- 作者：Marí ; a Ló ; pez-Cano Gó ; mez ; Pedro Laguna Del Estal ; pld02m@saludalia.com ; Pablo Garcí ; a Montero ; Manuel Gil Navarro ; Ana Castañ ; eda Pastor
- 关键词：Absceso hepá ; tico pió ; geno ; Enfermedades de la ví ; a biliar ; Pronó ; stico ; Radiologí ; a intervencionista
- 刊名：Gastroenterolog¨ªa y Hepatolog¨ªa
- 出版年：2012
- 出版时间：April, 2012
- 年：2012
- 卷：35
- 期：4
- 页码：229-235
- 全文大小：217 K
Objectives
To describe the clinical features of pyogenic liver abscesses (PLA) and identify the factors associated with an unfavorable outcome.
Material and methods
We performed a retrospective review of the clinical histories of patients with liver abscess (1996-2009), including those that met the diagnostic criteria for PLA. Outcome was classified as favorable or unfavorable (severe sepsis, distant infectious complications, local complications, intensive care unit admission, admission for > 30 days, death, readmission).
Results
There were 54 patients with PLA (65 % men), with a mean age of 61 years. Predisposing factors consisted of biliopancreatic disease in 33 % , recent admission in 20 % , alcoholism in 15 % , diabetes mellitus in 15 % , a history of gastrointestinal neoplasm in 11 % and abdominal surgery in 11 % . The cause was cryptogenic in 65 % , biliary in 31 % , and portal in 4 % . Symptoms consisted of fever in 100 % , abdominal pain in 65 % , vomiting in 37 % , enlarged liver in 33 % , systemic inflammatory response syndrome in 26 % , and jaundice in 9 % . Blood and pus cultures were positive in 40 % and 65 % , respectively. The most frequently isolated microorganisms were E. coli and Streptococcus spp. Percutaneous drainage was performed in 72 % (surgical drainage was also performed in 6 % ), and antibiotic treatment alone was administered in 28 % . Outcome was unfavorable in 52 % and was associated with greater age (p = 0.016), a history of biliopancreatic disease (p = 0.007), systemic inflammatory response syndrome at diagnosis (p = 0.005), coagulation alterations (p = 0.043), aspartate aminotransferase elevation (p = 0.033), and biliary etiology (p < 0.001).
Conclusions
PLA developed in patients with comorbidity, although most were cryptogenic. The majority of PLA were resolved with antibiotic therapy and percutaneous drainage, without surgery. Mortality was 9 % , but half the patients had unfavorable outcome, associated with biliary etiology and some laboratory alterations.