Surgical management of pyogenic liver abscess: A retrospective cross-sectional multi-center study

Surgical management of pyogenic liver abscess: A retrospective cross-sectional multi-center study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical management of pyogenic liver abscess: A retrospective cross-sectional multi-center study Yongxia Li, Qin Gao, Yujun Shi, Jiamei Jiang, Xiaoguang Zhu, Hairong Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2014969/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pyogenic liver abscess(PLA)is a potentially life-threatening disease associated with elevated risk of morbidity and mortality. Ultrasound or CT-guided percutaneous catheter drainage (PCD) and needle aspiration (PNA) are important surgical methods for the treatment of PLA. While their comparative efficacy is still debated, the aim of the study was to compare PCD and PNA in the treatment of liver abscesses. Methods Taking a retrospective comparative approach, 172 patients with liver abscesses from Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine Affiliated with Renji Hospital South Campus and Xinhua Hospital were studied between April 2015 and April 2021. These were modeled using an analysis of covariance (ANCOVA) with a-priori covariates: age, sex, general health, clinical symptoms, and Sequential Organ Failure Assessment (SOFA) score was collated from medical records. Results Liver abscess was more common in middle-aged men, occurring more frequently in the right hepatic lobe. Single abscess was common in both groups. The rate of blood culture that was positive for bacteria was higher in PCD-treated patients than those treated with PNA, with Klebsiella pneumonia the most common bacteria species identified in both groups. The side effect in PCD is worse than in PLA. Conclusion Patients with liver abscess use were more seriously ill, but their mortality or fever time did not significantly increase, suggesting that PLA is beneficial for severe patients for its safety. pyogenic liver abscess percutaneous needle aspiration (PNA) percutaneous catheter drainage (PCD) Figures Figure 1 Figure 2 Highlights What is already known: • Image-guided percutaneous treatment PCD or PNA has replaced surgical intervention as the procedure of choice • If performed carefully, both the procedures are safe with minimal complications What the new findings are: PLA is a better modality as compared to PCD in terms of safety. Introduction A liver abscess is a suppurative cavity in the liver, resulting from the invasion and multiplication of microorganisms from a direct injury, through the blood vessels or via the biliary ductal system. Pyogenic liver abscesses (PLA), resulting from bacterial infection, account for 80% of all liver abscesses, which are also commonly amebic and mixed infections. Less commonly liver abscesses can be fungal in origin [ 1 , 2 ] . Liver abscesses continue to be an important cause of morbidity and mortality in tropical countries [ 3 ] , where amebic infections are more common historically. The morbidity of PLA has remarkably increased in Asian regions, e.g. Taiwan, where the annual incidence has gradually increased from 10.83 to 15.45 cases per 100,000 population since 2000 to 2011, and the mortality is up to 2–19% [ 4 – 5 ] . However, advances in interventional radiology, intensive care, antibiotic therapy, sonography, and computerized tomography scanning have led to earlier diagnoses and treatment, and improved the patient outcomes. Percutaneous interventions have been important advancements in the treatment of pyogenic liver abscesses [ 6 , 7 ] . With a success rate of between 70–100% overall, image-guided percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) have been increasingly used to treat liver abscesses [ 8 – 10 ] . Treatment of 3–6 cm PLA using a combination of PNA with antibiotics has safe, effective, and promising outcomes [ 11 ] . Comparatively, PCD appears to be a better modality for PLA that are partially liquefied or with thick pus [ 8 ] and for the management of larger abscesses (> 10 cm), in terms of attaining clinical relief and for the duration parenteral antibiotics are needed [ 12 ] . While PCD is widely preferred to drain liver abscesses [ 12 ] , PNA offers a potentially simpler, less costly, and equally effective mode of treatment. PNA of multiple pyogenic abscesses under sonographic guidance is a safe, effective, and low-cost procedure [ 13 ] . The potential differential efficacy of PNA or PCD, however, remains to be established [ 14 ] . The aim of our retrospective study of PLA patients was to identify the comparative efficacy of both treatments. Materials And Methods Participants This retrospective comparative study was conducted between April 2015 and April 2021, using the medical records of 172 adult patients with a diagnosis of Pyogenic Liver Abscess (PLA). PLA was defined as per the ICD-10 diagnosis code K75.0, and participant included patients who had been discharged from one of three comprehensive tertiary care teaching hospitals in East China. Participants were excluded if they were surgical patients, had incomplete information, presented with parasitic, fungal, or amebic liver abscess, were under 18 years old, had a subphrenic, subhepatic or gall bladder abscess or tumor, consistent with previous studies [ 15 ] . Of all the patients included in the study, n = 91 underwent percutaneous needle aspiration (PNA) and n = 81 had percutaneous catheter drainage (PCD). The diagnosis of diabetes and sepsis was referred to relevant literature [ 16 , 17 ] . All patients were treated with antibiotics, combined with image-guided PCD or PNA. Antipyretics, liver-protecting drugs and nutritional support were also required, according to patients’ clinical conditions. The third-generation cephalosporin or cephalomycin, combined with quinolones (levofloxacin or moxifloxacin), were used as the initial empiric antibiotics. Each patient was underwent a liver ultrasound every 2–3 days, with PCD or PNA conducted according to abscess liquefaction, location and size. Liver abscess etiology was determined from pus culture results. For a small number of patients, if infection worsened, antibiotics were adjusted according to the drug sensitivity of the pathogen, or upgraded to fourth-generation cephalosporins or carbapenems if there was no etiological basis. The study was approved by the ethics committees of all three hospitals; Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine Affiliated with Renji Hospital South Campus and Xinhua Hospital. All data were obtained from electronic medical records and reported without personal identifiers. Study Variables A suite of variables was extracted from participants’ medical records to measure patient health status, abscess condition and treatment. These variables included clinical signs and symptoms, medical imaging, and culture and specimen analyses of blood or pus. Etiology was also determined per patient, including whether blood or pus culture was performed, whether culture is positive for bacteria, and which type of bacteria is positive. The characteristics of the abscesses: number (single or multiple), size (the long or short axis of the abscess, if multiple, the sum of the long or short axis of the abscess was taken as the size), location (left lobe of liver, right lobe of liver or both lobes). Information on clinical outcomes included the duration of hospital stay (days), duration of fever in hospital (days), and the occurrence of complications, such as sepsis, myocardial injury, pleural effusion, deep vein thrombosis, endophthalmitis, abscess spread, liver injury, and mortality. Statistical analysis The comparison between groups was performed using the independent samples T test or Wilcoxon rank sum test. The qualitative data were described using numbers and percentages. The comparison between groups was performed by chi-square test or Fisher’s exact test. The primary efficacy index was based on baseline as a covariate. T-test and Fisher's exact test were used to compare continuous variables (e.g., age) and categorical variables (e.g., gender and comorbidity) to test for differences between the PCD and PNA treatment groups. Multivariable logistic regression analysis was performed to explore the independent association of treatment on fever duration in hospital with independent variables. These were modeled using an analysis of covariance (ANCOVA) with a-priori covariates: age, sex, general health, clinical symptoms, and Sequential Organ Failure Assessment (SOFA) score was collated from medical records. A two-sided P of less than 0.05 was considered statistically significant. The statistical analyses were performed using SPSS software, version 28.0. Results Demographic and clinical characteristics Of the medical records obtained, 172 patients were eligible for inclusion in the study, and 81 were treated with PCD and 91 treated with PNA. The flowchart is Fig. 1 . the proportion of male PLA patients treated with PCD (66%) was significantly higher (P < 0.001) than those treated with PNA (39%; Table 1 ). Patient age was approximately consistent between the treatment groups, at 64 ± 13 and 64 ± 14 for PCD and PNA, respectively. Similarly, basic disease presentation, including presence of diabetes, biliary tract, tumor and/or pneumonia, were consistent among treatment groups, as were the symptoms; fever, abdominal pain, anorexia and vomiting (Table 1 ). The SOFA score was significantly higher in patients treated with PCD compared to those treated with PNA (P = 0.02). (Table 1 ) Table 1 Baseline Group Variables Total (n = 172) PNA (n = 91) PCD (n = 81) Statistics P Sex, n(%) χ 2 = 27.407 < .001 1 100 (58.14) 36 (39.56) 64 (79.01) 2 72 (41.86) 55 (60.44) 17 (20.99) Age, Mean ± SD 64.05 ± 13.94 63.53 ± 14.32 64.64 ± 13.57 t=-0.52 0.602 Age, n(%) χ 2 = 0.210 0.647 <65 86 (50.00) 47 (51.65) 39 (48.15) ≥65 86 (50.00) 44 (48.35) 42 (51.85) Diabetes, n(%) χ 2 = 0.407 0.523 0 83 (48.26) 46 (50.55) 37 (45.68) 1 89 (51.74) 45 (49.45) 44 (54.32) Biliary tract disease, n(%) χ 2 = 0.245 0.621 0 120 (69.77) 62 (68.13) 58 (71.60) 1 52 (30.23) 29 (31.87) 23 (28.40) Position, n(%) - 0.217 1 127 (73.84) 64 (70.33) 63 (77.78) 2 38 (22.09) 21 (23.08) 17 (20.99) 3 7 (4.07) 6 (6.59) 1 (1.23) Number, n(%) χ 2 = 0.777 0.378 one 151 (87.79) 78 (85.71) 73 (90.12) More than one 21 (12.21) 13 (14.29) 8 (9.88) sofa, M(Q 1 ,Q 3 ) 1.00 (0.00, 2.00) 0.00 (0.00, 1.00) 1.00 (0.00, 3.00) Z = 2.695 0.007 WBC, M(Q 1 ,Q 3 ) 10.77 (8.07, 13.94) 10.47 (8.10, 13.50) 11.41 (8.04, 14.39) Z = 0.656 0.512 CRP, M(Q 1 ,Q 3 ) 120.88 (81.27, 160.00) 120.60 (74.00, 160.00) 123.00 (84.84, 161.59) Z = 1.397 0.162 ALT, M(Q 1 ,Q 3 ) 38.00 (21.50, 73.00) 35.00 (21.00, 70.00) 41.00 (23.00, 77.00) Z = 1.243 0.214 AST, M(Q 1 ,Q 3 ) 32.00 (21.00, 55.00) 30.00 (20.00, 52.00) 33.00 (21.00, 67.00) Z = 1.183 0.237 Scr, M(Q 1 ,Q 3 ) 60.00 (48.00, 75.95) 48.00 (44.60, 55.30) 75.60 (65.00, 97.00) Z = 9.554 < .001 SD: standard deviation, M: Median, Q 1 :1st Quartile, Q 3 :3st Quartile Table 2 Efficacy of both groups PNA (n = 91) PCD (n = 81) P Primary outcome 0.173 Better 79 (86.81) 64 (79.01) Woese 12 (13.19) 17 (20.99) Secondary outcome Hospital Duration 16.36 ± 8.34 17.76 ± 12.71 0.402 Table 3 Percentage of samples cultured and with pathogens between PNA and PCD PNA(n = 96) PCD(n = 81) P value Blood culture, % (n) 28.1 (27) 67.5 (56) ＜0.001* Positive, % (n) 12.5 (12) 21.7 (18) Negative, % (n) 15.6 (15) 45.8 (38) Klebsiella pneumoniae , % (n) 9.4 (9) 15.7 (13) 0.147 Pus culture, % (n) 84.4 (81) 73.5 (61) 0.083 Positive, % (n) 70.8 (68) 54.2 (45) Negative, % (n) 13.5 (13) 19.3(16) Klebsiella pneumoniae , % (n) 27.1 (26) 36.1 (30) 0.127 Note: * P ＜0.05 PCD, percutaneous catheter drainage; PNA, and needle aspiration Table 4 Multivariate linear regression analyses Group Model1 Model2 Model3 OR (95%CI) P OR (95%CI) P OR (95%CI) P PNA Reference Reference Reference PCD 1.75 (0.78–3.93) 0.176 1.27 (0.53–3.04) 0.592 0.87 (0.32–2.35) 0.788 Ref: Reference, OR: Odds Ratio, CI: Confidence Interval Model1:adjust: None Model2:adjust: Gender, age Model3:adjust: Gender, age, sofa, Scr Table 5 Subgroup analysis Model1 Model2 Model3 OR (95%CI) P OR (95%CI) P OR (95%CI) P Male (n = 100) Group PNA Reference Reference Reference PCD 1.27 (0.46–3.47) 0.644 1.27 (0.46–3.49) 0.639 0.86 (0.28–2.66) 0.798 Female (n = 72) Group PNA Reference Reference Reference PCD 1.33 (0.23–7.58) 0.746 1.01 (0.17–6.08) 0.995 0.83 (0.07–10.11) 0.884 Age < 65 (n = 86) Group PNA Reference Reference Reference PCD 2.17 (0.65–7.27) 0.210 1.34 (0.35–5.04) 0.670 0.70 (0.15–3.33) 0.655 Age ≥ 65 (n = 86) Group PNA Reference Reference Reference PCD 1.44 (0.48–4.30) 0.512 1.17 (0.37–3.71) 0.795 0.83 (0.23–3.05) 0.782 Diabetes = 0 (n = 83) Group PNA Reference Reference Reference PCD 0.81 (0.21–3.11) 0.756 0.62 (0.15–2.60) 0.510 0.59 (0.12–2.96) 0.521 Diabetes = 1 (n = 89) Group PNA Reference Reference Reference PCD 2.73 (0.93-8.00) 0.068 1.88 (0.59–6.04) 0.287 1.29 (0.34–4.87) 0.708 Biliary tract disease =否 (n = 120) Group PNA Reference Reference Reference PCD 3.26 (1.17–9.09) 0.024 2.32 (0.79–6.80) 0.125 1.51 (0.46–4.98) 0.499 Biliary tract disease =是 (n = 52) Group PNA Reference Reference Reference PCD 0.37 (0.07–2.01) 0.247 0.25 (0.04–1.71) 0.160 0.81 (0.07–10.05) 0.869 Position = 1 (n = 127) Group PNA Reference Reference Reference PCD 1.27 (0.51–3.20) 0.611 0.90 (0.33–2.49) 0.838 0.50 (0.15–1.65) 0.257 Position = 2 (n = 38) Group PNA Reference Reference Reference PCD 8.33 (0.87–80.11) 0.066 4.21 (0.39–45.41) 0.237 3.89 (0.28–54.68) 0.314 Number (Single) (n = 151) Group PCD Reference Reference Reference PNA 1.90 (0.74–4.88) 0.185 1.19 (0.42–3.31) 0.746 0.75 (0.23–2.44) 0.637 Number (Multiple) (n = 21) Group PCD Reference Reference Reference PNA 2.25 (0.36–13.87) 0.382 2.13 (0.25–18.21) 0.491 2.81 (0.14–58.36) 0.504 Age subgroup： Model1: adjust: None. Model2: adjust: gender. Model3:adjust: gender, sofa, Scr Gender subgroup： Model1: adjust: None. Model2: adjust: age. Model3:adjust: age, sofa, Scr Others subgroup： Model1: adjust: None. Model2: adjust: gender, age. Model3: adjust: gender, age, sofa, Scr Disease complications and outcomes Regrading comorbidities, no patients in the PNA group presented with pleural effusion, though a total of 7 with PCD did (Table 2 ; P = 0.027). The duration of hospital stay, mortality rate, incidence of sepsis and complications were not significantly different between the two treatment methods (Table 2 ). Microbiological characteristics Blood was cultured from 56 patients (67.5%) in the PCD group and 27 patients (28.1%) in the PNA group, with microorganisms isolated from 18 (21.7%) and 12 (12.5%) samples of the respective groups (Table 3 ). In the PCD group, 61 (73.5%) patients had pus cultured and 81 (84.4%) patients from the PNA group. Microorganisms were isolated in the samples of 45 (54.2%) patients in the PCD group via pus culture, whereas they were isolated in the samples of 68(70.8%) patients in the PNA group (Table 3 ). The bacteria isolated from the blood and pus cultures were predominantly gram-negative, with Klebsiella pneumonia the most common species in both groups (Table 3 ). Abscess characteristics Of 81 PCD-treated participants, 77.8% (n = 63) had PLA in the right lobe, as compared to 85.7% (n = 78 of n = 92) of PNA-treated participants. Single abscess was common in both groups, accounting for 90.1% and 85.7% in PCD and PNA-treated participants, respectively. The size of abscess was also approximately consistent between treatment groups, with no significant statistical difference (Table 1 ). We further conducted multivariate linear regression analyses with adjustments for age, gender, sofa score and Scr. (Table 4 ,, 5 , Fig. 2 ). The three models showed no differences. Complications The most common complications happened in PCD group is pleural effusion 8.6% (n = 7). The patients in PCD had higher score in Sofa than in PNA (Table 1 ). The rate of sepsis happens more often in PCD (Table 1 ). To remove confounding factors, the analysis of covariance (ANCOVA) with a-priori covariates was used. The models predicted a significant treatment effect of PCD. (Table 6 ) Table 6 Complications of PNA and PCD PNA (n = 91) PCD (n = 81) P Complications 22 (24.18) 40 (49.38) < .001 Sepsis 19 (20.88) 33 (40.74) 0.005 Endophthalmitis 3 (3.30) 4 (4.94) 0.708 Pleural effusion 0 (0.00) 7 (8.64) 0.004 Deep venous thrombosis 0 (0.00) 1 (1.23) 0.471 Liver injury 4 (4.40) 5 (6.17) 0.736 Discussion Pyogenic liver abscess (PLA) is a common disease, whereby the liver produces a pocket of pus in response to a bacterial infection. PLA can originate from blood or liver infections or abdominal injury, and accounts for 80% of the incidence of liver abscess [ 1 ] . Associated with increased morbidity and mortality, PLA continue to present cause for concern, especially in tropical countries [ 3 ] . However, the treatment for PLA is still controversial. We try to identify the better choice for PLA. The results showed that PLAs were more common in men [ 18 ] , and men were likely to have a poor prognosis [ 19 ] , as consistent with previous findings. Increased PLA prevalence in men may be related to higher levels of the hormone testosterone level, which has been demonstrated to increase susceptibility to amebic liver abscess [ 20 ] . The SOFA score of the PCD group was significantly higher than that of the PNA group, may therefore be related to the higher proportion of males. The clinical presentation of the patients studied in our series was similar to the descriptions in previous reports [ 21 ] . 75.9% and 71.9% of the abscesses were located in the right lobe of liver separately in the PCD and PNA group, similar to previous studies, and 90.4% and 86.5% of our patients had solitary abscesses separately in the PCD and PNA group, similar to a previous report [ 8 ] . In our study, 8(9.7%) patients had multiple abscesses in the PCD group, while 13 (8.5%) patients had multiple abscesses in the PNA group. The most frequently isolated bacteria from pus culture were Escherichia coli. In PLA, Escherichia coli has been reported to be the organism most frequently grown in Western series [ 22 , 23 ] . However, in Asian countries, Klebsiella spp. is the most frequently isolated bacteria from liver abscess patients’ pus cultures [ 24 – 27 ] , which is consistent with our findings. The reasons for the prevalence of K. pneumonia infection in Asian people are unclear [ 28 ] . Patients usually present with a combination of fever, right-upper-quadrant abdominal pain, and hepatomegaly. The major advantages of PNA over PCD are: 1) it is less invasive and less expensive; 2) avoids problems related to catheter care; and 3) multiple abscess cavities can be aspirated easier in the same setting [ 29 , 30 ] . One study showed that there was no difference between PCD and PLA group in the treatment. There are some problems with catheter drainage like nuisance to the patient, pain, cellulites at the insertion site and sometimes catheter dislodgement. Previous studies compared the two methods for liver abscesses of different sizes, they recommended PNA for simple abscesses of 5 cm or smaller in size [ 32 ] . In our study, the size of liver abscess was similar between the two groups, and no significant difference was found in the incidence of sepsis, mortality and length of hospital stay between the two groups. However, the complications happened less in PLA than in PCD group. Conclusion This retrospective study suggests that PLA appears to be safer. Limitations Relevant missing information that could have influenced the outcome may have been excluded from the analysis and it was not feasible to obtain all the data because this was a retrospective study. PSM was used to minimize the bias in patient selection. Randomized controlled study (RCTS ) is ideal, but retrospective studies of propensity score matching can be performed if a sufficient number of RCTS have not been performed. Declarations All methods were carried out in accordance with relevant guidelines and regulations. Since this is the retrospective research, the ethics and need for informed consent was waived by Shanghai Sixth People's Hospital. All experimental protocols were approved by Shanghai Sixth People's Hospital. Funding This study was funded by Cardiovascular Multidisciplinary Integrated Research Fund（Z-2016-23-2101-47）, Submission declaration and verification: This manuscript has not been published previously, is not under consideration for publication elsewhere and this publication is approved by all authors and the responsible authorities where the work has been carried out. This manuscript will not be published elsewhere in the same form. Data availability statement The data that support the findings of this study are available on request from the corresponding author upon reasonable request. Conflict of interest The authors report no conflict of interest. Acknowledgment We would like to thank all the patients. Consent for Publication Not applicable Author contribution section Statement of authorship: All the authors have made substantial contributions to the conception, design of the work; or the acquisition, analysis, or interpretation of data for the work. They have participated in drafting the manuscript and approved the version to be published. CRediT author statement Yongxia Li: Data collection, data analysis, Writing – Original Draft, Visualization. Yujun Shi: Data collection, data analysis, Writing – Original Draft JiameiJiang and Xiaoguang Zhu: Data collection, data analysis, Writing – Original Draft Hairong Wang: Data collection, data analysis QimingFeng: paper design，Methodology, Data Curation，Writing – Review & Editing.. Qing Gao: Conceptualization, data analysis, Writing – Review & Editing. Conflict of Interest The authors declare that they have no conflict of interest. References Khim G, Em S, Mo S, Townell N. 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Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance. Radiology. 1995;195(1):122–4. doi: 10.1148/radiology.195.1.7892451 . Singh S, Chaudhary P, Saxena N, Khandelwal S, Poddar DD, Biswal UC. Treatment of liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Ann Gastroenterol. 2013;26(4):332–9. Singh O, Gupta S, Moses S, Jain DK. Comparative study of catheter drainage and needle aspiration in management of large liver abscesses. Indian J Gastroenterol. 2009;28(3):88–92. doi:10.1007/s12664-009-0032-1. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2014969","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":145034444,"identity":"e9ae98b6-32fb-4080-939c-fea7f5da7622","order_by":0,"name":"Yongxia Li","email":"","orcid":"","institution":"Shanghai Sixth People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yongxia","middleName":"","lastName":"Li","suffix":""},{"id":145034445,"identity":"7dbf70dc-c87f-4248-89f5-9efed471ff8b","order_by":1,"name":"Qin Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIie3QsWrDMBCA4TOC6yJqsl0guK8gCHjyw5wIaEqgo4dAPZR6qItfJWO3Ohg8KZ29RSZPkC1TifeUyN066Jvv504CCIJ/COP67FhSEj/Ug+N8608eqVkqt8iW88oK5WznTxLgdOYyo3f9GufDq5hwGDQGeN1GRbPpcl0gxOU7309E0Tm2rYiKb9PrzwWQPew8W/al0lWLY5P22iIo2viSFZL+aSUKSJ/1m5iSGCSWhiTKFKYlNP4ty0yNzYrYdtL7lqe6ioaLpJev42l/vuTbJC4/7ic35N/GgyAIgl9dARSjSgYyTQ2HAAAAAElFTkSuQmCC","orcid":"","institution":"Shanghai Tongji Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Qin","middleName":"","lastName":"Gao","suffix":""},{"id":145034447,"identity":"2da8bb4f-6e65-4c91-b366-3ba94187882a","order_by":2,"name":"Yujun Shi","email":"","orcid":"","institution":"South Campus, Shanghai Jiaotong University School of Medicine affiliated Renji Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yujun","middleName":"","lastName":"Shi","suffix":""},{"id":145034449,"identity":"6bf26cd0-277e-4fb6-b6b1-fbfb8dbdf5c2","order_by":3,"name":"Jiamei Jiang","email":"","orcid":"","institution":"Shanghai Sixth People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jiamei","middleName":"","lastName":"Jiang","suffix":""},{"id":145034451,"identity":"27d750ea-f4cd-4095-bab9-4c24df06705f","order_by":4,"name":"Xiaoguang Zhu","email":"","orcid":"","institution":"Shanghai Sixth People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoguang","middleName":"","lastName":"Zhu","suffix":""},{"id":145034452,"identity":"97f9fd8a-4694-412d-83fa-b2a662acd2c4","order_by":5,"name":"Hairong Wang","email":"","orcid":"","institution":"XinHua Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hairong","middleName":"","lastName":"Wang","suffix":""},{"id":145034453,"identity":"b22c4f8a-7b37-4ae8-979f-6c80ac42585b","order_by":6,"name":"Qiming Feng","email":"","orcid":"","institution":"Shanghai Sixth People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qiming","middleName":"","lastName":"Feng","suffix":""}],"badges":[],"createdAt":"2022-08-30 17:44:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2014969/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2014969/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":28054028,"identity":"fa5b9712-cc90-47a4-9ead-ee5ea9ae9645","added_by":"auto","created_at":"2022-10-20 17:57:29","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":271137,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2014969/v1/529eab0bb6fcf534214932fc.jpg"},{"id":28054029,"identity":"f77f3d80-a004-44a1-a1b3-47434d72082b","added_by":"auto","created_at":"2022-10-20 17:57:29","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":176962,"visible":true,"origin":"","legend":"\u003cp\u003eForest of model\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2014969/v1/9b1be9016db5f732d5ad5578.jpg"},{"id":32261782,"identity":"5c6918bb-89c4-4251-ae6e-572137e4eee2","added_by":"auto","created_at":"2023-01-31 10:29:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":562679,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2014969/v1/446c04fa-96f7-42ad-84c5-a19de102cfa7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical management of pyogenic liver abscess: A retrospective cross-sectional multi-center study","fulltext":[{"header":"Highlights","content":"\u003cp\u003e\u003cstrong\u003eWhat is already known:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; Image-guided percutaneous treatment PCD or PNA has replaced surgical intervention as the procedure of choice\u003c/p\u003e\n\u003cp\u003e\u0026bull; If performed carefully, both the procedures are safe with minimal complications\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat the new findings are:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePLA is a better modality as compared to PCD in terms of safety.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eA liver abscess is a suppurative cavity in the liver, resulting from the invasion and multiplication of microorganisms from a direct injury, through the blood vessels or via the biliary ductal system. Pyogenic liver abscesses (PLA), resulting from bacterial infection, account for 80% of all liver abscesses, which are also commonly amebic and mixed infections. Less commonly liver abscesses can be fungal in origin \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Liver abscesses continue to be an important cause of morbidity and mortality in tropical countries\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, where amebic infections are more common historically. The morbidity of PLA has remarkably increased in Asian regions, e.g. Taiwan, where the annual incidence has gradually increased from 10.83 to 15.45 cases per 100,000 population since 2000 to 2011, and the mortality is up to 2\u0026ndash;19%\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, advances in interventional radiology, intensive care, antibiotic therapy, sonography, and computerized tomography scanning have led to earlier diagnoses and treatment, and improved the patient outcomes. Percutaneous interventions have been important advancements in the treatment of pyogenic liver abscesses \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith a success rate of between 70\u0026ndash;100% overall, image-guided percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) have been increasingly used to treat liver abscesses \u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Treatment of 3\u0026ndash;6 cm PLA using a combination of PNA with antibiotics has safe, effective, and promising outcomes \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Comparatively, PCD appears to be a better modality for PLA that are partially liquefied or with thick pus\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e and for the management of larger abscesses (\u0026gt;\u0026thinsp;10 cm), in terms of attaining clinical relief and for the duration parenteral antibiotics are needed \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. While PCD is widely preferred to drain liver abscesses \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, PNA offers a potentially simpler, less costly, and equally effective mode of treatment. PNA of multiple pyogenic abscesses under sonographic guidance is a safe, effective, and low-cost procedure \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. The potential differential efficacy of PNA or PCD, however, remains to be established \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe aim of our retrospective study of PLA patients was to identify the comparative efficacy of both treatments.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eThis retrospective comparative study was conducted between April 2015 and April 2021, using the medical records of 172 adult patients with a diagnosis of Pyogenic Liver Abscess (PLA). PLA was defined as per the ICD-10 diagnosis code K75.0, and participant included patients who had been discharged from one of three comprehensive tertiary care teaching hospitals in East China. Participants were excluded if they were surgical patients, had incomplete information, presented with parasitic, fungal, or amebic liver abscess, were under 18 years old, had a subphrenic, subhepatic or gall bladder abscess or tumor, consistent with previous studies \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Of all the patients included in the study, n\u0026thinsp;=\u0026thinsp;91 underwent percutaneous needle aspiration (PNA) and n\u0026thinsp;=\u0026thinsp;81 had percutaneous catheter drainage (PCD).\u003c/p\u003e\n\u003cp\u003eThe diagnosis of diabetes and sepsis was referred to relevant literature \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. All patients were treated with antibiotics, combined with image-guided PCD or PNA. Antipyretics, liver-protecting drugs and nutritional support were also required, according to patients\u0026rsquo; clinical conditions. The third-generation cephalosporin or cephalomycin, combined with quinolones (levofloxacin or moxifloxacin), were used as the initial empiric antibiotics. Each patient was underwent a liver ultrasound every 2\u0026ndash;3 days, with PCD or PNA conducted according to abscess liquefaction, location and size. Liver abscess etiology was determined from pus culture results. For a small number of patients, if infection worsened, antibiotics were adjusted according to the drug sensitivity of the pathogen, or upgraded to fourth-generation cephalosporins or carbapenems if there was no etiological basis.\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committees of all three hospitals; Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine Affiliated with Renji Hospital South Campus and Xinhua Hospital. All data were obtained from electronic medical records and reported without personal identifiers.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eStudy Variables\u003c/h2\u003e\n\u003cp\u003eA suite of variables was extracted from participants\u0026rsquo; medical records to measure patient health status, abscess condition and treatment. These variables included clinical signs and symptoms, medical imaging, and culture and specimen analyses of blood or pus. Etiology was also determined per patient, including whether blood or pus culture was performed, whether culture is positive for bacteria, and which type of bacteria is positive. The characteristics of the abscesses: number (single or multiple), size (the long or short axis of the abscess, if multiple, the sum of the long or short axis of the abscess was taken as the size), location (left lobe of liver, right lobe of liver or both lobes). Information on clinical outcomes included the duration of hospital stay (days), duration of fever in hospital (days), and the occurrence of complications, such as sepsis, myocardial injury, pleural effusion, deep vein thrombosis, endophthalmitis, abscess spread, liver injury, and mortality.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eThe comparison between groups was performed using the independent samples T test or Wilcoxon rank sum test. The qualitative data were described using numbers and percentages. The comparison between groups was performed by chi-square test or Fisher\u0026rsquo;s exact test. The primary efficacy index was based on baseline as a covariate. T-test and Fisher's exact test were used to compare continuous variables (e.g., age) and categorical variables (e.g., gender and comorbidity) to test for differences between the PCD and PNA treatment groups. Multivariable logistic regression analysis was performed to explore the independent association of treatment on fever duration in hospital with independent variables. These were modeled using an analysis of covariance (ANCOVA) with a-priori covariates: age, sex, general health, clinical symptoms, and Sequential Organ Failure Assessment (SOFA) score was collated from medical records. A two-sided \u003cem\u003eP\u003c/em\u003e of less than 0.05 was considered statistically significant. The statistical analyses were performed using SPSS software, version 28.0.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003eDemographic and clinical characteristics\u003c/h2\u003e\n \u003cp\u003eOf the medical records obtained, 172 patients were eligible for inclusion in the study, and 81 were treated with PCD and 91 treated with PNA. The flowchart is Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. the proportion of male PLA patients treated with PCD (66%) was significantly higher (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than those treated with PNA (39%; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Patient age was approximately consistent between the treatment groups, at 64\u0026thinsp;\u0026plusmn;\u0026thinsp;13 and 64\u0026thinsp;\u0026plusmn;\u0026thinsp;14 for PCD and PNA, respectively. Similarly, basic disease presentation, including presence of diabetes, biliary tract, tumor and/or pneumonia, were consistent among treatment groups, as were the symptoms; fever, abdominal pain, anorexia and vomiting (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The SOFA score was significantly higher in patients treated with PCD compared to those treated with PNA (P\u0026thinsp;=\u0026thinsp;0.02). (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;172)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatistics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;27.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (58.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (39.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (79.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72 (41.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (60.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (20.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.53\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.64\u0026thinsp;\u0026plusmn;\u0026thinsp;13.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et=-0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.602\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (51.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (48.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (48.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (51.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (48.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (50.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (45.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (51.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (49.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (54.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiliary tract disease, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120 (69.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62 (68.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (71.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (30.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (31.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (28.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePosition, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127 (73.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (70.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63 (77.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (22.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (23.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (20.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (4.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (6.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e151 (87.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (85.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (90.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMore than one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (12.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (14.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (9.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esofa, M(Q\u003csub\u003e1\u003c/sub\u003e,Q\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.00, 2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00 (0.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00 (0.00, 3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;2.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBC, M(Q\u003csub\u003e1\u003c/sub\u003e,Q\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.77 (8.07, 13.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.47 (8.10, 13.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.41 (8.04, 14.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCRP, M(Q\u003csub\u003e1\u003c/sub\u003e,Q\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120.88 (81.27, 160.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120.60 (74.00, 160.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123.00 (84.84, 161.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT, M(Q\u003csub\u003e1\u003c/sub\u003e,Q\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.00 (21.50, 73.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.00 (21.00, 70.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.00 (23.00, 77.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST, M(Q\u003csub\u003e1\u003c/sub\u003e,Q\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.00 (21.00, 55.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.00 (20.00, 52.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.00 (21.00, 67.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScr, M(Q\u003csub\u003e1\u003c/sub\u003e,Q\u003csub\u003e3\u003c/sub\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.00 (48.00, 75.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.00 (44.60, 55.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.60 (65.00, 97.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;9.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eSD: standard deviation, M: Median, Q\u003csub\u003e1\u003c/sub\u003e:1st Quartile, Q\u003csub\u003e3\u003c/sub\u003e:3st Quartile\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEfficacy of both groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePNA (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePCD (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBetter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79 (86.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64 (79.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWoese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (13.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17 (20.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.76\u0026thinsp;\u0026plusmn;\u0026thinsp;12.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePercentage of samples cultured and with pathogens between PNA and PCD\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePNA(n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePCD(n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood culture, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28.1 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.5 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.5 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21.7 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.6 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.8 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.4 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.7 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePus culture, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.4 (81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.5 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.8 (68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.2 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.5 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.3(16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.1 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.1 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: * \u003cem\u003eP\u003c/em\u003e＜0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003ePCD, percutaneous catheter drainage; PNA, and needle aspiration\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate linear regression analyses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel3\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.75 (0.78\u0026ndash;3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.53\u0026ndash;3.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87 (0.32\u0026ndash;2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eRef: Reference, OR: Odds Ratio, CI: Confidence Interval\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eModel1:adjust: None\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eModel2:adjust: Gender, age\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eModel3:adjust: Gender, age, sofa, Scr\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab5\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSubgroup analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eModel3\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.46\u0026ndash;3.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.46\u0026ndash;3.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86 (0.28\u0026ndash;2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.798\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33 (0.23\u0026ndash;7.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.01 (0.17\u0026ndash;6.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83 (0.07\u0026ndash;10.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;65 (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.17 (0.65\u0026ndash;7.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.34 (0.35\u0026ndash;5.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70 (0.15\u0026ndash;3.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65 (n\u0026thinsp;=\u0026thinsp;86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44 (0.48\u0026ndash;4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.17 (0.37\u0026ndash;3.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.83 (0.23\u0026ndash;3.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eDiabetes\u0026thinsp;=\u0026thinsp;0 (n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81 (0.21\u0026ndash;3.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62 (0.15\u0026ndash;2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59 (0.12\u0026ndash;2.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eDiabetes\u0026thinsp;=\u0026thinsp;1 (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.73 (0.93-8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.88 (0.59\u0026ndash;6.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29 (0.34\u0026ndash;4.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eBiliary tract disease =否 (n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.26 (1.17\u0026ndash;9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.32 (0.79\u0026ndash;6.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.51 (0.46\u0026ndash;4.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eBiliary tract disease =是 (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37 (0.07\u0026ndash;2.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25 (0.04\u0026ndash;1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81 (0.07\u0026ndash;10.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003ePosition\u0026thinsp;=\u0026thinsp;1 (n\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27 (0.51\u0026ndash;3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90 (0.33\u0026ndash;2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.50 (0.15\u0026ndash;1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003ePosition\u0026thinsp;=\u0026thinsp;2 (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.33 (0.87\u0026ndash;80.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.21 (0.39\u0026ndash;45.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.89 (0.28\u0026ndash;54.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eNumber (Single) (n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.90 (0.74\u0026ndash;4.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.19 (0.42\u0026ndash;3.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 (0.23\u0026ndash;2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eNumber (Multiple) (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25 (0.36\u0026ndash;13.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.13 (0.25\u0026ndash;18.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.81 (0.14\u0026ndash;58.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAge subgroup：\u003cp\u003eModel1: adjust: None. Model2: adjust: gender. Model3:adjust: gender, \u0026nbsp;sofa, Scr\u003c/p\u003e\n \u003cp\u003eGender subgroup：\u003c/p\u003e\n \u003cp\u003eModel1: adjust: None. Model2: adjust: age. Model3:adjust: age, \u0026nbsp;sofa, Scr\u003c/p\u003e\n \u003cp\u003eOthers subgroup：\u003c/p\u003e\n \u003cp\u003eModel1: adjust:\u0026nbsp;None. Model2: adjust:\u0026nbsp;gender, age. Model3: adjust:\u0026nbsp;gender, age,\u0026nbsp;sofa,\u0026nbsp;Scr\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eDisease complications and outcomes\u003c/h2\u003e\n \u003cp\u003eRegrading comorbidities, no patients in the PNA group presented with pleural effusion, though a total of 7 with PCD did (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027). The duration of hospital stay, mortality rate, incidence of sepsis and complications were not significantly different between the two treatment methods (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003eMicrobiological characteristics\u003c/h2\u003e\n \u003cp\u003eBlood was cultured from 56 patients (67.5%) in the PCD group and 27 patients (28.1%) in the PNA group, with microorganisms isolated from 18 (21.7%) and 12 (12.5%) samples of the respective groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). In the PCD group, 61 (73.5%) patients had pus cultured and 81 (84.4%) patients from the PNA group. Microorganisms were isolated in the samples of 45 (54.2%) patients in the PCD group via pus culture, whereas they were isolated in the samples of 68(70.8%) patients in the PNA group (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The bacteria isolated from the blood and pus cultures were predominantly gram-negative, with \u003cem\u003eKlebsiella\u003c/em\u003e pneumonia the most common species in both groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec10\"\u003e\n \u003ch2\u003eAbscess characteristics\u003c/h2\u003e\n \u003cp\u003eOf 81 PCD-treated participants, 77.8% (n\u0026thinsp;=\u0026thinsp;63) had PLA in the right lobe, as compared to 85.7% (n\u0026thinsp;=\u0026thinsp;78 of n\u0026thinsp;=\u0026thinsp;92) of PNA-treated participants. Single abscess was common in both groups, accounting for 90.1% and 85.7% in PCD and PNA-treated participants, respectively. The size of abscess was also approximately consistent between treatment groups, with no significant statistical difference (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eWe further conducted multivariate linear regression analyses with adjustments for age, gender, sofa score and Scr. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e,,\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The three models showed no differences.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec11\"\u003e\n \u003ch2\u003eComplications\u003c/h2\u003e\n \u003cp\u003eThe most common complications happened in PCD group is pleural effusion 8.6% (n\u0026thinsp;=\u0026thinsp;7). The patients in PCD had higher score in Sofa than in PNA (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The rate of sepsis happens more often in PCD (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). To remove confounding factors, the analysis of covariance (ANCOVA) with a-priori covariates was used. The models predicted a significant treatment effect of PCD. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab6\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComplications of PNA and PCD\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePNA (n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePCD (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22 (24.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40 (49.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (20.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33 (40.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndophthalmitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (3.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (4.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePleural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (8.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeep venous thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiver injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (4.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (6.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePyogenic liver abscess (PLA) is a common disease, whereby the liver produces a pocket of pus in response to a bacterial infection. PLA can originate from blood or liver infections or abdominal injury, and accounts for 80% of the incidence of liver abscess \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Associated with increased morbidity and mortality, PLA continue to present cause for concern, especially in tropical countries \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. However, the treatment for PLA is still controversial. We try to identify the better choice for PLA.\u003c/p\u003e \u003cp\u003eThe results showed that PLAs were more common in men \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, and men were likely to have a poor prognosis \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, as consistent with previous findings. Increased PLA prevalence in men may be related to higher levels of the hormone testosterone level, which has been demonstrated to increase susceptibility to amebic liver abscess \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. The SOFA score of the PCD group was significantly higher than that of the PNA group, may therefore be related to the higher proportion of males.\u003c/p\u003e \u003cp\u003eThe clinical presentation of the patients studied in our series was similar to the descriptions in previous reports \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. 75.9% and 71.9% of the abscesses were located in the right lobe of liver separately in the PCD and PNA group, similar to previous studies, and 90.4% and 86.5% of our patients had solitary abscesses separately in the PCD and PNA group, similar to a previous report \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. In our study, 8(9.7%) patients had multiple abscesses in the PCD group, while 13 (8.5%) patients had multiple abscesses in the PNA group.\u003c/p\u003e \u003cp\u003eThe most frequently isolated bacteria from pus culture were Escherichia coli. In PLA, Escherichia coli has been reported to be the organism most frequently grown in Western series \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. However, in Asian countries, Klebsiella spp. is the most frequently isolated bacteria from liver abscess patients\u0026rsquo; pus cultures \u003csup\u003e[\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, which is consistent with our findings. The reasons for the prevalence of K. pneumonia infection in Asian people are unclear \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePatients usually present with a combination of fever, right-upper-quadrant abdominal pain, and hepatomegaly. The major advantages of PNA over PCD are: 1) it is less invasive and less expensive; 2) avoids problems related to catheter care; and 3) multiple abscess cavities can be aspirated easier in the same setting \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. One study showed that there was no difference between PCD and PLA group in the treatment. There are some problems with catheter drainage like nuisance to the patient, pain, cellulites at the insertion site and sometimes catheter dislodgement.\u003c/p\u003e \u003cp\u003ePrevious studies compared the two methods for liver abscesses of different sizes, they recommended PNA for simple abscesses of 5 cm or smaller in size \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. In our study, the size of liver abscess was similar between the two groups, and no significant difference was found in the incidence of sepsis, mortality and length of hospital stay between the two groups. However, the complications happened less in PLA than in PCD group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis retrospective study suggests that PLA appears to be safer.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eRelevant missing information that could have influenced the outcome may have been excluded from the analysis and it was not feasible to obtain all the data because this was a retrospective study. PSM was used to minimize the bias in patient selection. Randomized controlled study (RCTS ) is ideal, but retrospective studies of propensity score matching can be performed if a sufficient number of RCTS have not been performed.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003eSince this is the retrospective research, the ethics and need for informed consent was waived by Shanghai Sixth People\u0026apos;s Hospital. All experimental protocols were approved by Shanghai Sixth People\u0026apos;s Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Cardiovascular Multidisciplinary Integrated Research Fund（Z-2016-23-2101-47）,\u003c/p\u003e\n\u003cp\u003eSubmission declaration and verification: This manuscript has not been published previously, is not under consideration for publication elsewhere and this publication is approved by all authors and the responsible authorities where the work has been carried out. This manuscript will not be published elsewhere in the same form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution section\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatement of authorship: All the authors have made substantial contributions to the conception, design of the work; or the acquisition, analysis, or interpretation of data for the work. They have participated in drafting the manuscript and approved the version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT author statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYongxia Li: Data collection, data analysis, Writing \u0026ndash; Original Draft, Visualization.\u003c/p\u003e\n\u003cp\u003eYujun Shi: Data collection, data analysis, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eJiameiJiang and Xiaoguang Zhu: Data collection, data analysis, Writing \u0026ndash; Original Draft\u003c/p\u003e\n\u003cp\u003eHairong Wang: Data collection, data analysis\u003c/p\u003e\n\u003cp\u003eQimingFeng: paper design，Methodology, Data Curation，Writing \u0026ndash; Review \u0026amp; Editing..\u003c/p\u003e\n\u003cp\u003eQing Gao: Conceptualization, data analysis, Writing \u0026ndash; Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eKhim G, Em S, Mo S, Townell N. 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Indian J Gastroenterol. 2009;28(3):88\u0026ndash;92. \u003cspan\u003edoi:10.1007/s12664-009-0032-1.\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pyogenic liver abscess, percutaneous needle aspiration (PNA), percutaneous catheter drainage (PCD)","lastPublishedDoi":"10.21203/rs.3.rs-2014969/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2014969/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePyogenic liver abscess(PLA)is a potentially life-threatening disease associated with elevated risk of morbidity and mortality. Ultrasound or CT-guided percutaneous catheter drainage (PCD) and needle aspiration (PNA) are important surgical methods for the treatment of PLA. While their comparative efficacy is still debated, the aim of the study was to compare PCD and PNA in the treatment of liver abscesses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTaking a retrospective comparative approach, 172 patients with liver abscesses from Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine Affiliated with Renji Hospital South Campus and Xinhua Hospital were studied between April 2015 and April 2021. These were modeled using an analysis of covariance (ANCOVA) with a-priori covariates: age, sex, general health, clinical symptoms, and Sequential Organ Failure Assessment (SOFA) score was collated from medical records.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eLiver abscess was more common in middle-aged men, occurring more frequently in the right hepatic lobe. Single abscess was common in both groups. The rate of blood culture that was positive for bacteria was higher in PCD-treated patients than those treated with PNA, with \u003cem\u003eKlebsiella pneumonia\u003c/em\u003e the most common bacteria species identified in both groups. The side effect in PCD is worse than in PLA.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatients with liver abscess use were more seriously ill, but their mortality or fever time did not significantly increase, suggesting that PLA is beneficial for severe patients for its safety.\u003c/p\u003e","manuscriptTitle":"Surgical management of pyogenic liver abscess: A retrospective cross-sectional multi-center study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-20 17:57:27","doi":"10.21203/rs.3.rs-2014969/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af2e9594-03ab-4342-ad22-7a7ff9f52f8d","owner":[],"postedDate":"October 20th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-01-31T10:29:22+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-20 17:57:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2014969","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2014969","identity":"rs-2014969","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}