Lok Ka-Ho, Li Kam-Fu, Li Kin-Kong, Szeto Ming-Leung
Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
J Microbiol Immunol Infect. 2008 Dec;41(6):483-90.
Pyogenic liver abscess (PLA) is a major hepatobiliary infection with a significant mortality rate of 10% to 25%. Over the past 2 decades, there have been significant developments in the management of this disease. This study describes the demographic, clinical, and microbiological features, management, and poor prognostic factors of PLA in Hong Kong.
All patients with PLA admitted to the Tuen Mun Hospital, Hong Kong, from July 1998 to June 2004 were included. The medical records of eligible patients were reviewed to obtain demographic, clinical, laboratory, microbiological, and radiological data. Management strategies and factors associated with mortality were studied.
111 patients were included. Fever, chills, and right upper quadrant pain were the most common presenting symptoms. Low albumin level, elevated alkaline phosphatase, and leukocytosis were the most common laboratory features. Klebsiella spp. was the most common etiological agent detected in cultures of blood and abscess aspirates. Fifty two percent of these isolates were Klebsiella pneumoniae. Fifty three percent of PLA cases were cryptogenic in origin and 22.5% had underlying biliary pathology. The mortality rate was 11.7%. By multiple logistic regression analysis, hepato-pancreatico-biliary malignancy (p=0.001), requirement for open surgery (p=0.01), and significant delay in diagnosis (p=0.019) were independent risk factors associated with in-hospital mortality.
Although advances in imaging and therapeutic modalities have lead to substantial improvement of outcomes, patients with underlying malignancy and those requiring open surgery in particular are at significant risk of mortality. Delay in diagnosis can result in a fatal outcome. A high index of suspicion with prompt institution of treatment is the cornerstone of successful treatment for patients with PLA.
化脓性肝脓肿（PLA）是一种主要的肝胆系统感染性疾病，死亡率达10%至25%，相当可观。在过去20年里，该疾病的治疗有了显著进展。本研究描述了香港地区PLA的人口统计学、临床和微生物学特征、治疗方法及不良预后因素。
纳入1998年7月至2004年6月期间入住香港屯门医院的所有PLA患者。回顾符合条件患者的病历，以获取人口统计学、临床、实验室、微生物学和放射学数据。研究治疗策略及与死亡率相关的因素。
共纳入111例患者。发热、寒战和右上腹疼痛是最常见的首发症状。低白蛋白水平、碱性磷酸酶升高和白细胞增多是最常见的实验室特征。肺炎克雷伯菌是血液和脓肿穿刺液培养中最常见的病原体。这些分离株中有52%为肺炎克雷伯菌。53%的PLA病例病因不明，22.5%有潜在胆道病变。死亡率为11.7%。多因素逻辑回归分析显示，肝胰胆恶性肿瘤（p = 0.001）、需要进行开放手术（p = 0.01）以及诊断显著延迟（p = 0.019）是与院内死亡率相关的独立危险因素因素。
尽管影像学和治疗方式的进步已使治疗结果有了显著改善，但有潜在恶性肿瘤的患者，尤其是那些需要进行开放手术的患者，仍面临着较高的死亡风险。诊断延迟可能导致致命后果。高度怀疑并及时进行治疗是PLA患者成功治疗基础。
