Severity of disease as main predictor for mortality in patients with pyogenic liver abscess

Abstract 

Background

The purpose of this study was to explore the relationship between severity of illness at admission and mortality of patients with pyogenic liver abscess (PLA).

Methods

Medical records from 298 PLA patients ≥18 years old were reviewed. Severity of illness at admission was evaluated with the Acute Physiology and Chronic Health Evaluation (APACHE) II and the simplified acute physiology score (SAPS) II scoring systems. Stepwise logistic regression and receiver-operating-characteristic curve analyses were performed.

Results

The case-fatality rate was 10%. Multivariate analysis showed that APACHE II (P = .0004), SAPS II (P = .0008), the presence of gas-forming abscess (P <.0001), and the presence of anaerobic infection (P <.0001) all were associated with mortality. The area under the receiver-operating-characteristic curve was .884 (95% confidence interval .842 to .918) for APACHE II and .857 (95% confidence interval .812 to .895) for SAPS II, which were not significantly different (P = .490). The optimal cutoff APACHE II value of ≥15 had a sensitivity of 77% and a specificity of 92%, with a 20.3-fold risk of mortality (P <.0001). The SAPS II cutoff value of ≥28 had a sensitivity of 74% and a specificity of 82%, with a 7.2-fold risk of mortality (P = .008).

Conclusions

Both the APACHE II and the SAPS II scoring methods are appropriate for assessing mortality of PLA patients.

Keywords: Mortality, Pyogenic liver abscess, Risk factor, Severity of disease