Long HY, Yan X, Meng JX, Xie F. Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data. World J Gastrointest Surg 2025; 17(4): 104615 [DOI: 10.4240/wjgs.v17.i4.104615]
Corresponding Author of This Article
Feng Xie, Department of Interventional Medicine, Jin Qiu Hospital of Liaoning Province, No. 317 Xiaonan Road, Shenhe District, Shenyang 110016, Liaoning Province, China. 15040255877@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Long HY was responsible for the conceptualization and design of the study, literature search, and drafting of the manuscript; Yan X was in charge of data collection, organization, and analysis; Meng JX performed the critical analysis of the study, participated in data organization, and revised the manuscript; Xie F supervised the study, provided significant guidance, and finalized the manuscript as the corresponding author; All authors have read and approved the final manuscript.
Institutional review board statement: This study has passed the ethical review by the institutional review board of The People’s Hospital of Liaoning Province (No. 2023K028).
Informed consent statement: This study is a retrospective study that exempts patients from informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Anonymized data not presented herein is available upon reasonable request from the corresponding author on rational request by any qualified researcher.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Xie, Department of Interventional Medicine, Jin Qiu Hospital of Liaoning Province, No. 317 Xiaonan Road, Shenhe District, Shenyang 110016, Liaoning Province, China. 15040255877@163.com
Received: December 28, 2024 Revised: January 24, 2025 Accepted: February 20, 2025 Published online: April 27, 2025 Processing time: 93 Days and 2 Hours
Abstract
BACKGROUND
Effective management of liver abscess depends on timely drainage, which is influenced by the liquefaction degree. Identifying predictive factors is crucial for guiding clinical decisions.
AIM
To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.
METHODS
This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage. Patients were divided into a poor liquefaction group (n = 28) and a well liquefaction group (n = 82) based on the ratio of postoperative 24-hour drainage volume to abscess volume, using a cutoff value of 0.3. Clinical characteristics, laboratory indicators, and computed tomography imaging features were compared. A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.
RESULTS
Independent predictive factors for good liquefaction included the absence of diabetes [odds ratio (OR) = 0.339, P = 0.044], absence of pneumonia (OR = 0.218, P = 0.013), left-lobe abscess location (OR = 4.293, P = 0.041), cystic features (OR = 5.104, P = 0.025), and elevated preoperative serum alanine aminotransferase (ALT) levels (OR = 1.013, P = 0.041). The logistic regression model based on these factors demonstrated an area under the curve of 0.814, with a sensitivity of 90.24% and specificity of 67.86%. Five-fold cross-validation yielded an average accuracy of 83.61% and a kappa coefficient of 0.5209.
CONCLUSION
Pneumonia, diabetes, abscess location, abscess composition, and preoperative serum ALT levels are significant predictors of liver abscess liquefaction. The model can guide clinical decision-making.
Core Tip: This study identifies key clinical, laboratory, and imaging factors associated with the degree of liquefaction in pyogenic liver abscesses. A predictive model was developed based on these factors to assess the degree of liquefaction, providing valuable guidance for optimizing the timing of clinical aspiration and drainage, thereby improving patient outcomes.
Citation: Long HY, Yan X, Meng JX, Xie F. Predictive factors for liver abscess liquefaction degree based on clinical, laboratory, and computed tomography data. World J Gastrointest Surg 2025; 17(4): 104615
Pyogenic liver abscess (PLA) is a severe abdominal infectious disease. Although the incidence of PLA in the general population is relatively low and varies across different regions worldwide, its incidence has been rising steadily in recent years in many regions[1-4]. Currently, the combination of antibiotics and percutaneous catheter drainage (PCD) has become the first-line treatment for uncomplicated PLA, while surgical intervention is now reserved for cases where interventional treatment fails or is unsuitable due to specific clinical conditions[5,6]. Currently, the combination of antibiotics and PCD has become the first-line treatment for uncomplicated PLA, while surgical intervention is now reserved for cases where interventional treatment fails or is unsuitable due to specific clinical conditions[7-9]. Additionally, studies suggest that poorly liquefied abscesses might benefit more from conservative treatment, as drainage of these lesions often provides little or no benefit[10]. Conversely, if a well-liquefied abscess is not timely drained, the patient’s condition may worsen, adversely affecting prognosis and potentially leading to life-threatening complications[11]. In clinical practice, discrepancies often arise between imaging findings and actual drainage outcomes. For example, some abscesses appearing well-liquefied on ultrasound (US) or computed tomography (CT) produce less than 5 mL of drainage fluid within 24 hours post-PCD, or even none. Conversely, some abscesses that appear poorly liquefied on US or CT exhibit unexpectedly high drainage volumes. This highlights the limitations of relying solely on empirical judgment to assess abscess liquefaction, which may result in mistimed drainage procedures and compromise patient outcomes. Despite its clinical importance, research on factors affecting PLA liquefaction remains limited[12,13]. Therefore, it is necessary to further investigate the factors influencing the liquefaction of liver abscesses to optimize clinical decision-making and improve patient outcomes.
Although the liquefaction degree of PLA plays a critical role in determining the optimal timing for percutaneous drainage, research on the factors influencing liquefaction remains limited. Moreover, no reliable models or standardized criteria currently exist to accurately assess the liquefaction status of abscesses. To address this research gap, this study focuses on patients undergoing PCD, systematically analyzing the relationships between postoperative drainage volume, clinical characteristics, CT imaging features, and laboratory indicators. We aim to identify key predictive factors of liquefaction, providing a scientific basis for optimizing clinical decision-making and improving patient outcomes.
MATERIALS AND METHODS
Study population
Given that this study adopts a retrospective design, the ethics committee approved a waiver of written informed consent.
We identified patients coded asDB90.0 under the 11th revision of the International Classification of Diseases in the hospital database between January 2017 and February 2023. To control for potential variability in abscess drainage volume caused by differences in surgical techniques among operators, only patients whose procedures were performed by the same surgeon were included. The exclusion criteria were as follows: (1) Patients who did not undergo PCD or had more than one drainage catheter placed during PCD; (2) Patients whose drain age catheter dislodged within 24 hours post-PCD, either spontaneously or due to external factors; (3) Patients without recorded drainage volume within 24 hours post-PCD; (4) Patients with drainage catheter blockage within 24 hours post-PCD; (5) Patients with missing imaging or laboratory data within 24 hours preoperatively; and (6) Patients with multiple abscesses. A total of 110 patients met the inclusion criteria and were enrolled in the study.
Patient grouping
Currently, standardized quantitative criteria for differentiating between well-liquefied and poorly liquefied liver abscesses in the context of PCD are lacking. To address this, we established a pragmatic classification system based on the ratio of postoperative 24-hour drain age volume to the initial abscess volume (as determined by pre-procedural imaging). The cutoff value of 0.3 was selected primarily based on our clinical experience, as well as the practical challenges encountered during PCD, especially in cases of poorly liquefied abscesses. The rationale for recording the 24-hour postoperative drainage volume is that, under normal circumstances, the fluid within the abscess cavity is typically drained within 24 hours. Any additional fluid beyond this timeframe is primarily due to further necrosis of inflammatory cells or liver tissue. Specifically, our clinical observations indicated that when the ratio fell below 0.3, securing the drainage catheter became significantly more challenging. This difficulty in catheter fixation directly resulted in a considerably higher rate of catheter dislodgement, thus compromising both the efficacy of drainage and patient safety. Conversely, while a higher ratio could ensure a lower catheter dislodgement rate, it could also lead to missing the optimal drainage timing for some patients, consequently impacting their prognosis. Based on these considerations, we ultimately determined that 0.3 was the most appropriate cutoff value. This resulted in 82 patients being classified into the well-liquefied group and 28 into the poorly liquefied group.
Methods
The laboratory test data and demographic characteristics, including age, gender, BMI, preoperative clinical manifestations, laboratory test data within 24 hours before surgery, and postoperative 24-hour drainage volume, were all obtained from the hospital database. Abdominal CT scans performed within 24 hours prior to PCD were collected for the patients.
CT scan image processing and delineation
All patients underwent preoperative CT or contrast-enhanced CT (CECT) scans. However, only plain CT images (with a slice thickness of 1 mm) were used for contouring and software calculations. We did not utilize CECT images primarily because, in clinical practice, plain CT is considered superior for assessing the liquefaction degree of liver abscesses. The use of contrast agents increases the CT values of blood vessels and the normal liver tissue surrounding the lesions. Due to the “partial volume effect”, this can lead to the enhancement of CT values in certain parts of the lesions, thereby affecting the evaluation of lesion size and liquefaction. CECT is mainly used to differentiate liver abscesses from other diseases when the diagnosis is uncertain[14,15]. Some studies have also suggested that CECT is not entirely accurate in determining the liquefaction and necrosis of abscesses[16,17].
Before presenting the images to two radiologists with over ten years of experience, all patient-related information was removed. Discrepancies in image interpretation and region of interest (ROI) delineation between the two radiologists were resolved through consensus. In this study, the liquefied liver abscess features determined jointly by the two radiologists included: (1) The location of the abscess; and (2) The presence of gas. The delineated ROIs were then reconstructed in three dimensions, and the following characteristics of the liver abscess were calculated using software (three dimensional Slicer): (1) Lesion volume; (2) Maximum cross-sectional length of the lesion; (3) Maximum three-dimensional length of the lesion; (4) Mean CT value of the lesion; (5) Presence of solid components in the lesion (defined as components with CT values ≥ 20 HU accounting for more than 50% of the lesion); (6) 10th percentile and 90th percentile CT attenuation values (to minimize the influence of gas, hemorrhage, and calcification within the lesion on CT attenuation values); and (7) The attenuation range between the 10th and 90th percentiles.
Statistical analysis
Categorical data were expressed as n (%) and analyzed using the χ2 test. For continuous data, normality testing revealed that most variables did not conform to a normal distribution. To ensure consistent analysis methods, all continuous data were described using medians and interquartile ranges. Comparisons between two groups were performed using the Mann-Whitney U test. In multivariate analysis, variables identified as significant in univariate analysis (P ≤ 0.05) were included, and the final regression model was developed using a stepwise selection method. A diagnostic model was established based on the beta coefficients of the logistic regression model. The model’s performance was assessed using the receiver operating characteristic curve. A five-fold cross-validation method was employed to evaluate the model’s efficacy. This study utilized three-dimensional Slicer (version 5.6.2), statistical product and service solutions (version 25.0, IBM Co., Armonk, NY, United States), R (version 4.4.2, R Foundation for Statistical Computing, Vienna, Austria), and GraphPad Prism (version 10.1.2, GraphPad Software, San Diego, CA, United States) for image processing, statistical analyses, and data visualization.
RESULTS
A total of 110 patients who underwent PCD were included in this study and categorized into the well-liquefied group (82 patients) and the poorly liquefied group (28 patients) on the basis of their treatment outcomes; thus, the prevalence of poor liquefaction was 25.45%. Table 1 shows the clinical and laboratory characteristics of the two groups and the results of their statistical comparisons. There were no significant differences in demographic parameters or certain comorbidities (e.g., malignancy and hypertension) between the groups. Notably, the prevalence of diabetes in the well-liquefied group was 46.3%, which was significantly lower than the 71.4% reported in the poorly liquefied group (P = 0.022). Similarly, the prevalence of pneumonia was markedly lower in the well-liquefied group (12.2%) than in the poorly liquefied group (39.3%, P = 0.002). Additionally, the serum alanine transaminase (ALT) level was significantly greater in the well-liquefied group (P = 0.041). Although no patients with impaired consciousness were observed in the poorly liquefied group, the difference with the well-liquified group was not statistically significant (P = 0.057). Further multivariable analysis revealed that diabetes [odds ratio (OR) = 0.338, 95% confidence interval (CI): 0.118-0.971, P = 0.044] and pneumonia (OR = 0.213, 95%CI: 0.059-0.764, P = 0.018) were independent predictors of poor liquefaction. The serum ALT level (OR = 1.013, 95%CI: 1.001-1.025, P = 0.041) was also significantly associated with the liquefaction outcome.
Table 1 Clinical characteristics and laboratory indicators of patients, n (%).
Table 2 compares the CT characteristics of the patients in the two groups. Univariable analysis revealed that the lesion volume in the well-liquefied group was significantly smaller than that in the poorly liquefied group [median values: 88.48 cm³ (37.68, 164.03) vs 110.45 cm³ (89.16, 207.13), P = 0.035]. Additionally, the proportion of abscesses located in the left lobe was significantly greater in the well-liquefied group (61.0%) than in the poorly liquefied group (10.7%, P = 0.005), as was the occurrence of cystic features (34.1% vs 10.7%, P = 0.017). There were no significant differences between the two groups regarding the mean CT values, median CT values, or other imaging parameters. Multivariable logistic regression analysis revealed that abscess location in the left lobe (OR = 4.305, 95%CI: 1.065-17.404, P = 0.041) and the occurrence of cystic features (OR = 5.037, 95%CI: 1.187-21.378, P = 0.028) were independent predictors of good liquefaction. However, lesion volume was not significantly associated with patient outcomes (P = 0.919).
Table 2 Comparison of patient computed tomography characteristics, n (%).
CT features
PL (n = 28)
WL (n = 82)
Univariate analysis
Multivariate analysis
Z value
P value
P value
OR (95%CI)
Lesion volume (cm³), median (25th, 75th percentiles)
Multivariable logistic regression analysis was conducted again using the statistically significant factors identified in the previous analyses, including diabetes, pneumonia, serum ALT levels, abscess location, and abscess composition (Figure 1). The results revealed that pneumonia (OR = 0.218, 95%CI: 0.065-0.727, P = 0.013) and diabetes (OR = 0.339, 95%CI: 0.118-0.973, P = 0.044) were protective factors against good liquefaction, whereas the presence of cystic features (OR = 5.104, 95%CI: 1.229-21.196, P = 0.025), abscess location in the left lobe (OR = 4.293, 95%CI: 1.065-17.305, P = 0.041), and elevated preoperative serum ALT levels (OR = 1.013, 95%CI: 1.001-1.025, P = 0.041) were predictive of good liquefaction. The established logistic regression model was as follows: Logit (P) = 0.666 - 1.525A - 1.081B + 1.630C + 1.457D + 0.012E. Where A represents pneumonia (0 = no, 1 = yes), B represents diabetes (0 = no, 1 = yes), C represents cystic features (0 = no, 1 = yes), D represents abscess location (0 = right lobe, 1 = left lobe), and E represents preoperative ALT levels. The receiver operating characteristic curve of the diagnostic model is shown in Figure 2. The area under the curve was 0.814 (95%CI: 0.709-0.919). The maximum Youden index was 0.581, and the optimal cutoff value was 0.5485, yielding a sensitivity of 90.24% and a specificity of 67.86%. Fivefold cross-validation was performed to validate the model, yielding an average accuracy of 83.61% and an average kappa coefficient of 0.5209. Among the folds, the best performance was observed in fold 1, with an accuracy of 95.65% and a kappa coefficient of 0.8808, whereas the worst performance was in fold 5, with an accuracy of 73.91% and a kappa coefficient of 0.3235.
Figure 2 Receiver operating characteristic curve of the model.
AUC: Area under the curve; CI: Confidence interval.
DISCUSSION
In this study, the incidence of good abscess liquefaction was 75.55%. Our findings indicate that pneumonia, diabetes, abscess location, and internal abscess composition are independent predictors of liquefaction degree. Additionally, serum ALT levels were significantly associated with good abscess liquefaction.
Our study suggests that pneumonia is indicative of poor liquefaction in liver abscesses, which we believe may be associated with Klebsiella pneumoniae (K. pneumoniae) as the predominant pathogen in pneumonia-related PLA patients. Liver abscesses caused by K. pneumoniae are typically characterized by poor liquefaction. Since its initial identification in Taiwan in the 1980s, K. pneumoniae has become an increasingly common pathogen, eventually replacing Escherichia coli as the primary causative agent of liver abscesses[18]. K. pneumoniae frequently exhibits extrahepatic migration to other tissues and organs, such as the lungs, brain, and eyes, leading to the development of invasive K. pneumoniae liver abscess syndrome (IKPLAS)[19]. As this is a retrospective study, we cannot determine the exact sequence of events between the occurrence of PLA and pneumonia. However, a study by Chung et al[20] indicated that the likelihood of developing pneumonia significantly increases after the onset of PLA, with K. pneumoniae accounting for 84.9% of the pathogens involved. Meanwhile, a study by Ho et al[21] mentioned that if a distant abscess develops shortly after the onset of pneumonia, the likelihood of K. pneumoniae being the causative pathogen significantly increases. We believe that regardless of the sequence of disease onset, once a PLA patient develops pneumonia, the likelihood of K. pneumoniae being the causative pathogen increases. Due to its high invasion, K. pneumoniae can rapidly damage the surrounding normal liver tissue, preventing some of the necrotic liver tissue within the abscess from having sufficient time to undergo liquefaction[11,22,23]. Additionally, certain K. pneumoniae serotypes, especially in East Asia, possess anti-phagocytic and anti-neutrophil properties, which allow for the preservation of some liver tissue within the abscess that has not yet undergone necrosis[24,25]. Under the combined effects of these factors, IKPLAS typically presents as poor liquefaction. However, since we only recorded the drainage volume from the abscess 24 hours post-surgery, the time frame may be insufficient for IKPLAS. Some K. pneumoniae strains have high viscosity, which can lead to obstruction of the drainage tube and a slower drainage process, potentially preventing complete drainage of the abscess within 24 hours[26-28].
Diabetes is an important independent risk factor for PLA, not only increasing the incidence of PLA but also having a negative impact on the prognosis of PLA patients[29,30]. In the multivariate analysis, the absence of diabetes was identified as an independent predictor of good abscess liquefaction. One important reason for this might be the compromised immunity in diabetic patients. Diabetes can lead to a reduction in dendritic cells, diminished chemotaxis and phagocytic activity of neutrophils, and impairment of neutrophil extracellular traps and macrophage phagocytosis[30-32]. Additionally, compared to non-diabetic individuals, diabetic patients tend to have more biofilm-associated bacteria within their lesions. The formation of this biofilm enables microorganisms to partially evade the immune surveillance system[31,33]. Moreover, due to the compromised immune system in diabetic patients, they tend to use more antibiotics compared to non-diabetic individuals. Some studies have found a gradual increase in antibiotic use among diabetic patients[34,35]. The increased use of antibiotics in diabetic patients may lead to a higher likelihood of drug-resistant bacteria within PLA lesions. This, in turn, makes them more resistant to conventional antibiotics[35,36]. Finally, a study by Thurlow et al[37] revealed that the metabolic dysregulation caused by diabetes also affects the immune system’s ability to eliminate infected hepatocytes to a certain extent. Under the combined influence of the aforementioned factors, the immune function within liver abscess lesions of diabetic patients is weakened, resulting in impaired clearance of necrotic tissue and inflammatory cells in the affected area. This limitation hinders the adequate formation of pus, ultimately leading to poor liquefaction.
Liver abscess, as a benign space-occupying lesion of the liver, can have a certain impact on liver function. Two isoforms of serum alanine aminotransferase, ALT1 and ALT2, are highly expressed in hepatic cells[38]. Hepatocyte necrosis leads to an increase in serum ALT levels, which is positively correlated with the degree of liver damage[39,40]. In well-liquefied lesions, most hepatocytes have already undergone necrosis, whereas in poorly liquefied lesions, most hepatocytes remain in the stage of leukocyte infiltration. As a result, well-liquefied abscesses release more ALT into the serum, leading to higher ALT levels compared to patients with poorly liquefied abscesses.
Lesions exhibiting cystic features can indicate well-liquefied abscesses, a result consistent with our clinical experience. Many interventional physicians currently use this factor to determine whether an abscess has liquefied well. Our study results show that in the poorly liquefied group, lesions predominantly presented with solid features, accounting for as much as 89.3%, while in the well-liquefied group, the proportion of solid features decreased to 65.9%. This suggests that lesion composition offers a high accuracy for identifying poorly liquefied lesions, but the accuracy for identifying well-liquefied lesions is relatively lower. Therefore, we believe it is necessary to consider other predictive factors to improve the overall accuracy in assessing abscess liquefaction.
Our study results found that abscesses located in the left lobe had a higher degree of liquefaction compared to those located in the right lobe, and this difference was statistically significant. This conclusion was somewhat unexpected, as some studies suggest that anatomical location does not affect the overall structure of the abscess[41,42]. We believe this difference may be due to the distinct pathogenic microbiota in the left and right lobes. Infection originating from gut microbiota via the portal vein is an important cause of PLA[43]. Since the right liver is heavier in mass and has larger bile duct volume and density compared to the left liver, blood flow from the mesentery primarily flows through the portal vein to the right lobe of the liver[44,45]. Therefore, the hemodynamic differences between the left and right lobes may lead to distinct microbial infection characteristics, which in turn affect the degree of liquefaction of the abscess.
Among the 28 patients with poor liquefaction, none showed signs of consciousness disturbance, while 13 patients (15.9%) in the good liquefaction group experienced consciousness disturbances. Although this result was not statistically significant in the univariate analysis (P = 0.057), it may be due to the insufficient sample size. We believe that with a larger sample size, this result could achieve statistical significance. This could also be attributed to the longer course of the lesions in the good liquefaction group compared to the poor liquefaction group. As a result, the pathogens (such as K. pneumoniae) in the lesions had more opportunities to enter the bloodstream, leading to extrahepatic infections.
This study explored the predictive factors associated with good liquefaction in pyogenic liver abscesses and developed a prediction model based on these factors. The model aims to provide scientific evidence for clinicians to optimize the timing of puncture, ensuring that patients receive puncture drainage and other therapeutic interventions at the optimal time. This approach is intended to improve the success rate of treatment, reduce the occurrence of complications, enhance patient prognosis, and provide important support for clinical decision-making.
All patients in this study underwent preoperative US examination. However, for some patients, the judgment of abscess liquefaction degree based on preoperative US did not align with the actual postoperative drainage outcomes (Figure 3). In this study, we did not use any US images for data analysis, primarily due to the following reasons: (1) US images are two-dimensional, and since this is a retrospective study, the stored images were insufficient for three-dimensional reconstruction of the lesions using software. In contrast, CT images provide similar data but are more accurate; and (2) The US examinations were performed by different operators, and variations in their operating habits, image recording practices, and machine parameter settings were significant, leading to larger data collection errors in US compared to CT.
Figure 3 Elderly patients with diabetes and hypertension.
A and B: An elderly female patient; Computed tomography (CT) scan (A); Ultrasound (US) examination (B). These results were interpreted by two radiologists as showing well-formed liquefaction. The postoperative drainage volume was only 100 mL, with a ratio of 0.23 compared to the lesion volume; C and D: An elderly male patient; CT scan (C); US examination (D). The degree of liquefaction of the lesion is less than in A and B, but the postoperative drainage volume was 61 mL, with a ratio of 0.85 compared to the lesion volume.
Our study has several limitations that warrant discussion. First, as a retrospective, single-center study, the generalizability of our findings is inherently limited. The reliance on existing medical records, rather than standardized data collection, may have introduced bias or missing data, affecting the robustness of our conclusions. For instance, when assessing the influence of pneumonia and diabetes on abscess liquefaction, we hypothesized that differences between the liquefied and non-liquefied groups could, in part, be attributed to the predominance of K. pneumoniae in the diseased group. However, the lack of bacterial culture data for many patients prevented us from fully exploring this hypothesis. Additionally, most patients had comorbidities requiring multiple medications during treatment, which may have influenced abscess liquefaction, as suggested by prior research[46,47]. Lastly, the CT imaging data were obtained using different scanners with varying settings and parameters, which could have introduced subtle inconsistencies in CT values, potentially affecting the precision of our quantitative findings. To minimize such variability, future studies should adopt standardized imaging protocols.
CONCLUSION
This study analyzed the factors influencing the degree of liquefaction in hepatic abscesses and identified preoperative serum ALT levels, diabetes status, pneumonia status, abscess location, and cystic features as important predictors of liquefaction. The predictive model constructed based on these factors demonstrated good diagnostic performance, providing scientific evidence for clinicians to optimize the timing of puncture procedures. The occurrence of poor liquefaction is closely related to conditions such as diabetes and pneumonia, suggesting that the impact of underlying diseases on liquefaction should be considered during treatment. Future prospective, multi-center studies could further validate the clinical utility of the model to improve treatment success rates and outcomes for hepatic abscess patients.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade B
Novelty: Grade B, Grade B
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade B, Grade B
P-Reviewer: Zhao JP S-Editor: Fan M L-Editor: A P-Editor: Zheng XM
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