Clinical features and prognostic factors in patients with liver abscess and acquired immunodeficiency syndrome / 中华传染病杂志

ABSTRACT

Objective To investigate the clinical features and prognostic factors in patients with acquired immunodeficiency syndrome (AIDS) and liver abscess.Methods The clinical data of AIDS patients with liver abscess admitted in Beijing You-an Hospital during January 2013 to December 2017 were retrospective analyzed to reveal the clinical manifestations,etiologies,imaging features,therapeutic effects and prognostic factors.T test,x2 test or Fisher exact test were used for statistical analyses.Results A total of 76 patients were recruited.The most common clinical manifestations were fever (72 cases),chills (48 cases),anorexia (42 cases) and abdominal pain (35 cases).Liver abscesses were mainly located in right lobe (57 cases),then in left lobe (11 cases),in both right and left lobes (6 cases) and in caudate lobe (2 cases).Lobulation or division was seen in 19 cases and gas formation was seen in 5 cases.Single abscess was identified in 56 cases.Positive culture results were obtained in 15.5％ (9/58) from liver pus and 6.0％ (4/67) from blood samples.Thirteen strains of pathogens were detected by liver pus culture,including 9 strains of Staphylococcus,3 strains of Candida and 1 strain of Mycobacterium.Six strains of pathogens were detected by blood culture,including 5 strains of Staphylococcus and 1 strain of Corynebacterium.The main complications included acute kidney injury (10 cases) and septic shock (6 cases).Sixty-one cases were treated with antibiotics plus imaging-guided percutaneous aspiration,drainage or surgery,of whom 57 cases were effective.Fifteen cases were treated with antibiotics alone,of whom 12 cases were effective.Septic shock (OR =70.16,95％ CI4.77-1 032.06,P ＜0.01),respiratory failure (OR =68.41,95％ CI2.40-1 946.53,P =0.01) and gas formation (OR =23.36,95％ CI1.30-420.16,P =0.03) were independent risk factors for poor prognosis.Conclusions The clinical features of AIDS patients with liver abscess are uncharacteristic.Bacteria are the main pathogens.Septic shock,respiratory failure and gas formation are independent risk factors for poor prognosis.Imagingguided percutaneous aspiration,drainage combined with antibiotic therapy is safe and effective.