PROGNOSTIC MARKERS IN AMEBIC LIVER-ABSCESS - A PROSPECTIVE-STUDY

Objectives: Amebic liver abscess (ALA) is being increasingly recognize d with the progressive spread of AIDS. The prognosis of ALA needs to b e determined to decide whether aggressive intervention therapy should be used. A prospective study was conducted to determine the factors th at predicted mortality in patients with ALA. Methods: The study popula tion consisted of 135 consecutive patients with ALA who were treated w ith 80 mg/kg/day of metronidazole for 10 days if they survived. Needle aspiration or open surgical drainage was performed in patients who de teriorated despite drug therapy or had an abscess that clinically appe ared to be at risk of impending rupture. Survivors and nonsurvivors we re compared by univariate and multivariate analysis to identify predic tors of outcome. These predictors were then prospectively evaluated in a subsequent cohort of patients with ALA. Results: Twenty-four patien ts died during the acute phase. Significant differences between surviv ors and nonsurvivors were observed. A stepwise logistic regression sug gested that a bilirubin level >3.5 mg/dl, encephalopathy, volume of ab scess 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 wou ld be useful in assessing prognosis in patients with ALA.