Chen S C, Tsai S J, Chen C H, Huang C C, Lin D B, Wang P H, Chen C C, Lee M C
Department of Family Medicine, Chung Shan Medical University, No.110, Sec.1, South District, Taichung City 40201, Taiwan.
Neth J Med. 2008 May;66(5):196-203.
Pyogenic liver abscess (PLA) is uncommon but potentially life-threatening. The objective of this study was to identify the prognostic factors for PLA.
The medical records of 253 patients, 148 men and 105 women with a mean age of 56.4 years (SD : 15.0 years), who were hospitalised due to a PLA between January 1995 and June 2007 were reviewed. The underlying medical disorders, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatments, morbidity and mortality were recorded. Factors related to in-hospital case fatality were analysed.
The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at admission in patients with PLA was 8.7 points (SD 5.4 points). The most common co-existing disease was diabetes mellitus (41.9%), followed by biliary stone disorders (32.0%). Klebsiella pneumoniae was the most frequent pathogen, followed by Escherichia coli. The in-hospital case-fatality rate was 9.1%. Multivariate analysis revealed that gas-forming abscess (p=0.019), multi-drug resistant isolates (p=0.026), anaerobic infection (p=0.045), blood urea nitrogen level >7.86 mmol/l (p=0.004), and APACHE II score > or =15 (p= 0.004) were associated with mortality.
The prognosis of PLA may depend chiefly on the severity of the basic physical condition and underlying pathology. As the primary treatment for PLA is not completely effective, a more aggressive approach should be considered, especially for patients with poor prognosis.
化脓性肝脓肿（PLA）虽不常见，但有潜在生命危险。本研究的目的是确定PLA的预后因素。
回顾了1995年1月至2007年6月期间因PLA住院的253例患者的病历，其中男性148例，女性105例，平均年龄56.4岁（标准差：15.0岁）。记录基础疾病、临床症状和体征、实验室检查值、影像学检查、微生物学特征、治疗方法、发病率和死亡率。分析与院内病死率相关的因素。
PLA患者入院时急性生理与慢性健康状况评估（APACHE）II评分的平均值为8.7分（标准差5.4分）。最常见的并存疾病是糖尿病（41.9%），其次是胆石症（32.0%）。肺炎克雷伯菌是最常见的病原体，其次是大肠杆菌。院内病死率为9.1%。多因素分析显示，产气脓肿（p=0.019）、多重耐药菌（p=0.026）、厌氧菌感染（p=0.045）、血尿素氮水平>7.86 mmol/l（p=0.004）以及APACHE II评分>或=15（p=0.004）与死亡率相关。
PLA的预后可能主要取决于基本身体状况和基础病理的严重程度。由于PLA的主要治疗方法并非完全有效，应考虑采取更积极的治疗方法，尤其是对预后较差的患者。
