Neutrophilia, leukocytosis tied to poor outcomes in paediatric liver abscess

In children with liver abscess, factors such as age-related leukocytosis, neutrophilia, elevated aspartate transaminase or alanine transaminase, and hypoalbuminaemia at presentation are significantly associated with poor outcomes, suggests a study.

In this retrospective observational study conducted at a tertiary care hospital in India from January 2019 to September 2019, the authors obtained the records of children (aged <12 years) who were diagnosed ultrasonographically with liver abscess for clinic-radiological and demographic profile, laboratory investigations, treatment, complications, and outcomes.

Patients were divided into favourable or unfavourable groups based on predefined criteria. They were then compared for possible predictors of poor outcomes. Finally, the authors analysed the outcomes for the protocol-based management.

Overall, 120 children with liver abscess (median age 5 years at presentation) were included. The most common clinical features were fever (100 percent) and pain in the abdomen (89.16 percent). Most of the liver abscesses were solitary (78.4 percent) and located in the right lobe (73.3 percent). Of the patients, 27.5 percent had malnutrition, 76.5 percent had overcrowding, and 2.5 percent had worm infestation.

The unfavourable group were significantly more likely to have age-related leukocytosis (p=0.004), neutrophilia (p=0.013), elevated aspartate transaminase (p=0.008), elevated alanine transaminase (p=0.007), and hypoalbuminaemia (p=0.014) at presentation.

Overall, 29.2 percent of children underwent conservative management with antibiotics alone, 25.0 percent received percutaneous needle aspiration (PNA), 49.1 percent had ultrasound-guided percutaneous drain (PCD) insertion, and one patient required open surgical drainage (OSD).

The success rates were 100 percent for conservative management, 76.6 percent for PNA, 94.7 percent for PCD, and 100 percent for OSD. The overall mortality rate was 2.5 percent.

“Protocol-based management leads to the appropriate use of PNA and PCD while decreasing mortality and morbidity related to either,” the authors said.