[Analysis of factors associated to failure of medical treatment of amoebic liver abscess]. / Análisis de factores asociados al fracaso del tratamiento médico del absceso hepático amebiano.

INTRODUCTION: To identify the laboratory and ultrasound factors that could predict the response to medical treatment of amoebic liver abscess. MATERIAL AND METHOD: Retrospective study of patients diagnosis with amoebic liver abscess in Hospital Central in San Luis Potosí, Mexico. We included patients greater than 15 years of both sexes. We excluded those with probable pyogenic abscess, immunosupression, history of abdominal or biliary surgery, abdominal neoplasm abdominal or sepsis. We identified patients with good response to medical treatment and patients who needed the abscess drained. We studied the ultrasound findings, plasma levels of albumin, alkaline phosphatase and bilirubin. RESULTS: We analysed 45 patients, 31 had a good response (controls) and 14 needed drainage (cases). The medians of the variables with statistical significance in bivariate analysis were: albumin 2.65 g/dl and 1.7 g/dl (p < 0.001); alkaline phosphatase 133 U and 259 U (p = 0.02) and diameter of absences 5.9 cm and 9.95 cm (p < 0.001), controls and cases respectively. By logistic regression the diameter of the abscess showed a determination coefficient of 0.447 (p < 0.05) and OR = 14.85 (95% CI, 2.11-104.9) for drain if it was > or = 8 cm. CONCLUSIONS: A diameter bigger than 8 cm in hepatic amoebic abscess is associated with failure of medical treatment. Low albumin could be related to malnutrition and increased alkaline phosphatase with extrinsic compression of extrahepatic conducts due to big abscesses.

Análisis de factores asociados al fracaso del tratamiento médico del absceso hepático amebiano / Analysis of factors associated to failure of medical treatment of amoebic liver abscess

Introducción. Identificar los factores de laboratorio y ultrasonográficos que pudieran predecir la respuesta al tratamiento médico del absceso hepático amebiano. Material y método. Se realizó un estudio retrospectivo de pacientes con diagnóstico de absceso hepático amebiano en el Hospital Central de San Luis Potosí, México. Se incluyó a los pacientes mayores de 15 años de ambos sexos. Se excluyó a los sujetos con sospecha clínica de absceso piógeno, inmunosupresión o con antecedentes de cirugía abdominal o biliar o neoplasia abdominal. Se identificó a los pacientes que respondieron favorablemente al tratamiento médico y aquellos que requirieron de intervención para el drenaje del absceso. Se estudiaron los hallazgos ultrasonográficos, concentraciones séricas de albúmina, fosfatasa alcalina y bilirrubinas. Resultados. Se analizó a 45 pacientes, 31 respondieron al tratamiento (controles) y 14 requirieron intervención (casos). Las medianas de las variables con significación estadística en el análisis bivariable fueron: concentraciones de albúmina de 2,65 y 1,7 g/dl (p < 0,001); fosfatasa alcalina de 133 y 259 U (p = 0,02) y diámetro mayor del absceso de 5,9 y 9,95 cm (p < 0,001), en controles y casos, respectivamente. Mediante regresión logística el diámetro mayor del absceso mostró un coeficiente de determinación de 0,447 (p < 0,05) y odds ratio = 14,85 (intervalo de confianza del 95%, 2,11-104,9) de requerir drenaje a un valor de corte $ 8 cm. Conclusiones. Un diámetro > 8 cm del absceso hepático amebiano se relacionó con fracaso del tratamiento médico. La asociación con hipoalbuminemia probablemente se relaciona con desnutrición, mientras que valores elevados de fosfatasa alcalina pueden deberse a compresión extrínseca de los conductos extrahepáticos por abscesos de gran tamaño (AU)

Introduction. To identify the laboratory and ultrasound factors that could predict the response to medical treatment of amoebic liver abscess. Material and method. Retrospective study of patients diagnosis with amoebic liver abscess in Hospital Central in San Luis Potosí, Mexico. We included patients greater than 15 years of both sexes. We excluded those with probable pyogenic abscess, immunosupression, history of abdominal or biliary surgery, abdominal neoplasm abdominal or sepsis. We identified patients with good response to medical treatment and patients who needed the abscess drained. We studied the ultrasound findings, plasma levels of albumin, alkaline phosphatase and bilirubin. Results. We analysed 45 patients, 31 had a good response (controls) and 14 needed drainage (cases). The medians of the variables with statistical significance in bivariate analysis were: albumin 2.65 g/dl and 1.7 g/dl (p < 0.001); alkaline phosphatase 133 U and 259 U (p = 0.02) and diameter of absences 5.9 cm and 9.95 cm (p < 0.001), controls and cases respectively. By logistic regression the diameter of the abscess showed a determination coefficient of 0.447 (p < 0.05) and OR = 14.85 (95% CI, 2.11-104.9) for drain if it was $ 8 cm. Conclusions. A diameter bigger than 8 cm in hepatic amoebic abscess is associated with failure of medical treatment. Low albumin could be related to malnutrition and increased alkaline phosphatase with extrinsic compression of extrahepatic conducts due to big abscesses (AU)