Pyogenic liver abscess in non-liver cancer patients and liver cancer patients treated with TACE: etiological characteristics, treatment, and outcome analysis

Abstract Background: The purpose of this study was to evaluate the clinical, laboratory and microbiological features, clinical outcomes, and prognosis of pyogenic liver abscess (PLA) in non-liver cancer (Non-LC) patients and liver cancer patients treated with transarterial chemoembolization (TACE, LC-TACE). Methods: Clinical data of 48 consecutive PLA patients from January 2016 to December 2020 were retrospectively analyzed. The mortality was compared between the two groups of PLA patients, and risk factors for mortality were evaluated. Results: A total of 48 PLA patients meeting the inclusion criteria were included in this study from January 2016 to December 2020, including 31 males and 17 females. Among them, there were 32 patients in the Non-LC group and 16 patients in the LC-TACE group. Fever and chills were the most common symptoms in both groups, followed by abdominal pain. Shock occurred in 2 patient in the Non-LC group and 3 patients in the LC-TACE group. The positive rate of pus culture in the Non-LC group was 87.5%, among which the most common pathogen was Klebsiella pneumoniae (50%, 14/28), and the positive rate of pus culture in the LC-TACE group was 81.3%, among which the most common pathogen was Escherichia coli (30.8%, 4/13). In the Non-LC group, 28 patients improved after treatment, 1 patient did not improve, and 3 patients died during hospitalization, with a mortality rate of 9.4%. In the LC-TACE group, 9 cases improved after treatment, 3 cases did not improve, and 4 cases died during hospitalization, with a mortality rate of 25%. Multivariate analysis revealed no independent prognostic factor associated with mortality. The cure time of the Non-LC group was 37.4±23.1 days (6-90 days), while that of the LC-TACE group was 91.5±49.7 days (19-180 days), with a statistically significant difference between the two groups ( P < 0.001). Conclusions: PLA of the Non-LC group and the LC-TACE group were different in terms of pathogenic bacteria and cure time, etc. For PLA after TACE, a more aggressive and comprehensive treatment should be considered.