~141 (1988)
- Wang K, "ST-segment elevation in conditions other than acute myocardial infarction", N Engl J Med, 349, pp.2128~2135 (2003)
- Magnani JW, "Myocarditis: current trends in diagnosis and treatment", Circulation, 113, pp.876~890 (2006)
- Bamberger DM, "Outcome of medical treatment of bacterial abscesses without therapeutic drainage: review of cases reported in the literature", Clin Infect Dis, 23, pp.592~603 (1996)
- Lin AC, "Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department", Emerg Med J, 26, pp.273~275 (2009)
- Kurtz LE, "Pyogenic liver abscess associated with a gastrointestinal stromal tumor of the stomach", Am J Gastroenterol, 105, pp.232~233 (2010)
- Shah I, "Liver abscess in a newborn leading to portal vein thrombosis", Indian J Pediatr, 76, pp.1268~1269 (2009)
- Tsai FC, "Pyogenic liver abscess as endemic disease, Taiwan", Emerg Infect Dis, 14, pp.1592~1600 (2008)
- Cheung YC, "Survival outcome of lobar or segmental transcatheter arterial embolization with ethanol- lipiodol mixture in treating hepatocellular carcinoma", World J Gastroenterol, 11, pp.2792~2795 (2005)
- Hanazaki K, "Gas-forming liver abscess after transcatheter arterial embolization for hepatocellular carcinoma: report of a case", Surg Today, 23, pp.747~749 (1993)
- Hashimoto T, "Fatal septic complication of transcatheter chemoembolization for hepatocellular carcinoma", Cardiovasc Intervent Radiol, 16, pp.325~327 (1993)
- Foo NP, "Characteristics of pyogenic liver abscess patients with and without diabetes mellitus", Am J Gastroenterol, 105, pp.328~335 (2010)
- Santos SA, "Hepatic abscess induced by foreign body: case report and literature review", World J Gastroenterol, 13, pp.1466~1470 (2007)
- Lee SS, "Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess", Clin Infect Dis, 47, pp.642~650 (2008)
- Arakura N, "Abscess of the round ligament of the liver associated with acute obstructive cholangitis and septic thrombosis", Intern Med, 48, pp.1885~1888 (2009)
- Lam YH, "ERCP and pyogenic liver abscess", Gastrointest Endosc, 50, pp.340~344 (1999)
- Dull JS, "Non-surgical treatment of biliary liver abscesses: efficacy of endoscopic drainage and local antibiotic lavage with nasobiliary catheter", Gastrointest Endosc, 51, pp.55~59 (2000)
- Chu KM, "Pyogenic liver abscess. An audit of experience over the past decade", Arch Surg, 131, pp.148~152 (1996)
- Chong VH, "Pyogenic liver abscess as the first manifestation of hepatobiliary malignancy", Hepatobiliary Pancreat Dis Int, 8, pp.547~550 (2009)