Clinical Predictors for Early Aspiration in Patients With Liver Abscesses: Insights From a Combined-Risk Model.

BACKGROUND

Liver abscesses represent a significant contributor to surgical morbidity, particularly in developing nations, with amoebic liver abscess (ALA) being the most common type. The debate surrounding the role of early aspiration in preventing complications makes this study particularly important.

METHODS

This prospective observational study included 30 consecutive adult patients diagnosed with liver abscesses through radiological imaging over a two-year period at a tertiary care hospital in India. Patients who had ruptured abscesses necessitating surgical intervention were excluded to avoid confounding effects on predictive factors and the timing of aspiration. Clinical and imaging data, including age, sex, duration of symptoms, number and size of abscesses, and lobe involvement, were collected. Aspiration was categorized as early (≤4 days) or late (>4 days). Statistical associations were evaluated using chi-square/Fisher's exact test, and odds ratios (OR) were computed.

RESULTS

The study primarily comprised male patients (n=24, 80.0%), with a mean age of 47.6 years. ALA constituted n=29, 96.57% of the cases. No individual factor showed a statistically significant correlation with early aspiration (p>0.05). However, among patients with two or more moderate-risk factors, defined here as age ≥55 years, abscess size ≥5 cm, and bilateral involvement, there was a trend toward the need for early aspiration (n=6/10, 60.0% vs. n=5/20, 25.0%, OR=4.5, p=0.08).

CONCLUSION

In studies involving small, homogeneous samples, the statistical power of individual predictors may be limited. A combined-risk model could provide a more accurate method of identifying candidates for early aspiration. Nonetheless, the urgency of this issue is clear, indicating the necessity for validation through larger, multi-center studies to enhance treatment strategies for liver abscesses.