Pyogenic Liver Abscess as a Warning Sign for Primary Liver Cancer: A Nationwide Population-based Study

Abstract Background Pyogenic liver abscess (PLA) is a significant cause of morbidity and mortality. Epidemiological data regarding risk factors and outcome determinants are often ascertained from referral population bases. We utilized a population-based study design to better understand PLA. Methods Calgary Health Zone (CHZ) residents ≥18 years of age (population ~1.3 million) who were hospitalized with PLA in 2017 were included. Charts were manually reviewed to determine demographics and clinical outcomes. Univariate and multivariate logistic regression were used to assess for factors associated with 30-day mortality using STATA 15.1 (College Stn., TX). Results Forty-four patients with PLA were identified (39% female, median age 61 [IQR 56–68] years) corresponding to an incidence rate of 3.7 cases per 100,000 population. Prevalent co-morbidities with PLA included; hemodialysis dependence (4.5%), cancer (25%), diabetes (23%), and cirrhosis (6.8%), each of which was significantly more common (P < 0.05) than in the general population; 85.3X, 11.2X, 3.6X, 29.9X, respectively. Rates of other comorbidities including ischemic heart disease, COPD, and rheumatoid arthritis did not differ from general populations (P > 0.05). The etiology of PLA was established in 72% of cases, of which biliary was most common (48%). Most (91%) cases had at least one organism identified via blood or liver aspirate culture. The most common organisms were Streptococcus anginosus group (12), Klebsiella pneumoniae (11), Klebsiella oxytoca (6), Escherichia coli (4), and obligate anaerobes (3). Blood cultures were positive in 25/44 (56%) cases. Thirty-day mortality from admission was 11% and had multiple risk factors (Table-1). Conclusion PLA in the CHZ is common and associated with high mortality. Understanding factors influencing PLA occurrence and outcome can assist in correctly identifying and optimally treating patients. Disclosures All authors: No reported disclosures.

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Increased risk of pneumonia following pyogenic liver abscess: a nationwide population-based study

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2013.01.016 ◽

2013 ◽

Vol 17 (8) ◽

pp. e634-e637 ◽

Cited By ~ 4

Author(s):

Shiu-Dong Chung ◽

Ming-Chieh Tsai ◽

Herng-Ching Lin

Keyword(s):

Liver Abscess ◽

Pyogenic Liver Abscess ◽

Population Based ◽

Population Based Study ◽

Increased Risk

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Primary liver cancer presenting as pyogenic liver abscess: Characteristics, diagnosis, and management

Journal of Surgical Oncology ◽

10.1002/jso.22103 ◽

2011 ◽

Vol 105 (7) ◽

pp. 687-691 ◽

Cited By ~ 17

Author(s):

Cong Li ◽

Guangbing Li ◽

Ruoyu Miao ◽

Xin Lu ◽

Shouxian Zhong ◽

...

Keyword(s):

Liver Cancer ◽

Liver Abscess ◽

Primary Liver Cancer ◽

Pyogenic Liver Abscess ◽

Diagnosis And Management

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Clinical research of primary liver cancer mimicking liver abscess

International Surgery Journal ◽

10.18203/2349-2902.isj20170857 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1033

Author(s):

Kong Jun ◽

Leng Tongmin ◽

Gong Jianping ◽

Tang Maoming

Keyword(s):

Liver Cancer ◽

Liver Abscess ◽

Early Stage ◽

Primary Liver Cancer ◽

Clinical Manifestations ◽

Pyogenic Liver Abscess ◽

Diagnosis And Treatment ◽

Hepatic Arteriography ◽

Laboratory Findings ◽

Post Operation

Background: Aiming at diagnosing at an early stage, minimizing the misdiagnosis rate and improving the prognosis, the author has investigated the clinical characteristics, diagnosis and treatment of primary liver cancer mimicking liver abscess with a summary and discussion.Methods: All of the 11 cases of primary liver cancer mimicking liver abscess, diagnosed during January 2009 to December 2015, were retrospectively viewed in terms of clinical manifestations, laboratory tests, radiological feature, diagnosis and treatment. And statistic analysis was made in all aspects mentioned above with that of pyogenic liver abscess and other types of liver cancer diagnosed in the corresponding period. Results: The clinical manifestations of the 11 cases were mostly characterized by fever, abdominal pain and weight loss. There was no significantly statistic difference between the study group and any of the three matched groups in underlying disease and lab results. All of the 11 patients were treated with enhanced antibiotics as basic therapy. Furthermore, eight cases accepted surgical operation, among them, one object underwent puncture and drainage of the liver abscess by ultrasound (PDLA) twice pre-operation, one object underwent PDLA and hepatic arteriography pre-operation and death in hospital post-operation, one object suffered myocardial infarction post-operation. In addition, three cases received conservative treatment only, in which, one object died in hospital.Conclusions: It is difficult to distinguish primary liver cancer mimicking liver abscess from pyogenic liver abscess as there are no specific clinical manifestations and laboratory findings which is prone to leading to misdiagnosis. What’s worse, the prognosis is so poor that high alert and close follow-up are required as well as early diagnosis and treatment.

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Long-Term Mortality of Patients with Septic Ocular or Central Nervous System Complications from Pyogenic Liver Abscess: A Population-Based Study

PLoS ONE ◽

10.1371/journal.pone.0033978 ◽

2012 ◽

Vol 7 (3) ◽

pp. e33978 ◽

Cited By ~ 21

Author(s):

Yi-Tsung Lin ◽

Chia-Jen Liu ◽

Tzeng-Ji Chen ◽

Chang-Phone Fung

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Liver Abscess ◽

Pyogenic Liver Abscess ◽

Population Based ◽

Population Based Study ◽

Long Term Mortality

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Diagnostic Accuracy of Primary Liver Cancer: Implications for Cancer Registration

Tumori Journal ◽

10.1177/030089169508100203 ◽

1995 ◽

Vol 81 (2) ◽

pp. 86-90

Author(s):

Francesco Donato ◽

Stefania Rodella ◽

Roberta Chiesa ◽

Cosimo Picoco ◽

Luciano Fiore Donati ◽

...

Keyword(s):

Liver Cancer ◽

Primary Liver Cancer ◽

Population Based ◽

Case Definition ◽

Northern Italy ◽

Cancer Registration ◽

Population Based Study ◽

Definition Of ◽

Panel Review ◽

Incident Cases

Aims and background We evaluated some standardized criteria for classifying incident cases of liver cancer into either primary liver cancer (PLC) or unspecified liver cancer (ULC) on the basis of the diagnostic examinations performed and their results. Methods A pilot hospital-based study (98 cases) was carried out in Verona, northern Italy, with the main aim of assessing the feasibility of the method. The same procedures were subsequently applied in a population-based study (349 cases) in Brescia, northern Italy. Results Diagnosis was made on histologic data in 38.7% and 41.8% of the hospital based and population-based studies, respectively, with a wide variation among different hospitals. The percentage of cases classified as PLC was 78.6% in the hospital-based study and 78.8% in the population-based study. No differences in the proportion of cases attributed to PLC were found according to patients’ age and sex or hospital of admission. The repeatibility of the procedure was assessed by a cross-panel review of 198 cases, and concordance was found in 91.9% of them. Conclusions An operational method for case definition of PLC based on the results of the diagnostic examinations currently performed and some suggestions for cancer registration are proposed.

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