Analysis of the predictive factors for the effectiveness of bacterial liver abscess in patients with type 2 diabetes mellitus

Objective To discuss the clinical features of bacterial liver abscess (BLA) in patients with type 2 diabetes mellitus (T2DM), and analyzed the predictive factors of BLA effectiveness. Methods A total of 494 BLA patients who were admitted into hospital from January 2015 to December 2019 were enrolled and divided into two groups: a T2DM group (n=191) and a non-T2DM group (n=303). The two groups were compared for general information, laboratory and imaging examination, complications and treatment methods. According to their outcome, the patients were divided into two groups: an effective group (cure or remission) and an ineffective group (failure to responding to treatment, aggravation or death) and their predictive factors for BLA effectiveness was analyzed by univariate and multivariate logistic regression. Results For BLA patients with T2DM, their length of hospitalization stay, the percentages of patients with increases in C-reaction protein (CRP), procalcitonin (PCT) and neutrophil percentage (NE%), the detection rate of Klebsiella pneumoniae, the percentage of gas accumulation abscess, the incidence of bacteremia and hypoproteinemia were significantly higher than those in the non-T2DM group (P<0.05). The patients received one of the four treatment methods: antibiotics alone or a combined use of antibiotics and puncture pumping pus, percutaneous catheter drainage or surgery. Only antibiotics and catheter drainage showed significant differences in effectiveness between the T2DM and non-T2DM groups (P=0.019). Multivariate logistic analysis showed that the combined use of antibiotics and catheter drainage can improve the effectiveness of BLA (OR=0.027, P=0.011). Meanwhile, urea nitrogen>7.86 mmol/L (OR=7.655, P=0.010), septic shock (OR=9.247, P=0.022), abdominal effusion (OR=41.911, P=0.002) and aspartate aminotransferase (AST) > 40 U/L (OR=6.797, P=0.043) resulted in poor effectiveness of BLA. Conclusions BLA patients with T2DM have more severe infection and longer length of hospitalization stay, with a higher incidence of complications. The combined use of antibiotics and catheter drainage can improve the effectiveness of BLA, while urea nitrogen > 7.86 mmol/L, septic shock, abdominal effusion and AST > 40 U/L are the predictive factors for poor BLA effectiveness.