Comparison of Clinical Features and Treatment Outcomes of Pyogenic Liver Abscess in Diabetic and Non-Diabetic Patients in a Chinese Hospital

Qiaomai Xu,1,* Changhong Liu,2,* Zhengjie Wu,1 Shumeng Zhang,3 Zhuoling Chen,4 Silan Gu,1 Qi Xia1 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Department of Hepatology, The Fifth People’s Hospital of Ganzhou, Ganzhou Institute of Hepatology, Ganzhou, People’s Republic of China; 3Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4Hangzhou Medical College, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qi Xia, Email xiaqi@zju.edu.cnAim: Pyogenic liver abscess (PLA) is a common life-threatening infectious disease in patients with diabetes mellitus (DM). The objective of this research was to compare the clinical features of PLA patients with and without concurrent DM and to assess the impact of different treatment modalities on the prognosis of such patients.Patients and Methods: A retrospective analysis was performed to compare the clinical characteristics of PLA patients with and without concurrent DM in a Chinese university hospital between January 2017 and December 2019. This analysis compares the difference in efficacy between conservative treatment and percutaneous drainage in PLA patients, elaborating on the advantages and disadvantages of each treatment approach. Additionally, a multivariate logistic regression analysis was employed to identify the risk factors for treatment failure in PLA patients.Results: The research involved 712 patients diagnosed with PLA. DM is a common comorbidity of PLA, predominantly on the right side of the liver and single lesions. Klebsiella pneumoniae was identified as the predominant etiologic agent. Percutaneous drainage is proven to be an effective and safe treatment modality. Conservative treatment is more appropriate for patients with mild symptoms or small abscesses, while patients with severe symptoms or large abscesses are more likely to be treated with percutaneous drainage. Primary treatment failure is more likely in the non-DM group. In addition, tumors, elevated bilirubin, a longer duration for temperature normalization, surgical history, and positive blood cultures independently contribute to the risk of primary treatment failure (P < 0.05).Conclusion: DM and non-DM patients differed in terms of comorbidities and treatment approaches, and non-DM patients faced a significantly poorer outcome.