Liver abscess: retrospective review of 68 cases

To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.