Analysis of factors associated to failure of medical treatment of amoebic liver abscess [Análisis de factores asociados al fracaso del tratamiento médico del absceso hepático amebiano]
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Introduction. To identify the laboratory and ultrasound factors that could predict the response to medical treatment of amoebic liver abscess. Material and method. Retrospective study of patients diagnosis with amoebic liver abscess in Hospital Central in San Luis Potosí, Mexico. We included patients greater than 15 years of both sexes. We excluded those with probable pyogenic abscess, immunosupression, history of abdominal or biliary surgery, abdominal neoplasm abdominal or sepsis. We identified patients with good response to medical treatment and patients who needed the abscess drained. We studied the ultrasound findings, plasma levels of albumin, alkaline phosphatase and bilirubin. Results. We analysed 45 patients, 31 had a good response (controls) and 14 needed drainage (cases). The medians of the variables with statistical significance in bivariate analysis were: albumin 2.65 g/dl and 1.7 g/dl (p < 0.001); alkaline phosphatase 133 U and 259 U (p = 0.02) and diameter of absences 5.9 cm and 9.95 cm (p < 0.001), controls and cases respectively. By logistic regression the diameter of the abscess showed a determination coefficient of 0.447 (p < 0.05) and OR = 14.85 (95%25 CI, 2.11-104.9) for drain if it was ≥ 8 cm. Conclusions. A diameter bigger than 8 cm in hepatic amoebic abscess is associated with failure of medical treatment. Low albumin could be related to malnutrition and increased alkaline phosphatase with extrinsic compression of extrahepatic conducts due to big abscesses.
