Multiple septae as potential protective factors against spontaneous pyogenic liver abscess rupture: a propensity score m
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HEPATOBILIARY
Multiple septae as potential protective factors against spontaneous pyogenic liver abscess rupture: a propensity score matching analysis Hairui Wang1 · Yue Ren1 · Zhaoyu Liu1 · Zhihui Chang1 Received: 21 June 2020 / Revised: 25 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The symptoms of spontaneous rupture of a pyogenic liver abscess (PLA) are severe and often life-threatening. Multiple septae are important imaging features of PLA. However, the relationship between septation and abscess rupture is still under debate. Methods Patients diagnosed with PLA from January 2011 to November 2019 in our hospital were included. We collected demographic, clinical, and computed tomography data. Univariate and multivariate analyses determined liver abscess rupture risk factors. The relationship between multiple septae and abscess rupture was evaluated by propensity score matching after matching other influencing factors. Results A total of 583 patients of pyogenic liver abscesses were included in the study: 30 ruptured and 553 unruptured. Multivariate analysis revealed diabetes, single lesion, gas formation, left hepatic lobe location, and a diameter > 66.5 mm as independent risk factors for ruptures, while multiple septae were identified as a protective factor. After matching all the influencing factors (excluding multiple septae), multiple septae and abscess rupture maintain a negative relationship. Conclusions Multiple septae were identified as a potentially protective factor against spontaneous pyogenic liver abscess ruptures. Keywords Pyogenic liver abscess · Spontaneous rupture · CT · Multiple septae · Propensity score matching
Introduction Pyogenic liver abscesses (PLA) often occur in patients with diabetes mellitus, biliary tract disease, digestive tumours, or acquired immunodeficiencies [1–4]. Spontaneous rupture of pyogenic liver abscess is uncommon; however, once ruptured, patients experience life-threatening severe clinical symptoms, such as bacterial peritonitis, abdominal abscess, and sepsis.[5]. * Zhihui Chang [email protected] Hairui Wang [email protected] Yue Ren [email protected]
Exploring factors associated with spontaneous liver abscess rupture is essential to identify cases with a high rupture risk. Abscesses that are at risk of rupture are more likely to require emergency aspiration or drainage. It is known that diabetes, gas formation, location, and the diameter of the abscess or cirrhosis are associated with spontaneous rupture [5, 6]. However, the association of multiple septae (a vital feature of liver abscess identifiable with imaging) with spontaneous rupture of PLA(SRPLA) remains unclear [7]. In this study, the clinical and computed tomography (CT) features of ruptured and unruptured liver abscess were retrospectively analysed. First, we validated the association between the previously reported risk factors and the spontaneous rupture of liver abscesses. Then, multiple septae were found to be a
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