关键词: 肝脓肿, 脓毒血症, 肺炎克雷伯菌, 糖尿病, 降钙素原

Abstract: Objective To explore the clinical characteristics and risk factors of liver abscess complicated with sepsis. Methods A retrospective analysis was conducted on the clinical data of 169 patients with liver abscess admitted to the 988th Hospital of the Joint Logistics Support Force from January 2000 to June 2023. Patients were divided into sepsis group and non sepsis group based on clinical diagnosis. The basic information, laboratory tests, pathogenic bacteria, types of antibiotics, length of hospital stay, and disease outcomes of the two groups were compared and analyzed. Results There were 51 cases (30.2%) in the sepsis group and 118 cases (69.8%) in the non-sepsis group. Both groups were mainly middle-aged and elderly patients, with male patients accounting for 68.66% and 61.0% in each group, respectively. There was no significant difference in age and gender (P>0.05); In terms of basic diseases, the proportion of sepsis group complicated with diabetes was significantly higher than the non-sepsis group(64.7% vs 33.1%) (P<0.05); In terms of clinical manifestations, fever was the main clinical manifestation in both groups, and there was no significant difference between two groups(P>0.05); In terms of laboratory tests, the sepsis group showed higher levels of neutrophils (85.61 ± 10.33 vs 77.91 ± 12.45)%, C-reactive protein (199.75 ± 85.71 vs 129.76 ± 68.32) mg/L, procalcitonin (20.35 ± 10.16 vs 8.87 ± 6.73) ng/mL, creatinine (99.37 ± 72.69 vs 82.48 ± 60.81) umol/L, and lower levels of blood platelets (179.36 ± 84.84 vs 278.56 ± 110.82) ×10⁹/L and albumin (25.75 ± 5.08 vs 29.43 ± 4.26) g/L(P<0.05); In terms of pathogenic bacteria, the proportion of Klebsiella pneumoniae in the sepsis group was higher compared to the non-sepsis group (66.7% vs 42.4%) (P<0.05); In terms of antibiotic selection, the use rate of carbapenem antibiotics was significantly higher in the sepsis group compared to the non-sepsis group (80.4% vs 27.1%) (P<0.05); In terms of hospitalization time, the sepsis group had a significantly longer duration compared to the non-sepsis group (27.31 ± 12.16 vs 18.94 ± 9.27)d (P<0.05); In terms of disease progression, the improvement rates of both groups were relatively high, at 78.4% and 87.3%, respectively, but there was no significant difference between two groups (P>0.05). Multivariate regression analysis showed that diabetes (P<0.001, OR=1.021, 5% CI 1.011~1.032), Klebsiella pneumoniae infection (P=0.033, OR=1.891, 5% CI 1.059~3.379), thrombocytopenia (P=0.024, OR=1.053, 5% CI 1.009~1.102), and procalcitonin elevation (P=0.029, OR=1.257, 5% CI 0.793~1.826) were risk factors of liver abscess complicated with sepsis. Conclusion Patients with liver abscess complicated by sepsis exhibited a higher prevalence of diabetes and Klebsiella pneumoniae infection along with evelated levels of procalcitonin, neutrophil ratio, C-reactive protein and creatinine are higher, as well as reduced levels of platelet and albumin. Among them, combination of diabetes, Klebsiella pneumoniae infection, elevated procalcitonin, and decreased platelet count are risk factors for liver abscess complicated with sepsis, which should be focused on.

Key words: Liver abscess, Sepsis, Klebsiella pneumoniae, Diabetes, Procalcitonin