Sharma M P, Dasarathy S, Verma N, Saksena S, Shukla D K
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi.
Am J Gastroenterol. 1996 Dec;91(12):2584-8.
Amebic liver abscess (ALA) is being increasingly recognized with the progressive spread of AIDS. The prognosis of ALA needs to be determined to decide whether aggressive intervention therapy should be used. A prospective study was conducted to determine the factors that predicted mortality in patients with ALA.
The study population consisted of 135 consecutive patients with ALA who were treated with 80 mg/kg/day of metronidazole for 10 days if they survived. Needle aspiration or open surgical drainage was performed in patients who deteriorated despite drug therapy or had an abscess that clinically appeared to be at risk of impending rupture. Survivors and nonsurvivors were compared by univariate and multivariate analysis to identify predictors of outcome. These predictors were then prospectively evaluated in a subsequent cohort of patients with ALA.
Twenty-four patients died during the acute phase. Significant differences between survivors and nonsurvivors were observed. A stepwise logistic regression suggested that a bilirubin level >3.5 mg/dl, encephalopathy, volume of abscess cavity, hypoalbuminemia (serum albumin level <2.0 g/dl), and the number of abscesses were independent risk factors for mortality. The duration of symptoms and type of treatment did not influence mortality. The regression equation derived was then applied prospectively to 64 subsequent patients with ALA, and the validity of the prediction rule was confirmed. The qualities of simplicity, availability, low cost of derivation, and good discriminating power suggest that this index would be useful in assessing prognosis in patients with ALA.
随着艾滋病的逐渐传播，阿米巴肝脓肿（ALA）越来越受到关注。需要确定ALA的预后，以决定是否应采用积极的干预治疗。进行了一项前瞻性研究，以确定预测ALA患者死亡率的因素。
研究人群包括135例连续的ALA患者，若存活则接受80mg/kg/天的甲硝唑治疗10天。对于尽管接受药物治疗但病情恶化或临床上有脓肿即将破裂风险的患者，进行针吸或开放手术引流。通过单因素和多因素分析比较存活者和非存活者，以确定预后的预测因素。然后在随后的一组ALA患者中对这些预测因素进行前瞻性评估。
24例患者在急性期死亡。观察到存活者和非存活者之间存在显著差异。逐步逻辑回归表明，胆红素水平>3.5mg/dl、肝性脑病、脓肿腔体积、低白蛋白血症（血清白蛋白水平<2.0g/dl）和脓肿数量是死亡的独立危险因素。症状持续时间和治疗类型不影响死亡率。然后将得出的回归方程前瞻性地应用于随后的64例ALA患者，证实了预测规则的有效性。该指标具有简单、可用、推导成本低和区分能力强等特点，表明其在评估ALA患者预后方面将很有用。
