Analysis Of Clinical Features Of Bacterial Liver Abscess With And Without Type 2 Diabetes Mellitus

Background and Objective:With the rapid development of social economy,people's lifestyles have changed,and the prevalence of diabetes in China has increased year by year.Diabetic patients are prone to have a liver abscess due to metabolic disorders and decreased body defense function.Patients with diabetes and bacterial liver abscess (BLA)have atypical symptoms and signs,if they are not diagnosed early and given effective treatment,they may cause serious complications and even death.This study aimed to compare and analyze the difference of clinical features of bacterial liver abscess with and without type 2 diabetes mellitus in hospital,and provide the basis for clinical diagnosis and treatment.Methods:Retrospective analysis of clinical data of 181 cases of hospitalized patients with bacterial liver abscess in the First Affiliated Hospital of DaLian Medical University from January 2015 to January 2018,73 cases of bacterial liver abscess with type 2 diabetes mellitus(Diabetic group),108 cases of bacterial liver abscess without diabetes(Non-Diabetic group).To compare the general information,clinical manifestation,laboratory tests,imaging findings,pathogens and therapies and outcome in 2 groups.Results:1.The age of the patients in the diabetic group was higher than non-diabetic group{(63.05±13.79)years vs(58.59±15.41)years},and the difference was statistically significant(P<0.05).The two groups were more common in male patients(64%vs61%),no statistical difference(P>0.05).The hospitalization cost of the diabetic group was higher than that of the non-diabetic group{2.00(1.43,3.47)ten thousand yuan vs1.72(1.24,2.39)ten thousand yuan},and the difference was statistically significant(P<0.05).2.The infection pathways of the diabetic group and the non-diabetic group were mainly cryptogenic infections(67.12%vs 60.19%),and the patients in the diabetic group were more common,the difference was not statistically significant(P>0.05).3.The most common symptoms in the diabetic and non-diabetic groups were fever/chills(94.5%vs 90.7%,P>0.05),followed by nausea/vomiting(39.7%vs 45.4%,P>0.05)and right upper abdominal pain(37.0%vs 53.7%,P<0.05).There were no significant differences in symptoms such as general weakness(23.3%vs 15.7%)and cough/expectoration(12.3%vs 8.3%)(P>0.05).The incidence of upper right abdominal pain in the diabetic group was lower than that in the non-diabetic group(P<0.05),but there were no significant differences in signs such as the right upper quadrant tenderness(45.2%vs 44.5%),percussion pain in liver region(31.5%vs 23.1%),lung rales(4.2%vs 2.8%)and jaundice(1.4%vs 6.5%)(P>0.05).4.In the diabetic and non-diabetic groups,there was no significant difference in white blood cell counts{11.81(8.69,13.78)×10~9/L vs 10.73(7.97,14.98)×10~9/L},hemoglobin{(120.02±18.89)g/L vs(120.02±19.79)g/L},platelet count{219.00 (142.50,298.00)×10~9/L vs 242.00(135.00,350.75)×10~9/L},alanine aminotransferase{53.00(35.80,85.50)U/L vs 57.00(34.00,101.75)U/L},aspartate aminotransferase{65.43(27.50,66.00)U/L vs 36.50(26.00,63.50)U/L},alkaline phosphatase{154.20(114.50,195.00)U/L vs 131.50(104.00,207.75)U/L},total bilirubin{16.20(12.20,26.05)?mol/L vs 15.20(11.03,124.68)?mol/L},creatinine{62.00(54.00,84.00)?mol/L vs 68.50(53.55,81.00)?mol/L},activated partial prothrombin time{28.90(26.30,33.75)s vs 29.80(26.83,32.60)s},prothrombin time{13.30(12.50,14.10)s vs13.35(12.50,14.10)s}(P>0.05).The elevation of percentage of neutrophils in the diabetic group was more common than in the non-diabetic group(80.8%vs 63.9%,P<0.05).The increase of glutamyl transpeptidase in non-diabetic group was significantly higher than that in diabetic group{109.00(61.50,166.50)U/L vs 131.00(76.78,238.75)U/L,P<0.05}.Albumin in the diabetic group was lower than that in the non-diabetic group{(31.25±7.20)g/L vs(33.69±5.24)g/L},and the difference was statistically significant(P<0.05).Blood urea nitrogen in the diabetic group was higher than that in the non-diabetic group{5.41(4.22,8.05)mmol/L vs 4.52(3.38,5.62)mmol/L},which was statistically significant(P<0.05).Electrolyte disorders were more common in the diabetic group(68.5%vs 51.9%,P<0.05).5.In the diabetic and non-diabetic groups,the liver abscess lesions were mainly showed a single abscess(76.4%vs 78.1%),which was more common in the right hepatic lobe(64.4%vs 56.5%),and the size was mostly 5~10 cm(52.1%vs 49.1%),there were no significant difference(P>0.05).A gas-forming abscess was more common in the diabetic group(13.7%vs 4.6%,P<0.05).6.The positive rate of blood culture in both groups was not high(36.4%vs 24.5%,P>0.05).The pathogens of the two groups were more common with Klebsiella pneumonia,among them,the positive rate of Klebsiella pneumoniae in blood culture(75.0%vs 75.0%)and pus culture(92.9%vs 82.1%)were not different(P>0.05).7.There were no significant differences in the rates of simple antibiotic(43.8%vs49.1%),antibiotics+percutaneous catheter drainage(43.8%vs 39.8%),antibiotics+percutaneous aspiration(8.2%vs 8.3%),antibiotics+surgery(4.1%vs 2.8%)(P>0.05).There was no difference in the effective rate between the two groups(94.5%vs 98.1%,P>0.05).Conclusions:1.Middle-aged and old men are high-risk people with bacterial liver abscess,and they tend to be older when they have type 2 diabetes mellitus.2.When complicated with bacterial liver abscess,the patients with type 2 diabetes mellitus have no obvious right upper quadrant pain compared with non-diabetic patients,for diabetes mellitus complicated with fever of unknown cause,should be alert to the possibility of liver abscess.3.In patients with type 2 diabetes mellitus complicated with BLA,the degree of infection and hypoalbuminemia are more serious,the number of electrolyte disorders is more,and the hospitalization cost is higher.There were no significant differences in the infection route,common symptoms and signs,the main manifestations of imaging,and common pathogens between the two groups.