Pyogenic liver abscesses: a comparison of older and younger patients

Objective: to evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or if their management differs from that of younger patients. Design: retrospective chart review of all cases occurring from 1982 to 1992. Setting: a regional trauma centre and two large community hospitals. Patients: a total of 38 individuals with a final diagnosis of pyogenic liver abscess. Seventeen patients aged 70 or older comprised the study group and 21 patients under age 70 the comparison group. Measurements: clinical features, laboratory data, therapeutic interventions and outcomes were sought. The presumed aetiology of the abscess was determined. Results: the study group had fewer men (47% vs 81%, P=0.028), less abdominal tenderness on physical examination (41% vs 76%, P=0.028) and fewer positive blood cultures in those sampled (31% vs 67%, P=0.04) than the comparison group. No study group patient had a history of trauma. Times to diagnosis were 32 and 5.9 days (P=0.14) and lengths of stay 21.6 and 29.3 days (P=0.08) for study and comparison groups, respectively. There were no differences in mortality or other demographic, clinical, laboratory or pathological variables. Conclusions: elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with no difference in mortality.