Demographic data, lifestyle habits, coexistences and medical histories
Among the overall study population of 392 patients, there were 66 with GFPLA and 326 with non-GFPLA, aged 57.0 ± 13.7 and 56.7 ± 13.3 years, respectively (Table 1). The corresponding ratios of men-to-women in the two groups were 38:28 and 185:141. The GFPLA and non-GFPLA groups were statistically similar regard to gender ratio, age, smoking, drinking, and coexistences (hypertension, diabetes, hepatobiliary malignancy, lithiasis, liver cirrhosis, and viral hepatitis). A history of abdominal surgery was significantly more common in patients with GFPLA compared with non-GFPLA (62.1% vs. 41.7%; Table 1; P = 0.002), especially hepatobiliary surgery (50% vs. 30.3%; Table 1; P = 0.024). A greater percentage of the non-GFPLA group had no history of surgery compared with the GFPLA (58.3% vs. 37.9%; Table 1; P = 0.002). There was no significant difference in the medical history of PLA between the two groups (Table 1; P = 0.086).
Clinical manifestations, laboratory results, and imaging findlings
Clinical manifestations
Table 2 showed that there were no significant differences in the symptoms and signs of fever, chill, abdominal pain, nausea, vomit, fatigue, body temperature, respiratory rate, or mean arterial pressure (MAP) between the two groups (Table 2). However, the heart rate of the GFPLA group (88.3 ± 13.1 bpm) was significantly faster than that of the non-GFPLA group (84.5 ± 12.8 bpm; Table 2; P = 0.028).
Laboratory results
Blood routine examination: As showed in table 2, the GFPLA group had significantly higher leucocytes (13.0 ± 6.6 × 109/L) and neutrophils (10.9 ± 5.9 × 109/L) than did the non-GFPLA group (10.8 ± 5.5 × 109/L and 8.7 ± 5.3 × 109/L, respectively; Table 2; P = 0.005 and 0.003). However, the lymphocytes, platelets, and hemoglobins of the GFPLA group were significantly lower than that of the non-GFPLA. Specifically, the count of lymphocytes in GFPLA group (1.1 ± 0.5 × 109/L) was significantly lower than that of the non-GFPLA group (1.3 ± 0.6 × 109/L; Table 2; P = 0.007). The count of platelets in GFPLA group (190.9 ± 119.4 × 109/L) was significantly lower than that of the non-GFPLA group (230.5 ± 125.6 × 109/L; Table 2; P = 0.019). The content of hemoglobins in GFPLA group (104.5 ± 18.9 g/L) was significantly lower than that of the non-GFPLA group (13.1 ± 19.1 g/L; Table 2; P = 0.01).
Liver and renal functions: As showed in table 2, there were no significant differences in alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), total bilirubin (TBIL), direct bilirubin (DBIL), serum creatine (Cr) and blood urea nitrogen (BUN) between the two groups. However, the level of serum albumin (ALB) in the GFPLA group (28.0 ± 5.0 g/L) was significantly lower than that of the non-GFPLA group (31.4 ± 5.8 g/L; Table 2; P < 0.001).
Coagulation function: As showed in table 2, there were no significant differences in activated partial thromboplastin time (APTT) and fibrinogen (FIB) between the two groups. The prothrombin time (PT) of the GFPLA (15.1 ± 1.5 s) was significantly longer than that of the non-GFPLA (14.4 ± 1.9 s; Table 2; P = 0.006).
Image findings
As showed in table 2, the two groups were similar with regard to percentages of single or multiple abscesses. Specifically, in the GFPLA and non-GFPLA groups there were, respectively, 52 (78.8%) and 239 (73.3%) cases of single abscess, and 14 (21.2%) and 87 (26.7%) cases of multiple abscesses. However, the maximum diameter was significantly higher in the GFPLA (7.8 ± 2.8 cm) compared with the non-GFPLA (6.5 ± 2.8 cm; Table 2; P = 0.001). There were 57 patients in the GFPLA group and 288 in the non-GFPLA group. Among them, in the GFPLA and non-GFPLA groups there were, respectively, 11 (19.3%) and 35 (12.2%) located in the left lobe of the liver, and 39 (68.4%) and 216 (75.0%) were located in the right lobe. Seven (12.3%) GFPLA and 37 (12.8%) non-GFPLA were found in both sides of the liver lobe. And abscess site was similar in both groups.
Microbiological characteristics
Pus culture: There were similar in pus microbiological proportions (Table 3; P > 0.05), number of pus bacterial species (Table 3; multiple bacteria; 6.6% vs. 16.7%; P = 0.054) and pus negative rate (Table 3; 34.4% vs. 29.2%; P = 0.491) between two groups. Most of the positive bacteria in pus culture were K. pneumoniae, followed by Escherichia coli.
Blood culture: There were similar in blood microbiological proportions (Table 3; P > 0.05), number of blood bacterial species (Table 3; multiple bacteria; 3.1% vs. 6.3%, P = 0.335), most of the positive bacteria in pus culture were K. pneumoniae, followed by Escherichia coli, which were consistantly with results of pus culture between two groups. However, the Non-GFPLA group had a higher blood negative rate than GFPLA group (Table 3; 77.1% vs. 56.2%, P = 0.017).
Treatments, complications, and outcomes
Treatments: In the non-GFPLA group, 95 (29.1%), 159 (48.8%), and 72 (22.1%) patients received routine anti-infection therapy, percutaneous transhepatic puncture drainage under the guidance of ultrasound or CT, and surgical drainage, respectively (Table 4). In the GFPLA group, these corresponding treatments were administered to 12 (18.2%), 45 (68.2%), and 9 (13.6%) patients. A significantly higher percentage of patients in the GFPLA group received antibiotics combined with percutaneous drainage compared with the non-GFPLA, but a significantly lower percentage in the GFPLA underwent either conservative treatment or surgical drainage (Table 4; P = 0.016).
Complications: The GFPLA and non-GFPLA groups were similar in the occurrence of the following complications: septic shock, ARDS, spontaneous rupture of abscess, SIRS, and portal venous thrombosis (Table 4; P > 0.05). However, the GFPLA group had significantly higher rate of sepsis (Table 4; 21.2% vs. 9.2%; P = 0.005) and pleural effusion (Table 4; 51.5% vs. 31.9%) compared with the non-GFPLA.
Outcomes: The groups were similar in days for temperature normalization after admission (Table 4; 7.2 ± 6.3 vs.8.1 ± 6.0 d; P = 0.298). However, the patients of the GFPLA group experienced a significantly longer hospital stay compared with the non-GFPLA (Table 4; 19.6 ± 11.6 d vs. 16.2 ± 8.8 d; P = 0.029). There were no deaths in either group during hospitalization.