Abstract：
Peritoneal dialysis (PD)-related infection rates have improved, but serious complications such as liver abscesses remain an issue, posing unique management challenges including safety of continuing PD versus early PD catheter removal. Current literature describing this is unfortunately limited. This study aims to describe the characteristics, management and outcomes of liver abscesses in PD patients from a retrospective review of prevalent PD patients on follow-up at Tan Tock Seng Hospital between 1st January 2016 and 30th June 2021. A total of 11/383 PD patients (2.9%) were treated for liver abscesses. Most were diabetic (n =10, 90.9%), with a median PD vintage of 541 days (interquartile range: 310-931 days). Fever (n = 7, 63.6%), bacteraemia (n = 7, 63.6%) and concomitant PD peritonitis (n = 7, 63.6%) were the most common presenting symptoms. Majority of patients underwent radiological aspiration of abscess in addition to antibiotics (n = 7, 63.6%). PD catheter was removed in eight patients (72.7%), with the most common indications being empirical removal due to intra-abdominal abscess (n = 5, 62.5%) followed by septic shock (n = 2, 25%) and refractory PD peritonitis (n = 1, 12.5%). Only three patients (37.5%) remained on PD, as they did not develop PD peritonitis during their course of treatment. The overall mortality remains high with three patients (27.3%) passing away within 6 months of presentation. Liver abscesses in PD patients is associated with poor technique and overall survival. Absence of PD peritonitis appears to be a good prognostic factor, but larger studies are required to guide the optimal management of liver abscesses in PD patients.
摘要：
腹膜透析（PD）相关感染率有所改善，但是严重的并发症如肝脓肿仍然是一个问题，带来了独特的管理挑战，包括持续PD与早期PD导管拔除的安全性。不幸的是，目前描述这一点的文献有限。本研究旨在描述其特点，对2016年1月1日至2021年6月30日在TanTockSeng医院随访的PD患者进行回顾性分析,了解PD患者肝脓肿的管理和结局.共有11/383例PD患者（2.9％）接受肝脓肿治疗。大多数是糖尿病患者（n=10，90.9%），PD年份中位数为541天（四分位数范围：310-931天）。发烧（n=7，63.6%），菌血症（n=7，63.6％）和并发PD腹膜炎（n=7，63.6％）是最常见的症状。除抗生素外，大多数患者还接受了脓肿的放射学抽吸（n=7，63.6％）。8例(72.7%)患者拔除PD导管,最常见的适应症是由于腹内脓肿（n=5，62.5%）所致的经验性切除，其次是感染性休克（n=2，25%）和难治性PD腹膜炎（n=1，12.5%）。只有三名患者（37.5％）仍在PD中，因为他们在治疗过程中没有发生PD腹膜炎。总死亡率仍然很高，有3名患者（27.3%）在6个月内死亡。PD患者的肝脓肿与技术差和总体生存率相关。缺乏PD腹膜炎似乎是一个很好的预后因素，但需要更大规模的研究来指导PD患者肝脓肿的最佳治疗。
