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J Korean Soc Emerg Med > Volume 25(6); 2014 > Article
Journal of The Korean Society of Emergency Medicine 2014;25(6): 660-666.
Clinical Characteristics and Predictive Factors of Septic Shock in Patients with Pyogenic Liver Abscess
Sun Kim, Yoon Seon Lee, Youn Jung Kim, Byuk Sung Ko, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim, Kyoung Soo Lim
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ysdoc@amc.seoul.kr
ABSTRACT
PURPOSE:
The aim of this study was to describe clinical, biochemical, and radiologic features in patients with pyogenic liver abscess and to investigate predictors of septic shock.
METHODS:
We consecutively included subjects who were diagnosed as pyogenic liver abscess in the emergency department (ED) from January 1st, 2010 to June 30th, 2013. Through review of medical records, clinical, biochemical, and radiologic data were collected. The primary endpoint was septic shock during hospitalization.
RESULTS:
A total of 228 patients were included, with a mean age of 60.8+/-12.8 years, and 63.2% were men. Among them, 198 patients presented with fever and GCS <15 was observed in 15. Klebsiella spp. was most commonly identified in 33.8%, followed by E. coli and Streptococci spp. in 7% for each. Septic shock occurred in 55 (22.4%) and mortality rate was 1.3%. In univariable logistic regression, GCS <15, systolic BP <90 mmHg, pulse rate > or =120/min, respiratory rate > or = 22/min, body temperature (BT) > or =38degrees C, WBC, platelet, BUN, creatinine, albumin, AST, alkaline phosphatase (ALP), Creactive protein (CRP), abscess size > or =5 cm, and bilobal involvement were significantly associated with septic shock (p<0.05). In multivariate analysis, systolic BP <90 mmHg (OR 95.79, 95% CI: 11.16-822.02), BT > or =38degrees C (OR 1.95, 1.36-2.78), BUN (OR 1.03, 1.01-1.06), ALP (OR 1.003, 1.000-1.005), and abscess size > or =5 cm (OR 2.31, 1.08-4.94) were independent predictors of septic shock.
CONCLUSION:
Low Systolic Bp, High Bt, Elevated Bun And Alp, And Abscess Size > or =5 Cm Were Independently Associated With Septic Shock In Patients With Pyogenic Liver Abscess.
Key words: Pyogenic liver abscess, Septic shock, Prediction
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