Original Contribution Mortality in Emergency Department Sepsis score as a prognostic indicator in patients with pyogenic liver abscess ☆ , ☆☆ Sheng-Hung Kuo MD a, b , Yuan-Ti Lee MD, PhD a, c, d , Chi-Rong Li PhD a, e , Chien-Jen Tseng MD f, g , Wai-Nang Chao MD a, f, g , Po-Hui Wang MD, PhD a, c , Ruey-Hong Wong PhD a, h , Chun-Chieh Chen MD, PhD a, c, i, 1 , Shiuan-Chih Chen MD, PhD a, c, i, ⁎, Meng-Chih Lee MD, PhD, MPH a, i, j a Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan b Yuan-Lin Kuo Hospital, Changhua 51041, Taiwan c School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan d Division of Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan e School of Nursing and Institute of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan f Department of Emergency Medicine, Chi Mei Medical Center, Tainan City 710, Taiwan g Department of Surgery, Chi Mei Medical Center, Tainan City 710, Taiwan h School of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan i Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan j Department of Family Medicine, Taichung Hospital, Department of Health, Executive Yuan, ROC Taichung, Taiwan abstract article info Article history: Received 11 September 2012 Received in revised form 28 February 2013 Accepted 28 February 2013 Objectives: The purpose of this study was to explore the predictor index of mortality in patients with pyogenic liver abscess (PLA). Methods: We performed a retrospective review that enrolled 431 patients 18 years and older hospitalized due to PLA between January 2005 and December 2010. Clinical characteristics, laboratory results, treatments, and outcomes retrieved from medical records were analyzed. Multiple logistic regression and receiver operating characteristic curve analyses were performed. Results: The mean age of the 431 patients identified with PLA was 56.9 ± 15.0 years. The mean Mortality in Emergency Department Sepsis (MEDS) score on admission was 4.8 ± 4.1 (range, 0-17). During hospitalization, 94 patients (22%) required intensive care. Of the 431 patients, 63 died, yielding a 15% case fatality rate. Multivariate analysis revealed that higher MEDS scores on admission (P b .0001) and the presence of underlying malignancy (P = .006), multiple abscesses (P = .001), anaerobic infections (P b .0001), hyperbilirubinemia (P b .0001), and higher serum creatinine levels (P b .0001) were significantly associated with PLA mortality. The estimated area under the receiver operating characteristic curve for MEDS in predicting PLA mortality was 0.829 (95% confidence interval, 0.791-0.864; P b .0001). The optimal cutoff MEDS value of 7 or higher had a sensitivity of 76% sensitivity and a specificity of 81%, with a 10.7-fold PLA mortality risk (P b .0001) and a 26.2-fold intensive care unit admission risk (P b .0001). Conclusions: The MEDS scores on admission represent a significant prognostic indicator for patients with PLA. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Pyogenic liver abscess (PLA) is an uncommon but potentially life- threatening medical condition, with a reported worldwide case fatality rate ranging from 6% to 19% over the past 2 decades, despite improvements in diagnostic imaging techniques and therapeutic modalities [1–11]. Several investigators found that older age, elevated white blood cells counts, blood urea nitrogen, serum creatinine and total bilirubin, low serum albumin and hemoglobin levels, septic shock, abscess of biliary origin, multiple abscesses, and concomitant malignancy could be related to PLA mortality [1–3,7,10,12–15], but no consensus has been reached. Recently, some studies found that the Acute Physiology and Chronic Health Evaluation (APACHE) II score is a robust predictor of PLA mortality [7,10,15]. Given that the PLA mortality risk is associated with illness severity, early and aggressive therapy in the form of appropriate antibiotic treatment, fluid resuscitation, and even intensive care or surgical interventions may improve the outcome for these patients with severe infections [7,10,15,16]. The APACHE II score, initially designed to measure American Journal of Emergency Medicine 31 (2013) 916–921 ☆ Funding/Support: None. ☆☆ Competing interests declared: None. ⁎ Corresponding author. Faculty of Medicine, School of Medicine and Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan. Tel.: +886 4 24739595 ext. 34970; fax: +886 4 23248137. E-mail address: sccy399@yahoo.com.tw (S.-C. Chen). 1 Dr Chun-Chieh Chen made an equal contribution to this work as the first author. 0735-6757/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajem.2013.02.045 Contents lists available at SciVerse ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem