Liver abscess in the elderly: clinical features and outcomes
WU Zhenzhu1, CHEN Yi2, SUN Haoyue2,PAN Juyi2, YE Yi2.
1.Department of Infectious Disease, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China; 2.Department of Gastroenterology, Wenzhou People’s Hospital, Wenzhou 325000, China
WU Zhenzhu,CHEN Yi,SUN Haoyue, et al. Liver abscess in the elderly: clinical features and outcomes[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2022, 52(9): 724-728,735.
摘要目的：探讨老年肝脓肿患者的临床特点，为老年肝脓肿临床诊治提供依据。方法：收集2017年1月至2020年12月温州医科大学附属第二医院和温州市人民医院出院诊断为肝脓肿的成人患者。根据患者年龄分为老年组（≥65岁）和非老年组（＜65岁），比较2 组患者的人口学特点、临床特点、实验室及影像结果、病原学特点、并发症、治疗及预后等临床资料。结果：共纳入408 例成人肝脓肿患者，其中老年组200例（49.0%），非老年组208例（51.0%）。与非老年组患者相比，女性在老年组中更多见（46.0% vs. 29.8%，P =0.001），老年组患者更容易合并胆道疾病（45.0% vs. 28.8%，P =0.001）、高血压病（61.0% vs. 29.3%，P ＜0.001）和高尿酸血症（6.5% vs. 1.9%，P =0.025）；在影像表现上，2组患者均以5～10 cm大小、单发肝脓肿最多见。肺炎克雷伯菌是最常见的病原菌，2组患者病原菌分布差异无统计学意义（P ＞0.05）。抗生素联合经皮肝脏穿刺置管引流或穿刺抽液治疗是老年组肝脓肿患者最常见的治疗方法，与非老年组患者的治疗选择并无差异。并发症方面，老年组患者住院病死率与非老年组患者接近，但更容易并发胸腔积液、急性肾功能不全，往往需要更长的住院时间（均P ＜0.05）。结论：老年肝脓肿患者临床特点缺乏特异性，但女性
发病率较高，具有更多合并症，肺炎克雷伯菌是最常见致病菌，经有效治疗预后较好，但往往需要更长住院时间。
Abstract：Objective: To analyze the clinical characteristics in the elderly with liver abscess (LA) so as to provide reference for clinical diagnosis and treatment. Methods: Clinical data of patients with liver abscess from the Second Affiliated Hospital of Wenzhou Medical University and the Wenzhou People’s Hospital from 2017 to 2020 were collected. They were divided into two groups according to their age: the old group (≥65 years old) and the young group (<65 years old). Then clinical data such as the demographic characteristics, clinical characteristics, laboratory and imaging results, etiological characteristics, complications, treatment and prognosis were compared. Results: Of totally 408 patients in the study, 200 patients (49.0%) were in the old group and 208 (51.0%) in the young group. There were more females in the old group than in the young group (46.0% vs. 29.8%,P=0.001). Old patients were more likely to have biliary diseases (45.0% vs. 28.8%, P=0.001), hypertension (61.0% vs. 29.3%, P<0.001) and hyperuricemia (6.5% vs. 1.9%, P=0.025). In terms of imaging features, 5-10 cm and single liver abscess was most common in both groups. Klebsiella pneumoniae was the most common pathogen, and there was no difference in pathogens distribution between the two groups (P>0.05). There was no difference in the treatment options for the old group, and antibiotics combined with aspiration or drainage were most common in both groups. In terms of complications, the hospital mortality between the two groups was similar,but the old group were more likely to be complicated with pleural effusion and acute renal insufficiency, often
requiring longer hospitalization (P<0.05). Conclusion: The clinical characteristics of the elderly with LA are lack of specificity but the incidence of female patients is higher, with more complications. Klebsiella pneumoniae was the most frequent bacterium. Properly treated, old patients with LA can have comparable outcomes as the young,but require a longer hospital stay.
