Risk Factors for the Progression of Pyogenic Liver Abscess to Sepsis and Development of a Predictive Model

Abstract

Aims

This study aimed to examine risk factors associated with the progression of pyogenic liver abscess (PLA) to sepsis and to evaluate their predictive value.

Methods

A retrospective analysis was conducted on patients diagnosed with PLA at a single institution between January 2019 and December 2024. Demographic data and laboratory parameters were collected. Based on the occurrence of sepsis, patients were categorized into a sepsis group (n = 73) and a non-sepsis group (n = 103). Multivariate logistic regression analysis was used to determine independent risk factors for progression to sepsis. Receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive performance of the identified factors.

Results

Multivariate logistic regression identified uric acid (UA), total bilirubin (TBIL), and platelet count (PLT) as independent risk factors for the progression of PLA to sepsis. ROC analysis yielded the following results: (1) Sensitivity: UA 0.589, TBIL 0.753, PLT 0.726; (2) Specificity: UA 0.806, TBIL 0.913, PLT 0.704; (3) Threshold: UA 306.5 μmol/L, TBIL 26.75 μmol/L, PLT 155 × 10⁹/L.

Conclusion

Multivariate analysis identified elevated UA (per 1 μmol/L increase: OR 1.006, 95% CI 1.000-1.012) and TBIL (per 1 μmol/L increase: OR 1.301, 95% CI 1.183-1.478), and decreased PLT (per 1 ×10⁹/L decrease: OR 0.982, 95% CI 0.972-0.989) as independent risk factors for sepsis progression. Threshold values of UA ≥306.5 μmol/L, TBIL ≥26.75 μmol/L, and PLT ≤155 × 10⁹/L may serve as clinical indicators for identifying patients at high risk of progression to sepsis.