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Category: Volume 08 Issue 04 April 2020
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Title: Clinical Study of Prognostic Factors in Patients with Pyogenic Liver Abscess at G.R. Medical College and J.A. Group of Hospitals

Authors: Dr Manpreet Singh, Dr Anurag Chauhan, Dr Chandrakala Dutt

 DOI: https://dx.doi.org/10.18535/jmscr/v8i4.84

Abstract

   

Objective: To describe pyogenic liver abscess with respect to demography, clinical signs and symptoms, microbiological features, mode of treatment and adverse prognostic factors

Background: Pyogenic liver abscesses are the most common liver abscesses and has been recognized since the time of Hippocrates. Patients commonly present with right upper quadrant pain and fever. Jaundice occurs in up to one third of affected patients. Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening disorder with a crude annual incidence rate worldwide ranging from 2 to 45 cases per 1,00,000  hospital admissions. Because previous reports of patients with PLA have seldom included bacterial characteristics, we will collect microbiological data and other clinical information from PLA patients to identify the prognostic factors for this condition. We will also investigate the clinical features, abscess characteristics, causative pathogens, treatments and outcomes in these patients over this study period.

Methods: This prospective study involved 150 patients who were admitted in male and female surgical wards, Department of General surgery, J.A. Group of hospitals and G.R. Medical College, Gwalior during period December 2017-August 2019.

Results: The mean age was 44 years (ranging from 16 to 80 years). Out of these 150 patients, 140 patients were male and 10 patients were female ranging from 16 to 80 years with male to female ratio 14:1. The mean duration of symptoms prior to admission was 5.2 days (median – 3 days, range 1-60 days). The most common presenting feature was right upper quadrant abdominal pain – 96.6% followed by fever with chills 74%. Co-morbidities included were hypertension, diabetes mellitus, old stroke, ischaemic heart disease and congestive heart failure. 48 (32%) patients had diabetes mellitus, while 45(30%) patients had 2 or more co-morbid illness. Total bilirubin was elevated in 19 patients (12.7%). 131 patients (87.3%) had normal serum bilirubin level. The most common organism identified was E-coli (33.3% in pus culture and 20% in blood culture) followed by klebisella (25% in pus culture and 13.3% in blood culture).

Conclusion: Patients who are treated with antibiotics only are the ones having the abscess cavity size less than 5 cm. In pyogenic liver abscess patients having Jaundice,  CCF,  Diabetes Mellitus,  Ischemic Heart Disease,  Stroke,  Leukocytosis,  increased SGOT,  increased SGPT,  Uremia,  Large Size of Abscess,  Multiple Liver Abscesses,  Hepatomegaly and  Ruptured Liver Abscess the hospital stay duration was longer and  morbid.

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Corresponding Author

Dr Anurag Chauhan

Associate Professor, Department of Surgery, Gajra Raja Medical College, Gwalior (M.P.), India