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- Title
Large retrospective study analysing predictive factors of primary treatment failure, recurrence and death in pyogenic liver abscesses.
- Authors
Rossi, Geoffrey; Nguyen, Yann; Lafont, Emmanuel; Rossi, Benjamin; Canouï, Etienne; Roux, Olivier; Dokmak, Safi; Bert, Frédéric; Fantin, Bruno; Lefort, Agnès
- Abstract
Purpose: Pyogenic liver abscess (PLA) is a severe disease, which unfavourable evolution remains frequent. Our objective was to assess predictive factors of unfavourable outcome in patients with PLA. Methods: We conducted a retrospective study in a French tertiary care centre. All patients admitted for PLA between 2010 and 2018 were included. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence of PLA after an initial cure, or death within 3 months after diagnosis. Hazard ratios (95% CI) were calculated with multivariable Cox proportional hazard models. Results: 302 patients were included among which 91 (30.1%) patients had an unfavourable outcome because of PTF, recurrence or death in 55 (18.2%), 28 (9.2%) and 32 (10.6%) patients, respectively. Hepatic metastases (HR 2.08; 95% CI 1.04–4.15), a nosocomial infection (2.25; 1.14–4.42), portal thrombosis (2.12; 1.14–3.93), and the isolation of Enterococcus spp. (2.18; 1.22– 3.90) were independently associated with PTF. Ischemic cholangitis (6.30; 2.70–14.70) and the isolation of Streptococcus spp. (3.72; 1.36–10.16) were associated with the risk of recurrence. Charlson comorbidity index (HR 1.30 per one point; 95% CI 1.15–1.46; p < 0.001), portal thrombosis (3.53; 1.65–7.56) and the presence of multi-drug-resistant organisms (3.81; 1.73–8.40) were associated with mortality within 3 months following PLA diagnosis. PLA drainage was the only factor associated with a lower mortality (0.14; 0.06–0.34). Conclusion: Identification of specific risk factors may help to improve the management of PLA and to elaborate targeted recommendations according to patient's and disease's characteristics.
- Subjects
FRANCE; DISEASE relapse; CONFIDENCE intervals; RETROSPECTIVE studies; TERTIARY care; TREATMENT failure; RISK assessment; PYOGENIC liver abscess; DESCRIPTIVE statistics; DRUG resistance in microorganisms; PROPORTIONAL hazards models; COMORBIDITY
- Publication
Infection, 2022, Vol 50, Issue 5, p1205
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-022-01793-z