Increasing incidence of pyogenic liver abscess in Southern Sweden: a population-based study from 2011 to 2020

Figures & data

Figure 1. Flowchart of steps of inclusion. ^aICD diagnosis K750. ^bPatients were diagnosed with K750, but no record of abscess could be found. ^cNon-Skåne residents, transferred to hospitals outside of Skåne. ^dThe diagnosis K750 was not present in the medical record. PLA: pyogenic liver abscess.

Table 1. Baseline characteristics and information gathered from the first admission.

Baseline characteristic	n = 364
Male, sex, n (%)	206 (57)
Age, median years (range)	71 (3–97)
Smoking, n (%)	76 (21)
Charlson comorbidity index, median score (range)	5 (0–15)
Myocardial infarction, n (%)	59 (16)
Congestive heart failure, n (%)	59 (16)
Peripheral vascular disease, n (%)	19 (5)
Cerebrovascular accident or transient ischaemic attack, n (%)	54 (15)
Dementia, n (%)	11 (3)
Chronic obstructive pulmonary disease, n (%)	39 (11)
Connective tissue disease, n (%)	19 (5)
Peptic ulcer disease, n (%)	50 (14)
Liver disease, n (%)	19 (5)
Diabetes mellitus, n (%)	103 (28)
Hemiplegia, n (%)	1 (0)
Moderate to severe chronic kidney disease, n (%)	21 (6)
Solid tumour, n (%)	110 (30)
Leukaemia, n (%)	4 (1)
Lymphoma, n (%)	4 (1)
AIDS, n (%)	1 (0)
Immunosuppressed, n (%)	84 (23)
BMI, median score (range)	25.3 (15.7–51.9)

AIDS: acquired immunodeficiency syndrome; BMI: body mass index.

Figure 2. The annual incidence of pyogenic liver abscess in Skåne 2011–2020. Incidence rates were age- and sex-standardized to the population of south Sweden in 2020. The shaded area represents the 95% confidence interval.

Figure 3. Pyogenic liver abscess in Skåne divided into age groups.

Table 2. Clinical findings of all included PLA episodes (n = 375).

Variable	n (%)
Main symptoms
Fever, n (%)	166 (44)
Abdominal pain, n (%)	115 (31)
Fatigue, n (%)	25 (7)
Dyspnoea, n (%)	10 (3)
No symptom, n (%)	7 (2)
Abnormal lab results, n (%)	7 (2)
Dizziness, n (%)	4 (1)
Chills, n (%)	3 (1)
Vomiting, n (%)	3 (1)
Chest pain, n (%)	3 (1)
Back pain, n (%)	3 (1)
Jaundice, n (%)	2 (1)
Flank pain, n (%)	2 (1)
Thorax pain, n (%)	2 (1)
Bloated abdomen, n (%)	1 (1)
Other, n (%)	22 (6)
Clinical findings
History of abdominal pain, n (%)	217 (58)
Duration of symptoms prior admission, median (range)	4 (1–90)
Respiratory rate, median (range)	20 (10–50)
Oxygen saturations, median (range)	97 (80–100)
Temperature, median (range)	38.1 (34.4–41.9)
Systolic blood pressure, median (range)	130 (70–217)
Heart rate, median (range)	95 (47–210)
RLS, median (range)	1 (1–3)
NEWS, median (range)	3 (0–16)
qSOFA, median (range)	0 (0–3)

RLS: reaction level scale; NEWS: National Early Warning Score; qSOFA: Quick sequential organ failure assessment; PLA: pyogenic liver abscess. All calculations based on available data.

Table 3. Laboratory characteristics and diagnostic modalities of all PLA admissions.

Variable	n (%)
Laboratory findings
CRP, mg/L median (range)	184 (5.7–577)
WBC count × 10^9/L median (range)	13.8 (1.1–62)
Lactate, mmol/L median (range)	1.9 (0.6–13.6)
PT/INR, median (range)	1.2 (0.9–>8.0)
ALT, µkat/L median (range)	0.81 (0.1–35)
ALP, µkat/L median (range)	2.7 (0.34–29)
Bilirubin, µmol/L median (range)	14 (3–536)
Albumin, g/L median (range)	23 (10–44)
Diagnostic method
CT, n (%)	311 (83)
Ultrasound, n (%)	56 (15)
MRI, n (%)	8 (2)
Characteristics of abscess
Solitary abscess, n (%)	230 (61)
Multiple abscess, n (%)	144 (38)
Unknown	1 (0)
Size of abscess, cm median (range)	6.0 (0.8–25.0)
Right lobe, n (%)	254 (68)
Left lobe, n (%)	69 (18)
Both lobes, n (%)	42 (11)
Unknown	10 (3)
Portal thrombosis, n (%)	42 (11)

CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; WBC: white blood cells; PT/INR: prothrombin time/international normalised ratio; ALT: alanine aminotransferase; ALP: alkaline phosphatase; CT: computed tomography; MRI: magnetic resonance imaging; PLA: pyogenic liver abscess. All calculations based on available data.

Figure 4. Results of abscess cultures in relation to duration of antibiotics during the first 4 weeks.