Prognosis of liver abscess in the intensive care unit (POLAIR),
a multicentre observational study
Critical
Care volume 29, Article number: 146 (2025) Published: 07
April 2025
Background
Liver abscess (LA) is a rare but potentially serious
condition with a high mortality rate. Current epidemiological data of LA
patients requiring intensive care unit (ICU) admission are limited.
Methods
This multicentre retrospective study included adults
admitted to 24 ICUs in France between January 2010 and December 2020. Risk
factors for mortality were identified by multivariate analysis. A propensity
score was used to adjust for confounders related to the presence of portal vein
thrombosis.
Results
335 patients were enrolled. The median age was 66 years
[53–73] and 68% were male. Commons comorbidities included diabetes (29.9%) and
cancer or haematological disease. Septic shock was the main reason for
admission (58%). The median SAPS2 score at ICU admission was 42 [31–53] and the
SOFA score was 6 [3–9]. The putative origin of LA was biliary (31%), while 40%
were cryptogenic. Most patients (60%) had a solitary LA, involving the right
lobe (38.8%), with a median diameter of 67 mm [47–91]. Associated portal
vein thrombosis (PVT) was present in 13.4% of cases. Microbiological
documentation was obtained in 82% of patients, showing gram-negative bacilli
(59.7%), mainly Escherichia coli (19.6%) and Klebsiella spp.
(19.1%), and gram-positive cocci (29.6%), mainly Streptococcus spp.
(17.1%). Drainage was performed in 62% of cases, 40% within 48 h. The
median duration of antibiotic therapy was 35 days [21–42]. During
hospitalisation, 62% of patients required vasopressors and 29% required
mechanical ventilation. In-ICU mortality was 11.6%. Multivariate analysis
showed that organ dysfunction illustrated by SOFA score (HR 3.45
[1.95–6.09], p < 0.001) and PVT (HR 3.14 [1.54–6.39], p = 0.001) were significant risk
factors for mortality. Drainage was not associated with improved short-term
survival (HR 1.22 [0.65–2.72], p = 0.52).
In the population matched for PVT confounders, a higher sofa score was the only
factor associated with mortality (HR 3.11 [1.76–5.49]
IC95%, p = 0.001).
Conclusions
This multicentre study illustrates the severity of LA in
French intensive care units and identifies organ dysfunction (SOFA score) and
portal vein thrombosis as major risk factors for mortality. Prospective studies
are needed to improve management strategies, as the survival benefit of
drainage is unclear.
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