Abstract
Background
Pyogenic liver abscess (PLA) carries a significant mortality of between 2-12%. The incidence is higher in East Asia than in Western countries, and recent data looking at PLA in western populations is limited. Increasingly, we find that PLA is primary in the liver rather than from a secondary source, even in the western world. The aim of this retrospective study is to analyse data on presentation and outcomes of PLA at a UK tertiary liver centre.
Methods
Data was collected on patients diagnosed with a PLA and treated at the University Hospital of Wales, Cardiff between December 2010 and December 2020. Patients were identified by searching the Cardiff Liver Unit surgical database and Radiology database using the search term “liver abscess”. Patients with an abscess secondary to gallbladder perforation into the liver were excluded. Data was gathered using the available electronic health records, including comorbidities, mode of presentation, cause of PLA, microbiology, treatment received (surgical, radiological drainage, or antibiotic therapy), and outcomes.
Results
There were 86 patients with a median age of 69 (16-91), Male:Female ratio was 2:1. Main symptoms were abdominal pain and fever; 61.6% (n = 53). Treatment was surgical in 49% (n = 42), US guided drainage in 21% (n = 18) and antibiotics only in 30% (n = 26). Mortality was 9.3% (n = 8), with a median age of 76, significantly higher than survivors (p = 0.012). In this group, Male:Female ratio was 7:1; proportion with >2 co-morbidities was 62%, compared with 39% of survivors; and there was a greater delay in diagnosis (average 4 days versus 2 days in survivors), although these factors were not statistically significant.
Conclusions
PLA is a serious infection that can lead to mortality. Forty percent of patients can present with non-specific symptoms and early imaging in this group is essential for diagnosis. In our cohort, significant number of patients were treated with surgery compared to the literature, with good outcomes. Although the numbers are small to be statistically significant, delayed diagnosis, multiple comorbidities, and male gender confer an increased risk of mortality, as does advanced age. We conclude that early diagnosis and referral to a Liver centre for opinion or management is essential for optimal outcomes.
Ultra-sonography guided pigtail placement for drainage of liver abscess in 40 patients: A retrospective study
