Factors predicting mortality of patients with lung abscess

Background: The rates of morbidity and mortality associated with lung absce ss are still significant despite the introduction of antibiotic treatments. The aim of this work was to identify the factors that predict a poor outco me for patients with lung abscess. Methods: We retrospectively reviewed the records and the roentgenographic f iles of adult patients with lung abscess who were hospitalized from 1980 to 1986 at the Hadassah University Hospital, in Jerusalem, Israel. Results: The study population comprised 75 patients, and the mean age was 5 2 years old (range, 12 to 89 years), The mean (+/-SD) hospitalization durat ion was 25.7 +/- 21.5 days (range, 5 to 94 days). Fifteen patients (20%) su ccumbed to the infection. The patients who died had more predisposing facto rs (+/-SD), such as pneumonia, neoplasm, and altered consciousness, than th ose who survived, respectively: 2.73 +/- 1.4 vs 1.9 +/- 1.3 (p < 0.03), The patients with anemia on admission (hemoglobin levels of < 10 g/dL) had a h igher mortality rate than those with higher hemoglobin levels, respectively : 58.3 vs 12.9% (p = 0.0008). A higher mortality rate was also associated w ith infection by Pseudomonas aeruginosa (83%), Staphylococcus aureus (50%), and Klebsiella pneumoniae (44%). The patients who died had larger abscess volumes (+/-SD) than those who survived (233 +/- 99 vs 157 +/- 33 mL), alth ough it did not reach statistical significance, The diameter of the abscess correlated with the hospitalization time (r = 0.5; p < 0.001). Conclusion: High rates of morbidity and mortality are associated with lung abscess despite appropriate antibiotic therapy and better supportive care. In patients with several predisposing factors, such as a large abscess size and a right-lower-lobe location, the prognosis was worse, The patients inf ected with S aureus, K pneumoniae, and particularly P aeruginosa had an omi nous prognosis. As the prognosis for lung abscess has not improved sufficie ntly since the introduction of antibiotics, other modalities should be cons idered for patients with poor prognostic signs.