Top

European Journal of Trauma and Emergency Surgery

Published in:

01-10-2014 | Original Article

Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management

Authors: C.-P. Hsu, S.-Y. Wang, Y.-P. Hsu, H.-W. Chen, B.-C. Lin, S.-C. Kang, K.-C. Yuan, E.-H. Liu, I.-M. Kuo, C.-H. Liao, C.-H. Ouyang, S.-J. Yang

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2014

Abstract

Purpose

To identify risk factors for liver abscess formation in patients with blunt hepatic injury who underwent non-operative management (NOM).

Methods

From January 2004 to October 2008, retrospective data were collected from a single level I trauma center. Clinical data, hospital course, and outcome were all extracted from patient medical records for further analysis.

Results

A total of 358 patients were enrolled for analysis. There were 13 patients with liver abscess after blunt hepatic injury. Patients with abscess had a significant increase in glutamic oxaloacetic transaminase (GOT, p = 0.006) and glutamic pyruvic transaminase (GPT, p < 0.0001), and a decrease in arterial blood pH (p = 0.023) compared to patients without abscess in the univariate analyses. In addition, high-grade hepatic injury and transarterial embolization (TAE, p < 0.001) were also risk factors for liver abscess formation. Five factors (GOT, GPT, pH level in the arterial blood sample, TAE, and high-grade hepatic injury) were included in the multivariate analysis. TAE, high-grade hepatic injury, and GPT level were statistically significant. The odds ratios of TAE and high-grade hepatic injury were 15.41 and 16.08, respectively. A receiver operating characteristic (ROC) analysis was used for GPT, and it suggested cutoff values of 372.5 U/L. A prediction model based on the ROC analysis had 100 % sensitivity and 86.7 % specificity to predict liver abscess formation in patients with two of the three independent risk factors.

Conclusions

TAE, high-grade hepatic injury, and a high GPT level are independent risk factors for liver abscess formation.

Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995;221(6):744–53; discussion 53–5.PubMedCrossRefPubMedCentral

Velmahos GC, Toutouzas K, Radin R, Chan L, Rhee P, Tillou A, et al. High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg. 2003;138(5):475–80; discussion 480–1. doi:10.1001/archsurg.138.5.475.PubMedCrossRef

Meredith JW, Young JS, Bowling J, Roboussin D. Nonoperative management of blunt hepatic trauma: the exception or the rule? J Trauma. 1994;36(4):529–34; discussion 534–5.PubMedCrossRef

Pachter HL, Knudson MM, Esrig B, Ross S, Hoyt D, Cogbill T, et al. Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1996;40(1):31–8.PubMedCrossRef

Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000;231(6):804–13.PubMedCrossRefPubMedCentral

Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38(3):323–4.PubMedCrossRef

Farnell MB, Spencer MP, Thompson E, Williams HJ Jr, Mucha P Jr, Ilstrup DM. Nonoperative management of blunt hepatic trauma in adults. Surgery. 1988;104(4):748–56.PubMed

Federico JA, Horner WR, Clark DE, Isler RJ. Blunt hepatic trauma. Nonoperative management in adults. Arch Surg. 1990;125(7):905–8; discussion 908–9.PubMedCrossRef

Pachter HL, Spencer FC, Hofstetter SR, Liang HG, Coppa GF. Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg. 1992;215(5):492–500; discussion 500–2.PubMedCrossRefPubMedCentral

10.

Stassen NA, Lukan JK, Carrillo EH, Spain DA, Norfleet LA, Miller FB, et al. Examination of the role of abdominal computed tomography in the evaluation of victims of trauma with increased aspartate aminotransferase in the era of focused abdominal sonography for trauma. Surgery. 2002;132(4):642–6; discussion 646–7.PubMedCrossRef

11.

Puranik SR, Hayes JS, Long J, Mata M. Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children. South Med J. 2002;95(2):203–6.PubMedCrossRef

12.

Lee WC, Kuo LC, Cheng YC, Chen CW, Lin YK, Lin TY, et al. Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration. Am J Emerg Med. 2010;28(9):1024–9.PubMedCrossRef

13.

Karam O, La Scala G, Le Coultre C, Chardot C. Liver function tests in children with blunt abdominal traumas. Eur J Pediatr Surg. 2007;17(5):313–6. doi:10.1055/s-2007-965533.PubMedCrossRef

14.

Song SY, Chung JW, Han JK, Lim HG, Koh YH, Park JH, et al. Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol. 2001;12(3):313–20.PubMedCrossRef

15.

Kozar RA, Moore JB, Niles SE, Holcomb JB, Moore EE, Cothren CC, et al. Complications of nonoperative management of high-grade blunt hepatic injuries. J Trauma. 2005;59(5):1066–71.PubMedCrossRef

16.

Giss SR, Dobrilovic N, Brown RL, Garcia VF. Complications of nonoperative management of pediatric blunt hepatic injury: diagnosis, management, and outcomes. J Trauma. 2006;61(2):334–9. doi:10.1097/01.ta.0000197605.27190.2c.PubMedCrossRef

Title: Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management
Authors: C.-P. Hsu
S.-Y. Wang
Y.-P. Hsu
H.-W. Chen
B.-C. Lin
S.-C. Kang
K.-C. Yuan
E.-H. Liu
I.-M. Kuo
C.-H. Liao
C.-H. Ouyang
S.-J. Yang
Publication date: 01-10-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2014
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-013-0346-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for liver abscess formation in patients with blunt hepatic injury after non-operative management

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2014

Adherence to protocol in pregnant trauma patients? A 12-year retrospective study

Mechanism of injury and treatment of trauma-associated acute compartment syndrome of the foot

Acute compartment syndrome

Contrast enhanced ultrasound (CEUS) reliably detects critical perfusion changes in compartmental muscle: a model in healthy volunteers

Autotransfusion in emergent operative trauma resuscitation

The role of non-invasive ventilation in blunt chest trauma: systematic review and meta-analysis