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OJHAS: Vol. 5, Issue
3: (2006 Jul-Sep) |
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A note on the prothrombin time
abnormality in the patients with amebic liver abscess |
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Viroj Wiwaniikit
Department of Laboratory
Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok Thailand
Nattakarn
Suwansaksri
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok Thailand
Jamsai Suwansaksri
Department of Clinical Chemistry, Faculty of Allied Health Sciences,
Chulalongkorn University Bangkok Thailand |
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Address For Correspondence |
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Viroj Wiwaniikit
Department of Laboratory
Medicine,
Faculty of Medicine, Chulalongkorn University,
Bangkok Thailand.
E-mail:
wviroj@yahoo.com |
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Wiwaniikit V, Suwansaksri N, Suwansaksri J. A note on the prothrombin time
abnormality in the patients with amebic liver abscess.
Online J Health Allied Scs. 2006;3:6 |
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Submitted: Aug 24,
2006; Revised: Oct 18,
2006; Accepted: Oct 22, 2006; Published: Dec 7, 2006 |
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| Abstract: |
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Amebic liver abscess is reported worldwide and can present with a
a wide spectrum of clinical manifetations. Similar to the other liver diseases, the
prothrombin time abnormality can be seen in the patients with amebic
liver abscess. We retrospectively studied the prothrombin times
among 30 Thai hospitalized patients with amebic liver abscesses and did not find any correlation
between the prothrombin time and any other studied manifestation
Key Words:
Amebic liver abscess, Prothrombin time |
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Amebic
liver abscess is caused by the same organism, Entamoeba histolytica,
that causes intestinal amebiasis. The organism is carried through the
blood to the liver where abscess is formed. Patients may or may not
have symptoms of intestinal infection concurrently with liver abscess.1 The infection is present worldwide, but is most common in
tropical areas where crowded living conditions and poor sanitation exist.
Africa, Latin America, Southeast Asia, and India have significant health
problems associated with this disease.
Amebic abscess
can demonstrate a wide spectrum of clinical presentations from no complaints to
fatal disease.(2,3) Laboratory abnormalities, which can be seen on
admission, include leukocytosis, hypoalbuminemia, prolonged
prothrombin time, abnormal serum transaminase level and elevation of
serum ALP and hyperbilirubinemia.4,5
Pinilla et al noted that
an elevation in prothrombin time of less than 1.5 seconds had enough
discriminatory capacity for the diagnosis of amoebic liver abscess.6
We retrospectively studied the prothrombin test among 30 Thai hospitalized
patients with amebic liver abscesses to correlate the prothrombin
time and the other characteristics of the patients.
The
main aim of this work was to study the results of prothrombin test among
the hospitalized patients with amebic liver abscesses. The correlation
between the prothrombin time and the other characteristics of the patients
was also assessed. The medical records of 30 in-patients at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, who had been diagnosed
as cases of amebic liver abscess, between January 1992
and December 2001, were retrospectively reviewed.
The
inclusion criteria were 1) the cases with amebic liver abscess and 2)
the cases with complete medical records for further analysis. In each
case, the abscess was diagnosed on the basis of the abscess cavity’s
appearance on liver ultrasound and/or CT scans, and the recovery of pus from
the cavity during needle aspiration. The diagnosis of amebic liver abscess
was confirmed by a) the identification of E. histolytica
by microscopic examination of the pus or b) positive serological titer
(1:256) or greater by E. histolytica indirect hemagglutination
(IHA) test.(12) The exclusion criteria were 1) the cases with liver
cirrhosis 2) pediatric patients (age <15 years) and 3) the cases
with anti HIV seropositive, since these cases are known to have
incomplete biological response and reported to be at risk for aberrant
clinical and laboratory presentations.7
The
data of the prothromibin time result of all cases were extracted from
the records. Each
prothrombin time test was requested for a subjective assessment of liver
function in the patient. The mentioned prothrombin
time in this study was performed by an automated hematology analyzer Fibrintimer A, Dade Behring. All tests were carried out at room temperature.
All tests were performed in the same laboratory of King Chulalongkorn
Memorial Hospital. All investigations were investigated under the standard
quality management process.
Additional collated data from the records included the sex and age of
each patient and the symptoms and signs. The results from other related
laboratory investigations were reviewed as well. All recorded data were
collected and analyzed using descriptive statistics. The multiple logistic
regression analysis was used for determining the correlation between
the prothrombin time and the patients’ characteristics. Statistical
significance level was accepted at P-value equaled to 0.05. All the
statistical analyses in this study were performed by SPSS 7.0 for Windows
Program.
Thirty
patients with amebic liver abscess were included in this study. At
presentation, these 30 cases — 18 men (60 %) and 12 women (40 %)—
had a mean (SD) age of 48.46 (18.92) (range = 15-88 years).
Average duration of illness was 7.48+0.98 days. On
admission, the average prothrombin time was 17.42+4.82 seconds.
Concerning the multiple logistic regression analysis, there was no significant
correlation between the prothrombin time and the other characteristics
of the patients (P> 0.05; Table 1).
Table 1:
Correlation between prothrombin time and the other characteristics of the
patients
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Patients’
characteristics |
Correlation coefficient
( r ) |
p value |
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Age |
0.58 |
0.29 |
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Sex |
0.42 |
0.38 |
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Duration of present illness |
0.62 |
0.51 |
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Duration of admission |
0.46 |
0.20 |
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White blood count |
0.78 |
0.16 |
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Serum albumin |
0.72 |
0.14 |
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Serum aspartate transaminase (AST) |
0.45 |
0.21 |
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Serum alanine transaminase (ALT) |
0.48 |
0.24 |
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Serum alkaline phosphatase (ALP) |
0.29 |
0.28 |
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Serum bilirubin |
0.68 |
0.16 |
The prothrombin time abnormality can be seen in the patients with amebic
liver abscess, similar to the other liver diseases. Prolonged prothrombin time
was observed among our
patients of amebic liver abscess also, however, most of our patients did not
have a severe abnormality
(less than three times normal). Munoz et al8 reported some correlation of the prothrombin time to
the clinical aspects of the patients with amebic liver abscess in that
the finding of prolonged prothrombin time was strongly related to the
prolonged hospitalization and complications in the patients. Similar
findings were reported by Pimpakar and Abraham9
as well. However, we did not find any correlation between the prothrombin
time to any other studied characteristic of the patients.
Prolonged prothrombin time is an
important laboratory presentation among the patients with amebic liver
abscesses, but there may not be any correlation
with other manifestations of the illness.
- Hughe MA, Petri WA Jr. Amebic
liver abscess. Infect Dis Clin North Am
2000;14:565-82
- Hoffner RJ, Kilaghbian T, Esekogwu
VI, Henderson SO. Common presentations of amebic liver abscess. Ann
Emerg Med 1999;34:351-5
- Nunes A, Varela MG, Carvalho
L, Ranchhod R, Saavedra JA. Hepatic amebiasis. Acta Med Port
2000;13:337-43
- Gupta RK. Amebic liver abscess:
a report of 100 cases. Int Surg 1984;69:261-4
- Nigam P, Gupta RK, Kapoor KK,
Sharan GR, Goyal BM, Joshi LD.Cholestasis in amoebic liver abscess.
Gut 1985;26:140-5
- Pinilla AE, Lopez MC, Castillo B, Murcia
MI, Nicholls RS, Duque S, Orozco LC.
A diagnostic approach to hepatic abscess. Rev Med Chil 2003;131:1411-20.
- Branum GD, Tyson GS, Branum
MA, Meyers WC. Hepatic abscess: changes in etiology, diagnosis, and
management. Ann Surg 1990;212:655–62
- Munoz LE, Botello MA, Carrillo
O, Martinez AM. Early detection of complications in amebic liver abscess.
Arch Med Res 1992;23:251-3
- Pimpakar BD, Abraham P. Liver
scan in hepatic amebiasis: correlation with clinical and biochemical
studies. Mt Sinai J Med 1983;50:408-16
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