Chen Shiuan-Chih, Lee Yuan-Ti, Yen Chi-Hua, Lai Kuang-Chi, Jeng Long-Bin, Lin Ding-Bang, Wang Po-Hui, Chen Chun-Chieh, Lee Meng-Chih, Bell William R
Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Age Ageing. 2009 May;38(3):271-6; discussion. doi: 10.1093/ageing/afp002. Epub 2009 Feb 28.
pyogenic liver abscess (PLA) is a potentially life-threatening disease in middle-to-old aged persons.
to compare the differences in clinical features and outcomes between older and younger PLA patients, and to identify predictors of outcomes in older patients.
retrospective chart review of all PLA patients between July 1999 and June 2007.
a 1,600-bed primary and tertiary care centre.
in total, 339 patients were enrolled and included 118 > or =65 years of age (the elderly group) and 221 patients <65 years of age (the non-elderly group).
clinical features, laboratory, imaging and microbiologic findings, treatment and outcomes for each of the included patients were collected. The predictor of outcome was determined using logistic regression and purposeful selection of covariates.
the elderly group had a higher APACHE II score on admission, a biliary abnormality, a malignancy, a pleural effusion, polymicrobial, anaerobic or multi-drug-resistant isolates, inappropriate initial antibiotics, a longer hospitalisation and a longer parenteral antibiotic treatment period than the non-elderly group, whereas the non-elderly group was more likely to be alcoholic men with cryptogenic origin of abscess and Klebsiella pneumoniae infection. There was no difference in case fatality between the elderly (13.6%) and non-elderly (8.6%) groups despite the elderly group having a poorer host status on admission. In multivariate analysis, age (P = 0.028) and APACHE II score at admission > or =15 (P = 0.001) were risk factors, but K. pneumoniae infection (P = 0.012) was a protective factor for fatality in older PLA patients.
these data suggest that older PLA patients would have a fair outcome compared to younger patients, but require longer hospitalisations.
化脓性肝脓肿（PLA）是中老年人中一种潜在的危及生命的疾病。
比较老年和年轻PLA患者的临床特征和预后差异，并确定老年患者预后的预测因素。
对1999年7月至2007年6月期间所有PLA患者进行回顾性病历审查。
一家拥有1600张床位的一级和三级护理中心。
共纳入339例患者，其中118例年龄≥65岁（老年组），221例年龄<65岁（非老年组）。
收集纳入患者的临床特征、实验室检查、影像学和微生物学检查结果、治疗方法及预后情况。采用逻辑回归和有目的选择协变量的方法确定预后的预测因素。
老年组入院时急性生理与慢性健康状况评分系统（APACHE II）得分更高，存在胆道异常、恶性肿瘤、胸腔积液、多种微生物、厌氧菌或多重耐药菌感染、初始抗生素使用不当、住院时间更长和肠外抗生素治疗时间更长，而非老年组更可能是有酗酒史且脓肿病因不明的男性以及感染肺炎克雷伯菌。尽管老年组入院时宿主状态较差，但老年组（13.6%）和非老年组（8.6%）的病死率并无差异。多因素分析显示，年龄（P = 0.028）和入院时APACHE II评分≥15（P = 0.001）是危险因素，但肺炎克雷伯菌感染（P = 0.012）是老年PLA患者死亡的保护因素。
这些数据表明，与年轻患者相比，老年PLA患者预后尚可，但住院时间更长。
