Study Population and Patient Characteristics
From January 2016 to December 2020, a total of 48 PLA patients, including 31 males and 17 females, were included in this study after excluding patients who did not meet the inclusion criteria. Among them, there were 32 patients in the Non-LC group and 16 patients in the LC-TACE group (Table 1). In the Non-LC group, 17 patients had diabetes, while only 1 patient in the LC-TACE group had diabetes, showing a statistically significant difference between the two groups (P = 0.002). Although the maximum body temperature (39.0 ± 0.8℃ vs 38.8 ± 1℃) and maximum abscess diameter (7.6 ± 3.8cm vs 7.3 ± 2.6cm) of patients in the LC-TACE group were higher than those in the non-TACE group, there was no statistically significant difference between the two groups (P > 0.05). Most of the PLA in both groups were located in the right lobe of the liver, and most of the PLA were single abscess. Fever and chills were the most common symptom in both groups, followed by abdominal pain. Shock occurred in 2 patient in the Non-LC group and 3 patients in the LC-TACE group.
Table 1
Baseline characteristics of PLA patients in the two groups
Characteristics
|
|
Non-LC group (n = 32) (No, %; Mean ± SD)
|
|
LC-TACE group (n = 16) (No, %; Mean ± SD)
|
|
P value
|
Age (years)
|
|
58.4 ± 12.6
|
|
55.7 ± 13.9
|
|
0.548
|
Gender
|
|
|
|
|
|
|
|
0.831
|
Male
|
|
21 (65.6%)
|
|
10 (62.5%)
|
|
|
Female
|
|
11 (34.4%)
|
|
6 (37.5%)
|
|
|
Abscess location
|
|
|
|
|
|
|
|
0.605
|
Right lobe
|
|
21 (65.6%)
|
|
9 (56.3%)
|
|
|
Left lobe
|
|
10 (31.3%)
|
|
6 (37.5%)
|
|
|
Bilobar involvement
|
|
2 (6.3%)
|
|
1 (6.3%)
|
|
1
|
Number of abscess
|
|
|
|
|
|
|
|
0.433
|
1
|
|
25 (78.1%)
|
|
14 (87.5%)
|
|
|
> 1
|
|
7 (21.9%)
|
|
2 (12.5%)
|
|
|
Maximal abscess diameter (cm)
|
|
7.3 ± 2.6
|
|
7.6 ± 3.8
|
|
0.762
|
Symptoms and signs
|
|
|
|
|
|
|
|
|
Fever/chills
|
|
26 (81.3%)
|
|
14 (87.5%)
|
|
0.584
|
Abdominal pain
|
|
13 (40.6%)
|
|
9 (56.3%)
|
|
0.306
|
Nausea/vomiting
|
|
6 (18.8%)
|
|
2 (12.5%)
|
|
0.584
|
General weakness
|
|
5 (15.6%)
|
|
2 (12.5%)
|
|
0.772
|
Diarrhoea
|
|
3 (9.4%)
|
|
1 (6.3%)
|
|
0.712
|
Cough/dyspnoea
|
|
2 (6.3%)
|
|
0
|
|
0.307
|
Pleuritic/chest pain
|
|
2 (6.3%)
|
|
0
|
|
0.307
|
Shock
|
|
2 (6.3%)
|
|
3 (18.8%)
|
|
0.181
|
Body temperature, °C
|
|
38.8 ± 1
|
|
39.0 ± 0.8
|
|
0.518
|
Underlying disease
|
|
|
|
|
|
|
|
|
Diabetes mellitus
|
|
17 (53.1%)
|
|
1 (6.3%)
|
|
0.002
|
Hepatobiliary and pancreatic diseases
|
|
12 (37.5%)
|
|
4 (25%)
|
|
0.386
|
Hepatobiliary calculi
|
|
11 (34.4%)
|
|
3 (18.8%)
|
|
0.262
|
Hypertension
|
|
6 (18.8%)
|
|
2 (12.5%)
|
|
0.584
|
Note. PLA, Pyogenic liver abscess; Non-LC, Non liver cancer; LC-TACE, Liver cancer receiving TACE; SD, Standard deviation. |
Microbiologic identifications and Laboratory examinations
The positive rate of pus culture was 87.5% in the Non-LC group and 81.3% in the LC-TACE group, and there was no significant statistical difference between the two groups (P = 0.563) (Table 2). In the Non-LC group, among the 28 positive cases, 50% (14/28) of the pathogens were Klebsiella pneumoniae, followed by Viridians streptococcus, Escherichia coli and Pseudomonas aeruginosa; while in the LC-TACE group, among the 13 positive cases, the most common pathogens were Escherichia coli (30.8%, 4/13), followed by Staphylococcus aureus, Viridians streptococcus, and Proteus mirabilis, and only 1 case was Klebsiella pneumoniae, the differences were statistically significant between the two groups (P = 0.009).
Table 2
Microbiological characteristics of two groups of PLA patients during hospitalization: pus culture
Characteristics
|
|
Non-LC group (n = 32) (No, %)
|
|
LC-TACE group (n = 16) (No, %)
|
|
P value
|
Positive growth
|
|
28 (87.5%)
|
|
13 (81.3%)
|
|
0.563
|
Polymicrobial growth
|
|
2 (7.1%)
|
|
1 (7.7%)
|
|
0.95
|
Klebsiella pneumonia
|
|
14 (50%)
|
|
1 (7.7%)
|
|
0.009
|
Viridians streptococcus
|
|
5 (17.9%)
|
|
2 (15.4%)
|
|
0.845
|
Escherichia coli
|
|
3 (10.7%)
|
|
4 (30.8%)
|
|
0.112
|
Pseudomonas aeruginosa
|
|
3 (10.7%)
|
|
1 (7.7%)
|
|
0.762
|
Staphylococcus aureus
|
|
2 (7.1%)
|
|
3 (23.1%)
|
|
0.297
|
Proteus mirabilis
|
|
1 (3.6%)
|
|
2 (15.4%)
|
|
0.176
|
Note. PLA, Pyogenic liver abscess; Non-LC, Non liver cancer; LC-TACE, Liver cancer receiving TACE. |
Compared with the LC-TACE group, patients in the Non-LC group had higher inflammatory biomarkers, including leukocytes (13.5 ± 6.8 vs 11.5 ± 6.8, P = 0.4), neutrophils (11.7 ± 6.7 vs 10.2 ± 6.8, P = 0.509), C-reactive protein (142.7 ± 76.6 vs 121.6 ± 56.7, P = 0.388), and procalcitonin (20.1 ± 28.8 vs 6.4 ± 7.4, P = 0.102), but there was no statistically significant difference between the two groups. After treatment of PLA, C-reactive protein (Non-LC group 89.4 ± 64.1 vs 80.3 ± 41.5, P = 0.644) and procalcitonin (Non-LC group 7.9 ± 21.1 vs 2.3 ± 3.5, P = 0.352) were significantly decreased in both groups, and there was no significant difference between the two groups. Meanwhile, alanine transaminase (ALT, 65.4 ± 47.6 vs 48.7 ± 35.7, P = 0.275) and aspartate aminotransferase (AST, 55.7 ± 50.0 vs 47.9 ± 23.4, P = 0.601) in the Non-LC group were higher than those in the LC-TACE group, while albumin (28.2 ± 5.1 vs 29.6 ± 3.5, P = 0.334) and total bilirubin (22.3 ± 17.0 vs 24.4 ± 14.8, P = 0.717) were lower than those in the LC-TACE group, and there was no significant difference in liver function between the two groups. Although PLA patients had elevated inflammatory biomarkers and abnormal liver function, the mean renal function including blood urea nitrogen and creatinine were normal in both groups (Table 3).
Table 3
Laboratory results of two groups of PLA patients
Characteristics
|
|
Non-LC group (n = 32) (Mean ± SD)
|
|
LC-TACE group (n = 16) (Mean ± SD)
|
|
P value
|
WBCc (X109/L)
|
|
13.47 ± 6.76
|
|
11.50 ± 6.81
|
|
0.4
|
Neutrophil count (X109/L)
|
|
11.74 ± 6.68
|
|
10.21 ± 6.75
|
|
0.509
|
AST ( IU/L)
|
|
55.7 ± 50.0
|
|
47.9 ± 23.4
|
|
0.601
|
ALT( IU/L)
|
|
65.36 ± 47.64
|
|
48.69 ± 35.67
|
|
0.275
|
Prothrombin time, INR
|
|
14.4 ± 2.7
|
|
14.6 ± 1.2
|
|
0.81
|
Total bilirubin (µmol/L)
|
|
22.34 ± 16.96
|
|
24.37 ± 14.82
|
|
0.717
|
BUN (mmol/L)
|
|
5.85 ± 2.79
|
|
6.97 ± 5.24
|
|
0.394
|
Cr (µmol/L)
|
|
59.78 ± 13.24
|
|
74.68 ± 47.38
|
|
0.286
|
CRP (mg/L)
|
|
142.7 ± 76.6
|
|
121.6 ± 56.7
|
|
0.388
|
ALP (U/L)
|
|
251.56 ± 161.48
|
|
212.77 ± 90.80
|
|
0.429
|
PCT (µg/L)
|
|
20.1 ± 28.8
|
|
6.4 ± 7.4
|
|
0.102
|
Albumin (g/dL)
|
|
28.204 ± 5.08
|
|
29.58 ± 3.52
|
|
0.334
|
Note. PLA, Pyogenic liver abscess; Non-LC, Non liver cancer; LC-TACE, Liver cancer receiving TACE; SD, Standard deviation; WBCc, White blood cell count; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; BUN, Blood urea nitrogen; Cr, Creatinine; CRP, Cross-reacting protein; ALP, Alkaline phosphatase; PCT, Procalcitonin. |
Treatment outcomes and risk factors for mortality
All patients were treated with intravenous sensitive antibiotics while receiving PCD. Of the patients in the Non-LC group, 62.5% (20/32) received combined antibiotic treatment, i.e., third-generation cephalosporins or carbapenems combined with fluoroquinolones and metronidazole, and only 12 patients received single antibiotic treatment. Of the patients in the LC-TACE group, 62.5% (10/16) were treated with combination antibiotics and 6 patients were treated with single antibiotic.
In the Non-LC group, 28 patients improved after treatment, 1 patient did not improve, and 3 patients died during hospitalization, with a mortality rate of 9.4%. In the LC-TACE group, 9 cases improved after treatment, 3 cases did not improve, and 4 cases died during hospitalization, with a mortality rate of 25%. Univariate analysis (Table 4) demonstrated that leukocyte count (HR, 1.223; 95%CI: 1.040, 1.439, P = 0.015), neutrophils count (HR, 1.220; 95%CI: 1.041, 1.431, P = 0.014), and total bilirubin (HR, 1.042; 95%CI: 0.993, 1.093, P = 0.095) were associated with mortality. However, when these three factors were included in the multivariate analysis (Table 5), there was no independent prognostic factor associated with mortality. The cure time of the Non-LC group was 37.4 ± 23.1 days (6–90 days), while that of the LC-TACE group was 91.5 ± 49.7 days (19–180 days), with a statistically significant difference between the two groups (P < 0.001).
Table 4
Univariate analysis of prognostic factors for mortality of PLA patients in two groups
Variables
|
HR (95% CI)
|
P value
|
Age (y)
|
1.017 (0.942, 1.098)
|
0.663
|
Gender
|
|
|
Female
|
1
|
|
Male
|
0.333 (0.048, 2.297)
|
0.265
|
Abscess location
|
|
|
Bilobar involvement
|
1
|
|
Right lobe
|
0.087 (0.004, 1.981)
|
0.126
|
Left lobe
|
0.222 (0.009, 5.275)
|
0.352
|
Number of abscess
|
|
|
> 1
|
1
|
|
1
|
-
|
0.999
|
Maximal abscess diameter (cm)
|
1.093 (0.798, 1.498)
|
0.580
|
Body temperature, °C
|
0.825 (0.297, 2.291)
|
0.712
|
Pus culture
|
|
|
No bacteria
|
1
|
|
Positive growth
|
0.552 (0.049, 6.254)
|
0.631
|
WBCc (X109/L)
|
1.223 (1.040, 1.439)
|
0.015
|
Neutrophil count (X109/L)
|
1.220 (1.041, 1.431)
|
0.014
|
ALT( IU/L)
|
0.996 (0.972, 1.019)
|
0.715
|
AST ( IU/L)
|
0.992 (0.961, 1.023)
|
0.590
|
Prothrombin time, INR
|
1.506 (0.830, 2.734)
|
0.178
|
Total bilirubin (µmol/L)
|
1.042 (0.993, 1.093)
|
0.095
|
BUN (mmol/L)
|
1.133 (0.917, 1.399)
|
0.247
|
Cr (µmol/L)
|
1.019 (0.993, 1.046)
|
0.154
|
CRP (mg/L)
|
0.985 (0.966, 1.003)
|
0.109
|
ALP (U/L)
|
0.998 (0.991, 1.006)
|
0.665
|
PCT (µg/L)
|
0.978 (0.915, 1.046)
|
0.519
|
Albumin (g/dL)
|
0.867 (0.692, 1.086)
|
0.213
|
Group
|
|
|
LC-TACE
|
1
|
|
Non-LC
|
0.290 (0.042, 2.011)
|
0.210
|
Note. PLA, Pyogenic liver abscess; HR, Hazard ratio; CI confidence interval; WBCc, White blood cell count; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; BUN, Blood urea nitrogen; Cr, Creatinine; CRP, Cross-reacting protein; ALP, Alkaline phosphatase; PCT, Procalcitonin; LC-TACE, Liver cancer receiving TACE; Non-LC, Non liver cancer. |
Table 5
Multivariate analysis of prognostic factors for mortality of PLA patients in two groups
Variables
|
HR (95% CI)
|
P value
|
WBCc (X109/L)
|
2.098 (0.298, 14.757)
|
0.457
|
Neutrophil count (X109/L)
|
0.585 (0.086, 3.982)
|
0.584
|
Total bilirubin (µmol/L)
|
1.042 (0.984, 1.104)
|
0.161
|
Note. PLA, Pyogenic liver abscess; HR, Hazard ratio; CI confidence interval; WBCc, White blood cell count. |