Is hepatic neoplasm-related pyogenic liver abscess a distinct clinical entity?

Table 1 Demographic and clinical characteristics of patients with/without hepatic neoplasm-associated pyogenic liver abscess (mean ± SD) n (%)

Variable	HN group(n = 35)	Non-HN group(n = 283)	P value
Age (yr)	67.7 ± 16.2	65.4 ± 15.13	0.40
Sex (male: female)	18:17	163:120
Comorbidity
Diabetes mellitus	9 (25.7)	81 (28.6)	0.36
Hypertension	12 (34.3)	78 (27.6)	0.20
Ischemic heart disease	1 (2.9)	23 (8.1)	0.14
Stroke	2 (5.7)	31 (11.0)	0.17
Duration of symptoms before presentation (d)	3.7 ± 2.8	4.9 ± 4.9	0.18
Symptoms and signs
Fever and chill	34 (97.1)	268 (94.7)	0.27
Right upper quadrant pain	24 (68.6)	149 (52.7)	< 0.04
Diarrhea	1 (2.9)	21 (7.5)	0.16
Cough and sputum	6 (17.1)	59 (20.8)	0.41
Jaundice	5 (14.3)	16 (5.7)	< 0.03
Hepatomegaly	6 (17.1)	11 (3.9)	< 0.01
Right pleural effusion/ consolidation (on admission)	3 (8.6)	39 (13.8)	0.20

HN: Hepatic neoplasm.

Table 2 Laboratory findings and radiological features of patients with/without hepatic neoplasm-associated pyogenic liver abscess n (%)

Laboratory parameters	HN group(n = 35)	Non-HN group(n = 283)	P value
Hemoglobin (mean, g/dL)	10.0	11.3	0.22
White cell count (mean, 109/L)	18.9	16.8	0.13
ESR (mean, mm/h)	82.0	78.9	0.84
CRP (mean, mg/L)	120.0	141.8	0.56
Albumin (mean, g/L)	27.1	29.6	0.56
Total bilirubin (mean, mol/L)	43.3	30.0	0.05
Alanine aminotransferase (mean, U/L)	64.1	84.1	0.16
Hba1c (mean, %)	10.3	9.1	0.41
Bacteremia	13 (37.1)	120 (42.4)	0.27
Radiological features
Size (cm, mean ± SD)	6.8 ± 3.1	6.1 ± 3.0	0.19
Site
Right lobe	22 (62.9)	156 (55.1)	0.19
Solitary/multiple	15 (43)/ 7 (20)	133 (47)/ 23 (8.1)
Left lobe	7 (20)	82 (29)	0.13
Solitary/multiple	5 (14.3)/ 2 (5.7)	73 (25.8)/ 9 (3.2)
Bilobar	3 (8.6)	37 (13.1)	0.22
Echogenicity
Hypoechoic	31 (88.6)	256 (90.5)	0.36
Hyperechoic/heterogenous	4 (11.4)	27 (9.5)	0.37
Thicken wall	13 (37.1)	55 (19.4)	< 0.01
Rim enhancement	26 (74.3)	176 (62.2)	0.08
Septal lobulation	27 (77.1)	164 (58.0)	< 0.02
Aerobilia	7 (25.9)	16 (5.5)	< 0.01
Fluid/gaseous cavitation	33 (94.3)/ 6 (17.1)	243 (85.9)/ 21 (7.8)	0.08/ 0.03
Portal thrombophlebitis	4 (11.4)	5 (1.8)	< 0.01
Subcapsular rupture of the abscess	2 (5.7)	16 (5.6)	0.49

HN: Hepatic neoplasm; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate.

Table 3 Bacteriology, pathogenesis and confirmatory investigations of hepatic neoplasm- and non-hepatic neoplasm-associated pyogenic liver abscess n (%)

Bacteriology	HN group(n = 35)	Non-HN group(n = 283)	P value
Gram-positive organism	6 (17.2)	23 (8.1)	0.04
Streptococcus milleri	3 (8.6)	18 (6.4)
Others	3 (8.6)	5 (1.7)
Gram-negative organism	8 (22.8)	171 (60.4)	< 0.01
Escherichia coli	2 (5.7)	27 (9.5)
Klebsiella spp	5 (14.2)	135 (47.7)
Others	1 (2.9)1	9 (3.2)2
Mixed growth	14 (40.0)	43 (15.2)	< 0.01
Unknown	7 (20.0)	46 (16.3)	< 0.05
Antibiotic resistance	10 (28.6)	49 (17.3)	0.05
Pathogenesis
Biliary tract disorder	25 (71.4)	175 (61.8)	0.14
Portal pyemia	3 (8.6)	11 (3.9)	0.10
Direct spread	5 (14.3)	0 (0)	< 0.01
Hematogenous	2 (5.7)	5 (1.8)	0.07
Cryptogenic	0 (0)	15 (5.3)	0.08
Not investigated	0 (0)	77 (27.2)	< 0.01

¹Bacteriodes (n = 1);

²Enterobacter (n = 4), Citrobacter (n = 2), Fusobacterium (n = 2), Proteus (n = 1). HN: Hepatic neoplasm.

Table 4 Management and outcomes of pyogenic liver abscess with/without hepatic neoplasm n (%)

	HN group(n = 35)	Non-HN group(n = 283)	P value
Intervention
Imaging-guided aspiration ± drainage	27 (77.1)/ 6 (17.1)	233 (82.3)/ 206 (72.8)	0.23/ < 0.01
Surgical drainage	1 (2.9)	18 (6.4)	0.20
Complications and outcomes
Metastatic infection	0 (0)	17 (5.7)	0.07
Septic shock	14 (40)	77 (27.2)	0.06
DIC1	6 (17.1)	44 (15.5)	0.39
Acute coronary syndrome	2 (5.7)	14 (4.9)	0.42
Respiratory/renal failure	1 (2.9)	14 (4.9)	0.29
ICU care2	1 (2.9)	31 (11)	0.07
Recurrence	1 (2.9)	16 (5.7)	0.25
Death	25 (71.4)	25 (8.8)	< 0.01

¹For disseminated intravascular coagulation;

²For intensive care unit. HN: Hepatic neoplasm.

Table 5 Summary of multivariate logistic regression analysis of mortality of pyogenic liver abscess

Variable1	Wald estimate2	βcoefficient (B)	OR3 (95% CI)	P value
Hepatic malignancy	51.5	3.7	40.45 (14.76-111.65)	0.00
Hypoalbuminemia	15.2	0.2	1.22 (1.14-1.38)	0.00
DIC	5.2	1.2	3.32 (1.19-9.69)	< 0.05
Acute coronary syndrome	4.3	1.5	4.48 (1.08-17.80)	0.02
Impaired renal function	0.1	0	1.00 (0.82-1.12)	0.76
Total bilirubin	0.3	0	1.00 (0.71-1.51)	0.48
Septic shock	0.9	0.03	1.03 (0.82-2.67)	0.39
Surgical intervention	0.11	0.13	1.14 (0.71-3.90)	0.74

¹Variables were entered into the model by stepwise forwards method; only those clinically interested were listed;

²Wald estimate corresponds to the importance of the variable in the model;

³Odds ratio (OR): calculated by Exp (B). DIC: Disseminated intravascular coagulation.