Abstract: Objective The clinical features of Pyogenic liver abscess (PLA) with two most common treatment approaches for large abscesses were compared and analyzed. Methods Clinical data of 1 644 adult patients with PLA were retrospectively analyzed and divided into groups with diameter ≤ 50 mm (small abscess), 50~100 mm (large abscess), and > 100 mm (giant abscess) according to different abscess diameters. The clinical characteristics of each group were compared, and the two treatment methods of the large abscess group were compared. Independent sample t test, Mann-Whitney U test, Kruskal-Wallis H test and χ² test were used for statistical analysis. Results A total of 597 cases were included in the small abscess group, 944 cases in the large abscess group and 103 cases in the giant abscess group. Women in the giant abscess group (41.7% vs. 32.5%, P<0.05), The proportion was significantly higher than that of small abscess group. The fever ratio of large abscess and large abscess group was 91.4% and 81.6%, respectively, and the difference was not statistically significant (P>0.05). In the giant abscess group, the proportions of abdominal pain (64.1% vs. 43.0%, P<0.05), pulmonary changes (45.6% vs. 27.5%, P<0.05), and single lesion (84.3% vs. 71.0%, P<0.05) were significantly higher than those in the small abscess group. The proportion of gas-forming abscess in the three groups was 5.2%, 12.2% and 13.6%, respectively. The large abscess group and the giant abscess group were significantly higher than those in the small abscess group (P<0.05). The hospitalization days of the three groups were 12(8,17)d, 13(9,19)d and 15(10,21)d, respectively, and the hospitalization costs were 1.83 (1.19, 2.76), 2.31 (1.55, 3.31), and 2.58 (1.96, 3.9) ten thousand yuan, respectively, with statistical significance (P<0.05). The proportions of antibiotics combined with PD in the three groups were 58.6%, 72.7% and 75.7%, and the puncture times were 1 (0,1), 1 (0,2) and 1 (1,2) times, respectively. The large abscess and the giant groups were significantly higher than the small abscess group (P<0.05). Leukocyte count in the three groups was 10.51(7.67,14.09)×10⁹/L, 11.83(9.08,15.33)×10⁹/L, 13.19(10.63,18.09)×10⁹/L, respectively. Alanine aminotransferase (ALT) was 45(27,76.05)U/L, 58.4(34,99)U/L and 64.1(39,113.5)U/L, respectively Albumin was 33.55(29.5,37.53)g/L, 30.6(27,34.8)g/L, 27.9(24.48,30.8)g/L, respectively, and the differences were statistically significant (P<0.05). In the treatment of major abscess, the length of stay 14(10,19)d in PD group combined with antibiotics was significantly longer than 11(6,17) d in antibiotics alone group, P<0.05, and the hospitalization cost of 2.43(1.63,3.43) ten thousand yuan was significantly higher than that of 1.94(1.12, 2.93) ten thousand yuan in antibiotics alone group, P<0.05. The improvement rate of antibiotic combined with PD group was significantly higher than that of antibiotic alone group (97.5% vs. 87.7%, P<0.05). The WBC count of 12.26(9.45,15.77)×10⁹/L and ALT 61.4(36.70,104.00)U/L in antibiotic combined PD group were significantly higher than those in antibiotic alone group 11.26(7.95,14.77)×10⁹/L and 49.1(28.62,86.82)U/L, P<0.05. Conclusion The abscess size in PLA patients is related to many factors. In the treatment of large abscesses, antibiotics combined with PD have advantages and disadvantages compared with antibiotics alone.

Key words: Pyogenic liver abscess, Clinical characteristics, Therapy