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Wi, Cho, Jun, Park, Park, Joo, Kim, Choi, Rew, and Jung: Clinical Characteristics and Outcomes of Pyogenic Liver Abscess in Elderly Korean Patients
Original Article

Korean J Gastroenterol 2015;66(1):27-32.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.1.27

Clinical Characteristics and Outcomes of Pyogenic Liver Abscess in Elderly Korean Patients

Jin Woo Wi*, Eun Ae Cho*, Chung Hwan Jun, Seon Young Park, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew, Sook In Jung1

Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea

1Divisions of Gastroenterology and Infectious Disease, Gwangju, Korea

Correspondence to: Chung Hwan Jun, Division of Gastroenterology, Department of Internal Medicine, Chonnam National University College of Medicine, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel: +82-62-220-6296, Fax: +82-62-225-8578, E-mail: estevanj@naver.com

* These two authors have equally contributed to this work.

Received 7 April 2015       Revised 9 May 2015       Accepted 11 May 2015

Copyright © 2015 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Incidence of pyogenic liver abscess (PLA) has been increasing worldwide, especially in the elderly population. Therefore, the aim of this study is to elucidate the clinical features and outcomes of PLA in elderly patients.

Methods

A total of 602 patients diagnosed with PLA from January 2003 to January 2013 were analyzed retrospectively. The patients were divided according to two age groups; ≥65 years (n=296) and <65 years (n=306).

Results

The mean age was 73.59±5.98 (range, 65–93) years in the elderly group. Significantly higher incidence of females (52.4% vs. 29.1%, p<0.001), hepatobiliary disease (41.2% vs. 24.8%, p<0.001), hepatobiliary procedure (29.4% vs. 13.7%, p<0.001), underlying malignancy (18.2% vs. 4.6%, p<0.001), culture positivity of resistant organism (20.6% vs. 14.4%, p=0.047), occurrence of complication (19.6% vs. 12.8%, p=0.026), and higher white blood cell (13.44±6.56 vs. 12.26±5.89, p=0.021), but lower rates of right lobe abscess (67.2% vs. 80.4%, p<0.001), fever (68.6% vs. 79.3%, p=0.003), and lower CRP (16.79±9.67 vs. 18.80±9.86, p=0.012) was observed in elderly PLA patients, compared to younger patients. Regarding complications, elderly patients had higher incidence of septic shock (8.1% vs. 2.3%, p=0.001) and cardiovascular disease (2% vs. 0%, p=0.014).

Conclusions

More atypical presentations and complications tend to occur in elderly PLA patients compared with younger patients. Clinicians should be aware of these age-related differences in PLA and devise management strategies accordingly.

Keywords: Pyogenic liver abscess, Aged, Elderly, Prognosis

References

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Table 1.
Comparison of Baseline Characteristics between the Patient Groups
Characteristic Elderly group a (n=296) Non-elderly group b (n=306) p-value
Gender (female) 155 (52.4) 89 (29.1) <0.001
Age (yr) 73.59±5.98 51.29±9.72 <0.001
Underlying disease      
 Diabetes Mellitus 72 (24.3) 74 (24.2) 0.999
 Hypertension 147 (49.7) 76 (24.8) <0.001
 Hepatobiliary disease 122 (41.2) 76 (24.8) <0.001
 Malignancy 54 (18.2) 14 (4.6) <0.001
 Hepatobiliary procedure 87 (29.4) 42 (13.7) <0.001
 Alcohol drinker 76 (25.7) 112 (36.6) 0.005
 Liver cirrhosis 20 (7.4) 17 (5.6) 0.612
 Chronic kidney disease 7 (2.4) 2 (0.7) 0.103
Initial symptom      
 Fever 203 (68.6) 241 (78.8) 0.003
 Anorexia 68 (23.0) 62 (20.3) 0.488
 Abdominal pain 132 (44.6) 125 (40.8) 0.410
 Sepsis at admission 24 (8.1) 10 (3.3) 0.013
 DIC at admission 2 (0.7) 1 (0.3) 0.339
Initial antibiotics     0.069
 3rd generation cephalosporin 251 (84.8) 275 (89.9)  
 Quinolone 10 (3.4) 13 (4.2)  
 Piperacilline/tazobactam 29 (9.8) 13 (4.2)  
 Imipenem 3 (1.0) 0 (0)  
 Others 3 (1.0) 5 (1.6)  

Values are presented as n (%) or mean±SD.

DIC, disseminated intravascular coagulation.

a ≥65 years

b <65 years.

Table 2.
Comparison of Clinical Presentations and Outcomes between the Patient Groups
Variable Elderly group a (n=296) Non-elderly group b (n=306) p-value
Laboratory finding      
 WBC (/mm3) 13.44±6.56 12.26±5.89 0.021
 PLT (/mm3) 210.06±136.67 219.62±147.07 0.410
 AST (U/L) 121.56±355.26 99.22±263.92 0.381
 ALT (U/L) 86.88±217.13 93.06±199.51 0.716
 CRP (mg/dL) 16.79±9.67 18.80±9.86 0.012
Radiologic findings      
 Abscess size (cm) 5.70±2.57 5.94±2.77 0.271
 Multiple abscesses (yes) 73 (24.7) 75 (24.5) 0.999
 Abscess site (right lobe) 199 (67.2) 246 (80.4) <0.001
 Gas forming abscess (yes) 18 (6.1) 16 (5.2) 0.725
Microbilology      
 Polymicrobial infection (yes) 20 (6.8) 23 (7.5) 0.752
 Klebsiella pneumoniae (yes) 93 (31.4) 104 (34.0) 0.487
 Culture of resistant organism (yes) 61 (20.6) 44 (14.4) 0.047
Drainage method      
 Percutaneous drainage 110 (37.2) 126 (41.2) 0.317
 Surgical drainage 2 (0.7) 3 (1.0) 0.999
Duration of admission (day) 16.79±9.67 18.81±9.83 0.698
Total duration of antibiotics (day) 56.94±35.63 59.77±39.02 0.649
Duration of intravenous antibiotics (day) 14.13±0.82 11.73±0.67 0.223
Occurrence of complication (person) 58 (19.6) 39 (12.8) 0.026
Liver abscess related death (person) 9 (3.0) 4 (1.3) 0.170

Values are presented as mean±SD or n (%).

WBC, white blood cell; PLT, platelet.

a ≥65 years

b <65 years.

Table 3.
Comparison of Complications between the Patient Groups
Variables Elderly group a Non-elderly group b p-value
Septic shock 24 (8.1) 7 (2.3) 0.001
Septic pneumonia 4 (1.4) 3 (1.0) 0.482
Metastatic CNS infection 1 (0.3) 1 (0.3) 0.999
Metastatic psoas abscess 2 (0.7) 0 (0) 0.241
Endopthalmitis 5 (1.7) 7 (2.3) 0.773
Rupture of liver abscess 8 (2.7) 4 (1.3) 0.255
Cardiovascular disease 6 (2.0) 0 (0) 0.014
Others 12 (6.1) 17 (5.6) 0.845

Values are presented as n (%).

CNS, central nervous system.

a ≥65 years

b <65 years.

Table 4.
Bacterial Spectrum and Antibiotics-resistance of Culture Results
Organism Elderly group a (n=296)
 Non-elderly group b (n=306)
Blood Pus Antibiotics resistanc Blood Pus Antibiotics resistance
No growth 178 (60.1) 205 (69.3)   203 (66.8) 166 (54.6)  
Klebsiella pneumoniae 64 (21.6) 36 (12.2) 38 (12.8) 52 (17.1) 43 (14.1) 31 (10.1)
Escherichia coli 12 (4.1) 43 (14.5) 8 (2.7) 6 (2.0) 75 (24.7) 5 (1.6)
Citrobacter 1 (0.3) 2 (0.7) 1 (0.3) 0 (0) 6 (2.0) 0 (0)
Pseudomonas 4 (1.4) 2 (0.7) 2 (0.7) 3 (1.0) 0 (0) 0 (0)
Staphyllococcus 6 (2.0) 3 (1.0) 4 (1.4) 7 (2.3) 6 (2.0) 3 (1.0)
Streptococcus 0 (0) 2 (0.7) 0 (0) 2 (0.7) 1 (0.3) 2 (0.6)
Bacteroides 1 (0.3) 2 (0.7) 0 (0) 0 (0) 2 (0.7) 0 (0)
Bacillus 1 (0.3) 0 (0) 2 (0.7) 0 (0) 0 (0) 0 (0)
Brevibacterium 3 (1.0) 0 (0) 0 (0) 1 (0.3) 0 (0) 1 (0.3)
Enterobacter 0 (0.3) 1 (0.3) 3 (1.0) 1 (0.3) 1 (0.3) 1 (0.3)
Enterococcus 2 (0.7) 0 (0) 3 (1.0) 1 (0.3) 2 (0.7) 1 (0.3)
Proteus vulgaris 1 (0.3) 0 (0) 0 (0) 0 (0) 1 (0.3) 0 (0)

Values are presented as n (%).

a ≥65 years

b <65 years.

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