A Retrospective Study Of Clinical Features And Risk Factors For Sepsis In Patients With Liver Abscess

Objective The clinical characteristics of patients with liver abscess(LA)were retrospectively analyzed,and the risk factors for sepsis caused by LA were identified,which provided a basis for the clinical treatment of LA.Methods From January 2018 to December 2021,798 patients with liver abscess in the General hospital of Ningxia Medical University were selected as the research subjects,and their general data,underlying diseases,com Plications,clinical manifestations,laboratory data,imaging data,etiological data,treatment methods,etc.were collected in detail,and the acute Physiology and chronic health evaluation Ⅱ(APACHEⅡ)were calculated.Sequential Organ Failure Assessment(SOFA),Quick sepsis related organ failure assessment(q SOFA),divided into sepsis group and non-sepsis group according to whether there is sepsis and whether there is death is divided into death group and non-death group;According to whether patients with LA have sepsis and sepsis,they are divided into sepsis and non-sepsis groups;According to the 28-day prognosis of LA patients,they were divided into death group and survival group;According to the main pathogens,they were divided into Klebsiella pneumoniae infection group and non-Klebsiella pneumoniae infection group;Relevant statistical methods were used to analyze the clinical data,risk factors and predictors of each group.ResultsPart I: A retrospective study of liver abscess with sepsis and risk factors for death1.General information of LA patients: In this study,a total of 798 LA patients were included in LA,the inpatient department was mainly hepatobiliary surgery,the most common clinical manifestations were fever,chills,body temperature fluctuations of 38-43 degrees Celsius,followed by abdominal pain,bloating,pain was mainly concentrated in the right upper abdomen,and antibiotic combined with puncture catheter drainage was the most common in LA treatment;A total of 632 patients with LA were cultured,and the most common pathogen was Klebsiella pneumoniae;ultrasonic,MRI,CT examination are mainly right lobe,and the maximum diameter is 5-10 cm.2.There were 558 cases in the sepsis group and 240 cases in the non-sepsis group,and the age of onset and the length of hospital stay were longer(P<0.001)compared with the non-sepsis group.The proportion of sepsis combination with history of hepatobiliary surgery and cirrhosis was higher(P<0.05),and the proportion of AKI,DIC,MODS,hypoproteinemia,heart failure,thrombosis,lung infection,and serosal effusion was higher(P<0.05),while there was no difference between the two groups with diabetes,hypertension and biliary system disease(P>0.05).The quantification of Na ions,Cl ions,K ions,Ga ions and PLT in the sepsis group was lower than that in the non-sepsis group(P<0.05),and the WBC,NEUT% and NEUT were higher than those in non-sepsis patients(P<0.05).Biochemical indexes and coagulation indexes were worse than those in the non-sepsis group(P<0.05).3.The positive rate of blood culture in the sepsis group was significantly higher than that in the non-sepsis group(P<0.05).The average number of days of antibiotic application in the sepsis group was 9.52±7.212 days,and there were 219 patients with antibiotics alone,and the incidence of sepsis was 67.6%;There were 527 patients with antibiotic combined puncture catheter drainage,and the incidence of sepsis was 70.2%;There were 31 patients treated with antibiotics combined with surgery,and the incidence of sepsis patients was74.2%;Patients in the sepsis group had more types of antibiotics,more complex antibiotic combination use rates,and longer antibiotic days(P<0.001).The sepsis group had higher rates of cephalosporins,carbapenems,glycopeptides,antifungals,aminoglycosides,and quinolone antibiotics(P<0.05).4.The rate of ICU admission,mechanical ventilation rate,CRRT rate,28-day mortality,and vasoactive drug use were higher in the sepsis group(P<0.05);The APACHEII.score,SOFA score,and q SOFA score were higher in the sepsis group than in the non-sepsis group(P<0.05).5.History of hepatobiliary surgery,high APACHEII.score,and high q SOFA score were independent predictors of sepsis(P<0.05);There was a significant correlation between creatinine,total bilirubin,and PLT and the occurrence of sepsis(P<0.05).APACHEII.score,q SOFA score,APACHEII.combined with q SOFA score,total bilirubin combined with platelet combined creatinine curve area were 0.731,0.649,0.748 and 0.848,respectively,which showed that the effect of total bilirubin combined with platelet combined creatinine in predicting the occurrence of sepsis was better than that of APACHEII.score and q SOFA score.Part II Study on risk factors for death in LA patients1.The antibiotics in the death group were mainly carbapenems,accounting for 22(59.5%),and the average number of antibiotic days was 8.37±7.886 days,and the death group had more types of antibiotics and more complex antibiotic combinations(P<0.05).2.High APACHEII score and high q SOFA score were independent predictors of death(P<0.05);ROC curve analysis showed that the areas under the APACHEII.score,SOFA score and q SOFA score curve were 0.919,0.915 and 0.821,respectively,which showed that APACHEII.score,SOFA score and q SOFA score had good effects on predicting the occurrence of sepsis.Part III A retrospective study of risk factors for Klebsiella pneumoniae infection with LA1.There were 318 cases in the Klebsiella pneumoniae group,with an average age of59.77±13.281 years,an average length of hospitalization of 11.075±8.498 days,and a higher rate of previous diabetes,cholecystitis,cholangitis,history of hepatobiliary surgery,malignant tumors,and previous liver abscess(P<0.05)。2.A total of 289 cases were tested in Klebsiella pneumoniae,and the sensitivity rate to most antibiotics was greater than 90%,and the resistance rate to ampicillin was the highest,14.53%;There was no significant change in the detection rate of Klebsiella pneumoniae during the 4-year period;The positive rates of pus culture and blood culture in the Klebsiella pneumoniae group were higher than those in the non-Klebsiella pneumoniae group(P<0.05).The use rate of quinolones and carbapenems in the Klebsiella pneumoniae group was higher(P<0.05).3.The 28-day mortality rate and incidence of septic shock in the Klebsiella pneumoniae group were higher than those in the non-Klebsiella pneumoniae group(P<0.05).Increased blood glucose,cholecystitis,malignancy,and previous history of LA were independent predictors of Klebsiella pneumoniae infection(P<0.05);Positive blood culture,puncture catheter drainage,AG and K ions were significantly associated with Klebsiella pneumoniae infection(P<0.05).Conclusion1.Previous history of hepatobiliary surgery,high APACHEII.score,and high q SOFA score are independent risk factors for LA complicated by sepsis,which mainly involves the kidneys,liver and blood system.2.High APACHEII.score and high q SOFA score are closely related to death in LA patients and are independent predictors of patient death.3.LA pathogens are dominated by Klebsiella pneumoniae,and increased blood glucose is the main risk factor for Klebsiella pneumoniae infection.