Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess

Background: Pyogenic liver abscess is a threatening condition. The purpose of this study was to audit the clinical behavior and to analyze the risk fa ctors. Methods: One hundred and thirty-three patients treated in five hospitals du ring the years 1985 to 1997 were studied. By univariate and multivariate an alysis we tried to identify any risk factor associated with complicated cli nical course and complicated-related clinical course, and with hospital mor tality. Results: Sixty-three patients (47%) were subjected to a percutaneous draina ge, 45 (34%) were treated by open surgical drainage, and the remaining 25 c ases (19%) received antibiotic therapy alone. Prognostic variables for a co mplicated clinical course were the presence of shock, low hemoglobin level, elevated prothrombin time, and polymicrobial infection. Shock, distress, l ow hemoglobin level, increased creatinine, and positive blood culture were significant predictors of a complicated-related clinical course. Concerning mortality, a biliary origin, shock, multiple abscesses, low hemoglobin lev el, and high concentration of blood urea nitrogen were independent predicto rs. Conclusions: Treatment of pyogenic liver abscesses should be tailored to ea ch patient. however, the majority of them can be successfuly treated with a ntibiotics and percutaneous methods. Those with signs of organ failure or s epticemia should preferably be managed in the intensive care unit. (C) 2001 Excerpta Medica, Inc. All rights reserved.