Diabetes Monit 2000;1(1):63-77.
당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자
안유배, 오은숙, 강무일, 이원영, 오기원, 임동준, 이소영, 이정민, 고승현, 김성래, 손현식, 윤건호, 차봉연, 이광우, 손호영, 강성구
The Clinical Manifestations and Prognostic Factors in Pyogenic Liver Abscess with Diabetes Mellitus
Yoo Bae Ahn, Eun Sook Oh, Moo Il Kang, Won Young Lee, Ki Won Oh, Dong Jun Lim, So Young Lee, Jung Min Lee, Seung Hyeon Ko, Sung Rae Kim, Hyeon Sik Son, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Ho-Young Son, Sung-Koo Kang
Abstract
Background
Liver abscesses are commonly associated with underlying disease, particularly diabetes mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentations and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June. 1999 were reviewed retrospectively in detail. Major pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellitus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7±13.4 years in diabetic liver abscess group and 55.1±15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the biliary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1% and 7.1% in nondiabetic liver abscess. Complications, especially septicemia, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia: 31.5% vs 9.7%), The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess, Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patients with liver abscess.
Key Words: Liver abscess, 0abetee mellitus, Klebslella pneumoniae


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