Pyogenic Liver Abscess in the Elderly

Accepted 6 March 2009.

Summary

Background

We analyzed the characteristics of elderly patients with pyogenic liver abscess, including clinical features, laboratory analyses and outcomes.

Methods

A retrospective review of patient records from January 1, 2007 to June 30, 2008, identified 140 cases of liver abscess hospitalized in a medical center in northern Taiwan. Patients transferred from other hospitals, or those who had amoebic, fungal, traumatic or iatrogenic LA were excluded, and 122 cases were enrolled. We divided patients into two groups: an elderly group aged ≥ 65 years, and a non-elderly group. We collected information on clinical manifestations, laboratory data, imaging, blood and pus culture, and surgical findings for statistical analyses.

Results

We compared the elderly and the non-elderly with pyogenic liver abscess with respect to diabetes history (p = 0.03), presence of fever (p = 0.19), days of fever before hospital visit (p = 0.001), abdominal pain (p = 0.08), diarrhea (p = 0.36), shock (p = 0.25), white blood cell count (p = 0.70), serum glucose (p = 0.49), aspartate aminotransferase (p = 0.95), length of hospital stay (p = 0.10), and mortality (p = 0.12). Most positive results in cultures were for Klebsiella pneumoniae, and the positive rates in culture of blood and pus were 43% and 60%, respectively.

Conclusion

We found that there was no significant statistical difference between elderly and non-elderly pyogenic liver abscess patients in the presence of fever, abdominal pain, diarrhea, shock, white blood cell count, serum glucose, aspartate aminotransferase, hospital stay, and mortality. The elderly pyogenic liver abscess patients had fewer days of fever before hospital visit (2.2 ± 2.2 vs. 6.3 ± 6.9; p = 0.001). The elderly were taken to hospital earlier, because their families were more concerned about their constitutional symptoms. More cases of diabetes in the elderly pyogenic liver abscess group (44.7% vs. 39.3%) may arise because of more diabetes in the elderly population.

Key Words: abdominal pain , elderly , fever , pyogenic liver abscess , shock

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Article Outline

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References

1. 1 Smoger SH , Mitchell CK , McClave SA . Pyogenic liver abscesses: a comparison of older and younger patients . Age Ageing . 1998;27:443–448 . MEDLINE | CrossRef

2. 2 Ochsner A , DeBakey M , Murray S . Pyogenic abscess of the liver: an analysis of 47 cases with review of the literature . Am J Surg . 1938;40:292–319 . CrossRef

3. 3 Alvarez J , González J , Baldonedo R , et al. Pyogenic liver abscesses: a comparison of older and younger patients . HPB (Oxford) . 2001;3:201–206 .

4. 4 Beaumont DM , Davis M . Clinical presentation of pyogenic liver abscess in the elderly . Age Ageing . 1985;14:339–344 . MEDLINE

5. 5 Sridharan GV , Wilkinson SP , Primrose WR . Pyogenic liver abscess in the elderly . Age Ageing . 1990;19:199–203 . MEDLINE

6. 6 Wild S , Roglic G , Green A , et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 . Diabetes Care . 2004;27:1047–1053 . MEDLINE | CrossRef

7. 7 Chen SC , Wu WY , Yeh CH , et al. Comparison of Escherichia coli and Klebsiella pneumoniae liver abscesses . Am J Med Sci . 2007;334:97–105 . CrossRef

8. 8 Bowers ED , Robinson DJ , Doberneck RC . Pyogenic liver abscess . World J Surg . 1990;14:128–132 . MEDLINE | CrossRef

9. 9 Lee KT , Sheen PC , Chen JS , et al. Pyogenic liver abscess: multivariate analysis of risk factors . World J Surg . 1991;15:372–377 . MEDLINE | CrossRef

10. 10 McDonald MI , Corey GR , Gallis HA , et al. Single and multiple pyogenic liver abscesses: natural history, diagnosis and treatment, with emphasis on percutaneous drainage . Medicine . 1984;63:291–302 .

11. 11 Mischinger HJ , Hauser H , Rabl H , et al. Pyogenic liver abscess: studies of therapy and analysis of risk factors . World J Surg . 1994;18:852–858 . MEDLINE | CrossRef

12. 12 Greenstein AJ , Lowenthal D , Hammer GS , et al. Continuing changing patterns of disease in pyogenic liver abscess: a study of 38 patients . Am J Gastroenterol . 1984;79:217–226 . MEDLINE

13. 13 Chou FF , Sheen-Chen SM , Chen YS , et al. Prognostic factors for pyogenic abscess of the liver . J Am Coll Surg . 1994;179:727–732 . MEDLINE

14. 14 Chu KM , Fan ST , Lai ECS , et al. Pyogenic liver abscess: an audit of experience over the past decade . Arch Surg . 1996;131:148–152 . MEDLINE

15. 15 Pitt HA , Zuidema GD . Factors influencing mortality in the treatment of pyogenic hepatic abscess . Surg Gynecol Obstet . 1975;140:228–234 . MEDLINE

16. 16 Huang CJ , Pitt HA , Lipsett PA , et al. Pyogenic hepatic abscess: changing trends over 42 years . Ann Surg . 1996;223:600–609 . MEDLINE | CrossRef

17. 17 Farges O , Leese T , Bismuth H . Pyogenic liver abscess: an improvement in prognosis . Br J Surg . 1988;75:862–865 . MEDLINE | CrossRef

18. 18 Rintoul R , O'Riordain MG , Laurenson IF , et al. Changing management of pyogenic liver abscess . Br J Surg . 1996;83:1215–1218 . MEDLINE | CrossRef

19. 19 Koneru S , Peskin GW , Sreenivas V . Pyogenic hepatic abscess in a community hospital . Am Surg . 1994;60:278–281 . MEDLINE

20. 20 Seeto RK , Rockey DC . Pyogenic liver abscess: changes in etiology, management, and outcome . Medicine . 1996;75:99–113 .

21. 21 Branum GD , Tyson GS , Branun MA , et al. Hepatic abscess: changes in etiology, diagnosis, and management . Ann Surg . 1990;212:655–662 . MEDLINE | CrossRef

22. 22 Rahimian J , Wilson T , Oram V , et al. Pyogenic liver abscess: recent trends in etiology and mortality . Clin Infect Dis . 2004;39:1654–1659 . CrossRef

a Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan

b Department of Family Medicine, Mackay Memorial Hospital, Taipei, Taiwan

c Department of Mackay Medicine, Nursing and Management College, Taipei, Taiwan

d Department of College of Continuing Education, Aletheia University, Taipei, Taiwan

e Department of Anesthesiology, Municipal Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan

Correspondence to: Dr Yu-Jang Su, Department of Emergency Medicine, Mackay Memorial Hospital, 92, Section 2, North Chung-Shan Road, Taipei 10449, Taiwan

PII: S1873-9598(10)70002-8

doi:10.1016/S1873-9598(10)70002-8

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