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Older age as a poor prognostic sign in patients with pyogenic liver abscess

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Published:25th Mar 2020
Background: Previous studies have focused on the role of age as a prognostic factor in pyogenic liver abscess (PLA) and results have been controversial. The aim of this study was to compare the clinical characteristics of PLA in elderly (age ?65 years) and non-elderly patients in order to identify any differences so that an early diagnosis can be made and appropriate therapeutic measures can be instituted promptly. Methods: We performed a retrospective analysis of patients with PLA. The demographic and clinical features, laboratory and imaging findings, management, and clinical outcomes of elderly and non-elderly patients were studied. Results: Between January 2000 and December 2010 inclusive, 319 patients had PLA; 168 (52.7%) were aged ?65 years. Elderly patients were more likely to have acute onset of symptoms (4.2 vs. 5.3 days, p<0.04), co-morbidities, and respiratory symptoms (25.6% vs. 14.6%, p><0.01). they also had lower serum bilirubin (28.1 vs. 37.1?mol l, p><0.04), alanine aminotransferase (71.6 vs. 94.3 u l, p><0.02), and glycosylated hemoglobin (8.1% vs. 10%, p><0.01), and more often had septal lobulation (64.3% vs. 54.3%, p><0.04) and pneumobilia (10.1% vs. 4.0%, p><0.02). moreover, they required a longer duration of oral antibiotics (2.63 vs. 2.05 weeks, p><0.01) and had a higher incidence of acute coronary syndrome during the illness (7.7% vs. 2.0%, p><0.01). gram-negative organisms were the dominant isolates in both groups, but the elderly had a lower incidence of gram-positive infections (5.4% vs. 13.2%, p><0.01). lastly, old age was associated with local recurrence of pla (odds ratio (or) 3.1, 95% confidence interval (ci) 1.0�9.7, p><0.04) and mortality (or 3.17, 95% ci 1.25�8.04, p="0.015)." conclusions: elderly patients tend to have a more atypical presentation in pla, for which clinicians should be on high alert. we found older age to be associated with a higher recurrence of pla and a higher mortality rate.>

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