PYOGENIC LIVER-ABSCESSES - A COMPARISON OF OLDER AND YOUNGER PATIENTS

Objective: to evaluate whether older patients with pyogenic liver absc ess have distinctive presenting features or if their management differ s from that of younger patients. Design: retrospective chart review of all cases occurring from 1982 to 1992. Setting: a regional trauma cen tre and two large community hospitals. Patients: a total of 38 individ uals with a final diagnosis of pyogenic liver abscess. Seventeen patie nts aged 70 or older comprised the study group and 21 patients under a ge 70 the comparison group. Measurements: clinical features, laborator y data, therapeutic interventions and outcomes were sought. The presum ed aetiology of the abscess was determined. Results: the study group h ad fewer men (47% vs 81%, P=0.028), less abdominal tenderness on physi cal examination (41% vs 76%, P=0.028) and fewer positive blood culture s in those sampled (31% vs 67%, P=0.04) than the comparison group. No study group patient had a history of trauma. Times to diagnosis were 3 .2 and 5.9 days (P=0.14) and lengths of stay 21.6 and 29.3 days (P=0.0 8) for study and comparison groups, respectively. There were no differ ences in mortality or other demographic, clinical, laboratory or patho logical variables. Conclusions: elderly patients with pyogenic liver a bscess have some subtle differences in clinical and laboratory present ation, but these do not appear to delay diagnosis. Active management i s tolerated well, with no difference in mortality.