PYOGENIC LIVER-ABSCESS - AN AUDIT OF EXPERIENCE OVER THE PAST DECADE

Objective: To audit our experience in managing patients with pyogenic liver abscesses since 1984 and to identify any risk factor associated with hospital mortality. Design: Retrospective review. Setting: A tert iary referral center. Patients: Eighty-three patients with pyogenic li ver abscesses were studied to determine demographic characteristics; c linical features, laboratory, imaging, and microbiologic findings; met hods of treatment; and final outcome. The median follow-up period was 9.8 months. Intervention: All patients were treated with intravenous a ntibiotic drugs. Fifty-three patients were subjected to image-guided p ercutaneous aspiration of the abscess. A percutaneous drainage cathete r was inserted after aspiration in 27 patients. Laparotomy was perform ed in 27 patients; seven of them underwent an elective operation. Main Outcome Measure: Hospital mortality, defined as death within the same hospital admission for management of liver abscess. Results: Biliary tract disease was the most frequently identifiable cause. The right lo be abscess was more frequently cryptogenic, while the left lobe absces s was more frequently related to intrahepatic stones (P<.001). The ove rall hospital mortality rate was 18% (15/83). On univariate analysis, female gender, rupture on presentation, emergency laparotomy, manageme nt without aspiration or catheter drainage, presence of malignancy, hy perglycemia, hyperbilirubinemia, elevated prothrombin time, and elevat ed activated partial thromboplastin time were significantly associated with hospital mortality. On multivariate logistic regression analysis , presence of malignancy, hyperbilirubinemia, and elevated activated p artial thromboplastin time were found to be independent risk factors. Conclusions: Pyogenic liver abscess is still a disease with significan t mortality. Early diagnosis and prompt treatment are necessary to fur ther improve our results of management.