Clinicopathological presentation of liver abscesses and hydatid liver disease from two South African tertiary hospitals

Table 1 Differences in demographics between types of liver collections

Feature	Pyogenic (n = 166)	Amoebic (n = 36)	Hydatid (n = 20)	P value
Age	52 (41-60)	45.5 (35.5-55.5)	38.5 (26-44)	0.0005
Sex
Male	90 (54.22)	28 (77.78)	5 (25)	0.001
Female	76 (45.78)	8 (22.76)	15 (75)	0.001
HIV-positive	27 (17.88)	15 (45.45)	8 (42.11)	0.001
Diabetes mellitus	35 (21.34)	2 (5.56)	1 (5)	0.024

Data presented as n (%) or median (25^th-75^th percentiles).

Table 2 Etiology of pyogenic abscesses

Disease	n = 166	%
Biliary	81	48.80
Benign	42	25.30
Benign CBD/CHD stricture	8	4.82
Cholecystitis/complicated cholecystitis	6	3.61
Choledocholithiasis	23	13.86
Mirrizi syndrome	3	1.81
HIV cholangiopathy	1	0.60
Ruptured gallbladder (sickle cell crisis)	1	0.60
Malignant	22	13.25
Cholangiocarcinoma	7	4.22
Gallbladder cancer	6	3.61
Pancreatic cancer	5	3.01
Periampullary tumor	4	2.41
Iatrogenic injury/biliary intervention	17	10.24
Bile duct injury (laparoscopic cholecystectomy)	2	1.20
Bile duct stricture (laparoscopic cholecystectomy)	2	1.20
Bile duct stricture (post pancreaticoduodenectomy)	1	0.60
Benign stricture (blocked stent)	2	1.20
Choledocholithiasis (blocked biliary stent)	2	1.20
Biliary malignancy (blocked stent)	7	4.22
Post portal vein embolization (cholangiocarcinoma)	1	0.60
Portal pyemia	14	8.43
Appendicitis	7	4.22
Colitis	2	1.20
Diverticular disease	3	1.81
Perforated peptic ulcer	1	0.60
Jejunal perforation	1	0.60
Other	5	3.01
Locally advanced colon cancer	1	0.60
Metastatic colon cancer	2	1.20
Metastatic adenocarcinoma (unknown primary)	1	0.60
Rectosigmoid stricture	1	0.60
Hematogenous	1	0.60
Cryptogenic	65	39.16

CBD: Common bile duct; CHD: Common hepatic duct.

Table 3 Biochemical measurements according to abscess type

	Pyogenic		Amoebic		Hydatid
Laboratory test	Median	IQR	Median	IQR	Median	IQR	P value
WBC (4-10 × 109/L)	15.76	9.90-21.20	13.18	9.16-16.02	8.90	6.28-12.76	0.0002
CRP (< 10 mg/L)	211.0	110.0-289.0	181.0	60.5-246.5	90.0	28.5-215.5	0.0070
Hemoglobin (12-15 g/dL)	10.50	8.80-12.10	10.50	8.80-11.90	11.35	8.35-12.35	0.8300
Platelets (150-400 × 109/L)	391	242-575	495	401-615.5	483.5	322.5-562.5	0.0200
Albumin (35-50 g/L)	29.0	25.0-34.0	28.0	24.0-32.0	32.5	26.5-40.5	0.1100
Total bilirubin (5-21 μmol/L)	23.0	11.0-80.0	9.0	5.0-19.0	7.5	6.0-29.5	0.0001
Conjugated bilirubin (< 3 μmol/L)	16.0	6.0-52.0	4.0	3.0-14.0	4.5	3.0-21.5	0.0001
ALT (7-35 U/L)	39.0	25.0-89.0	26.0	12.0-44.0	20.5	14.0-32.0	0.0002
AST (13-35 U/L)	48.0	27.0-87.0	32.0	20.0-63.0	31.5	23.5-40.5	0.0080
ALP (42-98 U/L)	221	169-425	179	124-243	215	120-421	0.0100
GGT (< 40 U/L)	201.0	110.0-416.0	157.0	82.0-208.0	130.0	93.0-315.5	0.0300
Urea (2.1-7.1 mmol/L)	5.2	3.2-9.8	3.6	2.7-5.0	3.7	3.1-6.1	0.0200
Creatinine (49-90 mmol/L)	79.0	59.0-117.5	67.0	58.0-88.0	66.5	50.0-74.0	0.0200
INR (0.9-1.2)	1.31	1.18-1.49	1.27	1.21-1.46	1.20	1.14-1.43	0.5000

ALP: Alkaline phosphatase; ALT: Alanine transaminase; AST: Aspartate transaminase; CRP: C-reactive protein; GGT: Gamma-glutamyltransferase; INR: International normalized ratio; IQR: Interquartile range.

Table 4 Laboratory findings outside the normal range in patients presenting with pyogenic liver abscesses

Parameter	n (%)
Leukocytosis	121 (74.69)
Raised CRP (> 10 mg/L)	154 (98.09)
CRP (> 300 mg/L)	33 (21.02)
Thrombocytopenia	18 (12.02)
HB (< 10 g/dL)	65 (40.63)
Hypoalbuminemia (< 30 g/L)	89 (40.63)
Bilirubin (> 21 μmol/L)	85 (53.46)
ALT (> 2 normal)	44 (28.03)
AST (> 2 normal)	53 (33.76)
ALP (> 2 normal)	94 (58.75)
GGT (> 2 normal)	132 (82.50)
INR > 1.5	29 (22.83)

ALT: Alanine transaminase; AST: Aspartate transaminase; ALP: Alkaline phosphatase; CRP: C-reactive protein; GGT: Gamma-glutamyltransferase; HB: Hemoglobin; INR: International normalized ratio.

Table 5 Imaging characteristics and management modalities of infective liver collections

Item	Pyogenic	Amoebic	Hydatid	P value
Ultrasound	125 (79.11)	25 (78.13)	15 (72.22)
CT	146 (90.12)	30 (90.91)	17 (94.44)
MRI	13 (8.13)	0	2 (11.11)
Size (median; interquartile range)	8.00 (5.85-10.00)	11.00 (9.00-14.00)	14.50 (12.00-19.30)	0.0001
Range (cm)	1.5-25.0	4.5-25.0	3.0-22.0
Size > 5 cm	86 (76.79)	16 (84.21)	9 (90.00)
Multiple	80 (51.28)	15 (46.88)	8 (47.06)
Right	54.89	52.17	50.00
Left	25.56	13.04	21.43
Bilobar	19.55	34.78	28.57
Percutaneous drainage	120 (74.53)	30 (90.91)	8 (42.11)
ERCP	50 (31.25)	4 (12.12)	9 (45.00)
Surgery	6 (3.73)	5 (13.89)	9 (45.00)
Puncture, aspiration, injection, re-aspiration			2 (10.53)

Data presented as n (%). ERCP: Endoscopic retrograde cholangiopancreatography; MRI: Magnetic resonance imaging.

Table 6 Complications of liver abscesses

General complications	n	Complications of liver abscess	n
AKI	3	Lung abscess (pleuro-biliary fistula)	1
Aspiration pneumonia	1	Ruptured liver abscess	6
Clostridium difficile infection	1	Procedure related complications
DVT	2	Cecal stump blowout	1
DVT/PE	1	Contrast induced nephropathy	1
PE	2	Post-ERCP bleed	1
Pneumonia	1	Pneumothorax	2
Pleural effusion	2	Post-ERCP pancreatitis	1
		Small bowel injury	1

AKI: Acute kidney injury; DVT: Deep vein thrombosis; ERCP: Endoscopic retrograde cholangiopancreatography; PE: Pulmonary embolism.