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Age and Ageing Advance Access originally published online on February 28, 2009
Age and Ageing 2009 38(3):271-276; doi:10.1093/ageing/afp002
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Pyogenic liver abscess in the elderly: clinical features, outcomes and prognostic factors

Shiuan-Chih Chen1,2,3, Yuan-Ti Lee3,4,5, Chi-Hua Yen1,2,3,5, Kuang-Chi Lai5,6, Long-Bin Jeng6, Ding-Bang Lin7, Po-Hui Wang3,5, Chun-Chieh Chen1,3, Meng-Chih Lee1,2,5,8 and William R. Bell9

1 Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
2 Department of Geriatric Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
3 School of Medicine, Chung Shan Medical University, Taichung, Taiwan
4 Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
5 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
6 Department of Surgery, China Medical University Hospital, Taichung, Taiwan
7 School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
8 National Project for Excellence in Geriatric Care Education (NPEGCE), Chung Shan Medical University, Taichung, Taiwan
9 Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Address correspondence to: C.-C. Chen, Faculty of Medicine, Chung Shan Medical University School of Medicine, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan. Tel: (+886) 4-24739595, ext. 34971; Fax: (+886) 4- 23248137; Email: cccy218{at}yahoo.com.tw

Background: pyogenic liver abscess (PLA) is a potentially life-threatening disease in middle-to-old aged persons.

Objective: to compare the differences in clinical features and outcomes between older and younger PLA patients, and to identify predictors of outcomes in older patients.

Design: retrospective chart review of all PLA patients between July 1999 and June 2007.

Setting: a 1,600-bed primary and tertiary care centre.

Subjects: in total, 339 patients were enrolled and included 118 ≥65 years of age (the elderly group) and 221 patients <65 years of age (the non-elderly group).

Methods: clinical features, laboratory, imaging and microbiologic findings, treatment and outcomes for each of the included patients were collected. The predictor of outcome was determined using logistic regression and purposeful selection of covariates.

Results: the elderly group had a higher APACHE II score on admission, a biliary abnormality, a malignancy, a pleural effusion, polymicrobial, anaerobic or multi-drug-resistant isolates, inappropriate initial antibiotics, a longer hospitalisation and a longer parenteral antibiotic treatment period than the non-elderly group, whereas the non-elderly group was more likely to be alcoholic men with cryptogenic origin of abscess and Klebsiella pneumoniae infection. There was no difference in case fatality between the elderly (13.6%) and non-elderly (8.6%) groups despite the elderly group having a poorer host status on admission. In multivariate analysis, age (P = 0.028) and APACHE II score at admission ≥15 (P = 0.001) were risk factors, but K. pneumoniae infection (P = 0.012) was a protective factor for fatality in older PLA patients.

Conclusions: these data suggest that older PLA patients wound have a fair outcome compared to younger patients, but require longer hospitalisations.

Keywords: pyogenic liver abscess, elderly, risk factor, prognosis

Received 28 April 2008; accepted in revised form 2 October 2008.


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