Factors influencing mortality in the treatment of pyogenic hepatic abscess

An analysis of 80 patients with pyogenic hepatic abscess demonstrated that there was no significant change in the incidence, age, sex, race, location or number of abscesses, symptoms, physical findings, laboratory data, routine X rays, or complications over a 21 yr period. However, there were relatively more women, the patients were older, and the incidence of appendicitis as an etiologic factor was much lower in this series than in the preantibiotic era. Ascending cholangitis was the most common etiologic factor throughout this series, although malignant extrahepatic obstruction has become more prevalent in recent years. Escherichia coli remains the most commonly isolated organism, and gram negative organisms are found in 72% of the cultures. More than one organism was isolated in 65% of the patients, and there was a significant increase in the number of anerobic organisms isolated in recent years. Furthermore, the majority of anaerobic abscesses were solitary, and therefore had a better prognosis. The factors associated with a poor prognosis were age greater than 70 yr, multiple abscesses, a biliary cause, an associated malignant condition, jaundice, an elevated serum glutamic oxalacetic transaminase level, hypoalbuminemia, polymorphonucleocytosis, bacteremia especially with multiple organisms, aerobic infection, and pulmonary, peritoneal, or other significant complications.