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      Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance

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          Abstract

          Background

          Pyogenic liver abscesses (PLAs) represent potentially life‐threatening abdominal conditions that require immediate diagnosis and therapy. European and American incidence figures vary between one and 15 per 100,000 per year. Structured epidemiological data for European countries are not available.

          Objective

          To systematically characterize the epidemiology and clinical outcome of PLA in Germany.

          Methods

          In representative statutory health insurance data from four million people in 2013–2019, the prevalence and incidence with clinical coding of International Statistical Classification of Diseases and Related Health Problems (ICD)‐10 code K75.0 were selected ( n = 1118). Furthermore, demographics, relevant comorbidities, hospitalizations, mortality and complications were determined within one year.

          Results

          The incidence of PLA was approximately seven per 100,000. The average age at diagnosis was 66 years; 65% were male. Of these, biliary disease was documented in over 60% and infectious intestinal diseases were found in 21% within the same or previous calendar year. PLA patients had high comorbidity indices. Liver transplant status, malignancies of the liver and biliary system, liver cirrhosis and pancreatitis were strongly associated. Intensive care was documented in 27% of PLA cases. Nine percent died within 12 months, most with an underlying malignant disease.

          Conclusion

          Pyogenic liver abscess is a rare disease with high morbidity. Predisposing and risk factors include intestinal and biliary diseases as well as hepatic malignancies. Further research should focus on PLA therapy within prospective surveys and controlled clinical trials.

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          Most cited references27

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          Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.

          Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms. ICD-10 coding algorithms were developed by "translation" of the ICD-9-CM codes constituting Deyo's (for Charlson comorbidities) and Elixhauser's coding algorithms and by physicians' assessment of the face-validity of selected ICD-10 codes. The process of carefully developing ICD-10 algorithms also produced modified and enhanced ICD-9-CM coding algorithms for the Charlson and Elixhauser comorbidities. We then used data on in-patients aged 18 years and older in ICD-9-CM and ICD-10 administrative hospital discharge data from a Canadian health region to assess the comorbidity frequencies and mortality prediction achieved by the original ICD-9-CM algorithms, the enhanced ICD-9-CM algorithms, and the new ICD-10 coding algorithms. Among 56,585 patients in the ICD-9-CM data and 58,805 patients in the ICD-10 data, frequencies of the 17 Charlson comorbidities and the 30 Elixhauser comorbidities remained generally similar across algorithms. The new ICD-10 and enhanced ICD-9-CM coding algorithms either matched or outperformed the original Deyo and Elixhauser ICD-9-CM coding algorithms in predicting in-hospital mortality. The C-statistic was 0.842 for Deyo's ICD-9-CM coding algorithm, 0.860 for the ICD-10 coding algorithm, and 0.859 for the enhanced ICD-9-CM coding algorithm, 0.868 for the original Elixhauser ICD-9-CM coding algorithm, 0.870 for the ICD-10 coding algorithm and 0.878 for the enhanced ICD-9-CM coding algorithm. These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms.
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            A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.

            The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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              Klebsiella pneumoniae liver abscess: a new invasive syndrome.

              Klebsiella pneumoniae is a well known human nosocomial pathogen. Most community-acquired K pneumoniae infections cause pneumonia or urinary tract infections. During the past two decades, however, a distinct invasive syndrome that causes liver abscesses has been increasingly reported in Asia, and this syndrome is emerging as a global disease. In this Review, we summarise the clinical presentation and management as well the microbiological aspects of this invasive disease. Diabetes mellitus and two specific capsular types in the bacterium predispose a patient to the development of liver abscesses and the following metastatic complications: bacteraemia, meningitis, endophthalmitis, and necrotising fasciitis. For patients with this invasive syndrome, appropriate antimicrobial treatment combined with percutaneous drainage of liver abscesses increases their chances of survival. Rapid detection of the hypervirulent strain that causes this syndrome allows earlier diagnosis and treatment, thus minimising the occurrence of sequelae and improving clinical outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                thomas.karlas@medizin.uni-leipzig.de
                Journal
                United European Gastroenterol J
                United European Gastroenterol J
                10.1002/(ISSN)2050-6414
                UEG2
                United European Gastroenterology Journal
                John Wiley and Sons Inc. (Hoboken )
                2050-6406
                2050-6414
                30 July 2021
                November 2021
                : 9
                : 9 ( doiID: 10.1002/ueg2.v9.9 )
                : 1039-1047
                Affiliations
                [ 1 ] Division of Infectious Diseases and Tropical Medicine Department of Medicine II Leipzig University Medical Center Leipzig Germany
                [ 2 ] Interdisciplinary Center for Infectious Diseases (ZINF) Leipzig University Medical Center Leipzig Germany
                [ 3 ] Division of Gastroenterology Department of Medicine II Leipzig University Medical Center Leipzig Germany
                Author notes
                [*] [* ] Correspondence

                Thomas Karlas, Division of Gastroenterology, Department of Medicine II Leipzig University Medical Center, Liebigstraße 20, D‐04103 Leipzig, Germany.

                Email: thomas.karlas@ 123456medizin.uni-leipzig.de

                Author information
                https://orcid.org/0000-0001-6942-5785
                https://orcid.org/0000-0002-8109-8526
                Article
                UEG212132
                10.1002/ueg2.12132
                8598960
                34329537
                8ddd66d1-75d3-4335-b4f4-aaf0064f9654
                © 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 05 May 2021
                : 27 June 2021
                Page count
                Figures: 4, Tables: 2, Pages: 9, Words: 4894
                Funding
                Funded by: Open Access funding enabled and organized by Projekt DEAL
                Categories
                Original Article
                Hepatobiliary
                Custom metadata
                2.0
                November 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.9 mode:remove_FC converted:17.11.2021

                clinical coding,comorbidity,electronic health records,epidemiology,germany,incidence,liver abscess,mortality rate,prevalence,pyogenic,risk factors

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