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KMID : 0385920140250060660
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Journal of the Korean Society of Emergency Medicine
2014 Volume.25 No. 6 p.660 ~ p.666
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Clinical Characteristics and Predictive Factors of Septic Shock in Patients with Pyogenic Liver Abscess
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Kim Sun
Lee Yoon-Seon
Kim Youn-Jung
Ko Byuk-Sung
Ahn Shin
Sohn Chang-Hwan
Seo Dong-Woo
Kim Won-Young
Lim Kyoung-Soo
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Abstract
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Purpose: The aim of this study was to describe clinical, biochemical,and radiologic features in patients with pyogenicliver abscess and to investigate predictors of septic shock.
Methods: We consecutively included subjects who werediagnosed as pyogenic liver abscess in the emergencydepartment (ED) from January 1st, 2010 to June 30th,2013. Through review of medical records, clinical, biochemical,and radiologic data were collected. The primary endpointwas septic shock during hospitalization.
Results: A total of 228 patients were included, with a meanage of 60.8±12.8 years, and 63.2% were men. Amongthem, 198 patients presented with fever and GCS <15 wasobserved in 15. Klebsiella spp. was most commonly identifiedin 33.8%, followed by E. coli and Streptococci spp. in 7% foreach. Septic shock occurred in 55 (22.4%) and mortality ratewas 1.3%. In univariable logistic regression, GCS <15, systolicBP <90 mmHg, pulse rate ≥120/min, respiratory rate ≥22/min, body temperature (BT) ≥38 °C, WBC, platelet, BUN,creatinine, albumin, AST, alkaline phosphatase (ALP), Creactiveprotein (CRP), abscess size ≥5 cm, and bilobalinvolvement were significantly associated with septic shock(p<0.05). In multivariate analysis, systolic BP <90 mmHg (OR95.79, 95% CI: 11.16-822.02), BT ≥38 °C (OR 1.95, 1.36-2.78), BUN (OR 1.03, 1.01-1.06), ALP (OR 1.003, 1.000-1.005), and abscess size ≥5 cm (OR 2.31, 1.08-4.94) wereindependent predictors of septic shock.
Conclusion: Low systolic BP, high BT, elevated BUN andALP, and abscess size ≥5 cm were independently associatedwith septic shock in patients with pyogenic liver abscess.
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KEYWORD
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Pyogenic liver abscess, Septic shock, Prediction
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