Bleeding risk of image-guided percutaneous catheter drainage of pyogenic liver abscess in patients with coagulopathy. Abdominal radiology (New York) OBJECTIVE:Percutaneous catheter drainage (PCD) is the mainstream treatment for pyogenic liver abscess (PLA). However, in some patients with severe coagulopathy, there may increase the risk of bleeding complications related to PCD. Therefore, this study was aimed to evaluate the incidence of bleeding complications of PCD in PLA patients complicated with coagulopathy. METHODS:Between January 2011 and September 2019, patients diagnosed with PLA who had undergone PCD were selected retrospectively. Based on the preoperative coagulation parameters, the patients were divided into the coagulopathy group (PLT ≤ 50 × 10/L or INR ≥ 1.5) and the normal coagulation group. The major and minor bleeding complications related to PCD were compared between the two groups. The ICU occupancy and mortality rates in the coagulopathy group were assessed and compared with patients of normal coagulation group. RESULTS:A total of 583 PLA patients subjected to PCD were selected. 522 patients were finally included in this study: 64 cases (12.26%) in the coagulopathy group and 458 cases (87.74%) in the normal coagulation group. No major bleeding complications related to PCD was observed. Two patients (0.38%) of minor bleeding complications, one patient in each group, showed no statistically significant difference (0.2% vs.1.6%, P > 0.05). The ICU occupancy rate of coagulopathy group was significantly higher than normal coagulation group (6.2% vs. 0.7%, P < 0.05). No significant difference in mortality rate was noted between the two groups (4.7% vs.1.5%, P > 0.05). CONCLUSION:The incidence of bleeding complications related to PCD in PLA patients is rare even if complicated with coagulopathy. 10.1007/s00261-021-03075-y

Management and prognostic prediction of pyogenic liver abscess in a Chinese tertiary hospital: Percutaneous needle aspiration vs catheter drainage. PloS one Pyogenic liver abscess (PLA) is a serious infectious disease with high mortality. The aim of our study was to compare the efficacy of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) for PLA and to assess risk factors for unfavorable prognosis. This retrospective study was performed between 2017 to 2019 in a Chinese tertiary care hospital. We compared the therapeutic effectiveness of PNA versus PCD for PLA and analyzed the risk factors of treatment failure in PLA patients using multivariate logistic regression. A total of 445 patients with PLA were enrolled. The ultrasound-guided percutaneous treatment showed good therapeutic effects on PLA, with a total primary cure rate of 90.1%. PNA appeared to have advantages over PCD, with higher success rates, lower costs, and shorter hospital stays, as well as fewer puncture-induced pain, especially in patients with abscesses of 5-10 cm in diameter. The presence of positive blood culture (OR: 3.32, p = 0.002), liver cirrhosis (OR: 3.31, p = 0.023), and the length of fever resolution (OR: 1.043, p = 0.001) were independent predictors of primary treatment failure. PNA is more advantageous than PCD and is worth considering as a first-line treatment. 10.1371/journal.pone.0315371

Serial platelet count as a dynamic prediction marker of hospital mortality among septic patients. Burns & trauma Background:Platelets play a critical role in hemostasis and inflammatory diseases. Low platelet count and activity have been reported to be associated with unfavorable prognosis. This study aims to explore the relationship between dynamics in platelet count and in-hospital morality among septic patients and to provide real-time updates on mortality risk to achieve dynamic prediction. Methods:We conducted a multi-cohort, retrospective, observational study that encompasses data on septic patients in the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The joint latent class model (JLCM) was utilized to identify heterogenous platelet count trajectories over time among septic patients. We assessed the association between different trajectory patterns and 28-day in-hospital mortality using a piecewise Cox hazard model within each trajectory. We evaluated the performance of our dynamic prediction model through area under the receiver operating characteristic curve, concordance index (C-index), accuracy, sensitivity, and specificity calculated at predefined time points. Results:Four subgroups of platelet count trajectories were identified that correspond to distinct in-hospital mortality risk. Including platelet count did not significantly enhance prediction accuracy at early stages (day 1 C-index   C-index: 0.713 0.714). However, our model showed superior performance to the static survival model over time (day 14 C-index   C-index: 0.644 0.617). Conclusions:For septic patients in an intensive care unit, the rapid decline in platelet counts is a critical prognostic factor, and serial platelet measures are associated with prognosis. 10.1093/burnst/tkae016