Incidence Trends, Comorbidities and Outcomes of Pyogenic Liver Abscess Among Children. A Nationwide Population-Based Analysis

OBJECTIVES: Population based analysis of incidence, comorbid conditions, microbiological characteristics and outcomes of pyogenic liver abscess (PLA) in children. METHODOLOGY: Retrospective analysis of National Inpatient Sample (NIS) and Kids Inpatient database (KID) database from 2003 to 2014 and included patients between 1 and 20 years of age. Using ICD 9 codes, we identified all hospitalizations with PLA and compared them with 1:10 age and gender matched controls. Amebic liver abscess and candida infections were excluded. RESULTS: Total no. of PLA admissions = 4,075. The overall incidence of PLA is 13.5 per 100,000 hospitalizations which increased by 60% between 2003 and 2014. The mean age of patients was 13.03 +/- 6.1 years and were predominantly males - 61%. Of the comorbid conditions, hepatobiliary malignancy had the highest odds ratio (OR-71.8) followed by liver transplant (OR - 38.4), biliary disease (OR - 29.9), Inflammatory Bowel Disease (IBD) (OR - 5.35), other GI malignancies (OR -4.74), primary immune deficiency disorder (OR - 4.13). Patients with PLA had 12 times increased odds of having associated severe sepsis. Infective Endocarditis (IE) (OR-4.5), appendicitis (OR-1.8) and diverticulitis (OR-8.1) were significantly associated with PLA. Almost 39% (1575) of the PLA patients had positive culture, while Streptococcus (10.8%) and staphylococcus (9.2%) were the most common pathogens. About 45% of PLA patients underwent percutaneous liver abscess aspiration while 4.1% had hepatic resection for PLA. The mortality rate of PLA was 0.8% (n = 32). CONCLUSION: The incidence of PLA is steadily increasing over the last decade among pediatric population in the United States. Hepatobiliary malignancy and liver transplant are the most common comorbid conditions associated with PLA.