Clinical Features of Pyogenic Liver Abscess according to Age Group

Joo Ho Park; Tae Hee Lee; Sung Tae Kim; Jang Han Jung; Yong Seok Kim; Sun Moon Kim; Euyi Hyeog Im; Kyu Chan Huh; Young Woo Choi; Young Woo Kang

doi:10.4166/kjg.2010.56.2.90

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Park, Lee, Kim, Jung, Kim, Kim, Im, Huh, Choi, and Kang: Clinical Features of Pyogenic Liver Abscess according to Age Group

Original Article

Korean J Gastroenterol 2010;56(2):90-96.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.2.90

Clinical Features of Pyogenic Liver Abscess according to Age Group

Joo Ho Park, M.D., Tae Hee Lee, M.D., Sung Tae Kim, M.D., Jang Han Jung, M.D., Yong Seok Kim, M.D., Sun Moon Kim, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D., Young Woo Kang, M.D.

Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea

Correspondence to: Tae Hee Lee, M.D. Department of Internal Medicine, College of Medicine, Konyang University, 685, Gasuwon-dong, Seo-gu, Daejeon 302-718, Korea Tel: +82-42-600-9370, Fax: +82-42-600-9090 E-mail: green740@naver.com

Revised 13 May 2010 Accepted 14 June 2010

Abstract

Background/Aims

Pyogenic liver abscess remains a major diagnostic and therapeutic challenge, despite advances in diagnostic technology and new strategies for treatment. This study was conducted to compare the differences in clinical features and outcomes of pyogenic liver abscess according to age.

Methods

In total, 166 patients were enrolled and included 63 (＜65 years old, group I), 62 (65-74 years old, group II), 41 (＞75 years old, group III) patients in each group. We reviewed the medical records retrospectively including etiology, underlying diseases, characteristics of the liver abscess, laboratory and microbiologic findings, treatment, and outcome of the patients.

Results

Group I had higher prevalence rates of male patients and chronic alcoholics, but lower prevalence rates of biliary disease, hypertension, and malignancy. In laboratory findings, group II had higher incidence of thrombocytopenia, elevated blood urea nitrogen and creatinine. There were no differences in symptoms and microbiologic findings in blood and pus among the three groups. Liver abscesses were more common in right liver in Group I. The lengths of stay and the treatment modalities were similar in three groups.

Conclusions

Although there were differences in sex ratio, etiology, underlying disease among the different age groups, they did not cause difference in treatment and clinical outcome of pyogenic liver abscess. Thus, we recommend active treatments in patients of all age.

Keywords: Pyogenic liver abscess, Age, Klebsiella pneumoniae

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Fig. 1.

Presenting symptoms of pyogenic liver abscess. Other symptoms include flank pain, diarrhea, chest pain.

Table 1.

Comparison of Underlying Disease among Three Age Groups

	Total (n=166)	Age (years)
	Total (n=166)	＜65 (n=63)	65-74 (n=62)	≥75 (n=41)
Male	98 (59.0%)	45 (71.4%)	37 (59.7%)	16 (39.0%)^∗
Biliary disease	53 (31.9%)	9 (14.3%)	25 (40.3%)	19 (46.3%)^∗
Diabetes mellitus	52 (31.3%)	16 (25.4%)	25 (40.3%)	11 (26.8%)
Hypertension	50 (30.1%)	7 (11.1%)	25 (40.3%)	18 (43.9%)^∗
Liver cirrhosis	12 (7.2%)	6 (9.5%)	4 (6.5%)	2 (4.9%)
Chronic alcoholism	44 (26.5%)	26 (41.3%)	14 (22.6%)	4 (9.8%)^∗
Malignancy	31 (18.7%)	8 (12.7%)	10 (16.1%)	13 (31.7%)^∗

^∗ p＜0.05.

Table 2.

Comparison of Initial Laboratory Data among Three Age Groups

	Total (n=166)	Age (years)
	Total (n=166)	＜65 (n=63)	65-74 (n=62)	≥75 (n=41)
WBC (＞10,000 /uL)	114 (68.7%)	45 (71.4%)	42 (67.7%)	27 (65.9%)
Hemoglobin (＜12 g/dL)	98 (59.0%)	32 (50.8%)	37 (59.7%)	29 (70.7%)
Platelet (＜130,000 /uL)	43 (25.9%)	9 (14.3%)	25 (40.3%)	9 (22.0%)^∗
PT (＞15 sec)	69 (41.6%)	22 (34.9%)	29 (46.8%)	18 (43.9%)
AST (＞36 IU/L)	113 (68.1%)	44 (69.8%)	41 (66.1%)	28 (68.3%)
ALT (＞38 IU/L)	97 (58.4%)	41 (65.1%)	35 (56.5%)	21 (51.2%)
Bilirubin (＞1.3 mg/dL)	66 (39.8%)	23 (36.5%)	22 (35.5%)	21 (51.2%)
Albumin (＜3.0 g/dL)	62 (37.3%)	20 (31.7%)	25 (40.3%)	17 (41.5%)
BUN (＞20 mg/dL)	54 (32.5%)	10 (15.9%)	28 (45.2%)	16 (39.0%)^∗
Creatinine (＞1.2 mg/dL)	32 (19.3%)	6 (9.5%)	17 (27.4%)	9 (22.0%)^∗
ALP (＞120 IU/L)	115 (69.3%)	47 (74.6%)	41 (66.1%)	27 (65.9%)
γ-GT (＞40 IU/L)	122 (73.5%)	51 (81.0%)	48 (77.4%)	23 (56.1%)^∗

WBC, white blood count; PT, prothrombin time; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase.

^∗ p＜0.05.

Table 3.

Results of Blood and Abscess Culture in Pyogenic Liver Abscess

Microorganisms	Blood (n=153)	Abscess (n=112)
Klebsiella pneumoniae	46 (30.1%)	56 (50.0%)
Klebsiella oxytoca	1 (0.7%)	3 (2.7%)
Escherichia coli	3 (2.0%)	10 (8.9%)
Staphylococcus sp.	1 (0.7%)	1 (0.9%)
Coagulase negative staphylococcus	2 (1.3%)	-
Streptococcus sp.	1 (0.7%)	2 (1.8%)
Enterococcus sp.	1 (0.7%)	2 (1.8%)
Pasteurella multocida	-	1 (0.9%)
Citrobacter freundii	-	1 (0.9%)
Proteus sp.	-	2 (1.8%)
Pseudomonas sp.	-	1 (0.9%)
No growth	98 (64.1%)	33 (29.5%)

Table 4.

Comparison of Location, Size, and Number of Pyogenic Liver Abscess among Three Age Groups

	Total (n=166)	Age (years)
	Total (n=166)	＜65 (n=63)	65-74 (n=62)	≥75 (n=41)
Location
Right	113 (68.1%)	53 (84.1%)	39 (62.9%)	21 (51.2%)^∗
Left	45 (27.1%)	7 (11.1%)	21 (33.9%)	17 (41.5%)^∗
Both	8 (4.8%)	3 (4.8%)	2 (3.2%)	3 (7.3%)
Size
＜5 cm	59 (35.5%)	24 (38.1%)	22 (35.5%)	13 (31.7%)
5-10 cm	97 (58.4%)	35 (55.6%)	36 (58.1%)	26 (63.4%)
＞10 cm	10 (6.0%)	4 (6.3%)	4 (6.5%)	2 (4.9%)
Number
Solitary	144 (86.7%)	56 (88.9%)	54 (87.1%)	34 (82.9%)
Multiple	22 (13.3%)	7 (11.1%)	8 (12.9%)	7 (17.1%)

^∗ p＜0.05.

Table 5.

Comparison of Treatment and Clinical Outcome among Three Age Groups

	Total (n=166)	Age (years)
	Total (n=166)	＜65 (n=63)	65-74 (n=62)	≥75 (n=41)
Length of stay (＞3 wks)	56 (33.7%)	24 (38.1%)	16 (25.8%)	16 (39.0%)
PCD	97 (58.4%)	34 (54.0%)	39 (62.9%)	24 (58.5%)
PNA	14 (8.4%)	6 (9.5%)	3 (4.8%)	5 (12.2%)
Antibiotics only	54 (32.5%)	22 (34.9%)	20 (32.3%)	12 (29.3%)
Surgery	1 (0.6%)	1 (1.6%)	0	0
Improved	150 (90.4%)	58 (92.1%)	60 (96.8%)	32 (78.0%)^∗
Recurrence	2 (1.2%)	1 (1.6%)	0	1 (2.4%)
Death	8 (4.8%)	2 (3.2%)	2 (3.2%)	4 (9.8%)

PCD, percutaneous catheter drainage; PNA, percutaneous needle aspiration.

^∗ p＜0.05.

Table 6.

Clinical Outcome by Treatment Methods

		Age (years)
		＜65 (n=59)	65-74 (n=62)	≥75 (n=36)
Percutaneous drainage^∗	Improved	37 (36.0%)	40 (39.2%)	24 (23.5%)
Percutaneous drainage^∗	Death	1 (20.0%)	2 (40.0%)	2 (40.0%)
Antibiotics only	Improved	20 (41.7%)	20 (41.7%)	8 (16.7%)
Antibiotics only	Death	1 (33.3%)	0	2 (66.7%)

^∗ Percutaneous drainage includes percutaneous catheter drainage and percutaneous needle aspiration.

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