Evaluation of APACHE II score as predictor of outcome in patients with ruptured liver abscess: prospective study in a tertiary care hospital

Ruptured liver abscess is a critical condition with high morbidity and mortality, especially in patients with systemic comorbidities. This 18-month observational cohort study at Safdarjung Hospital, New Delhi, evaluated the prognostic value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting outcomes for patients with radiologically confirmed ruptured liver abscesses. A total of 69 patients (88.4% male, mean age 44 years) were included. The most common presenting symptoms were abdominal pain (100%) and fever (76.8%). Treatment modalities included percutaneous catheter drainage (PCD) in 46.4% of patients, open surgical drainage in 34.8%, and conservative management in the remainder. Patients undergoing surgical drainage had significantly higher APACHE II scores (mean 9 ± 4) than those treated with PCD (mean 7 ± 3; p = 0.041). The overall mortality rate was 21%, with mortality significantly higher in the surgical group (45.8%) compared to the PCD group (3.1%; p = 0.000). An APACHE II score > 9 was strongly associated with increased mortality and the need for surgery (p = 0.010). Colonic involvement was seen in 41.6% of surgical cases, with 10 cases presenting with colonic perforation. Higher APACHE II scores correlated with longer hospital stays and more severe complications. The study concludes that the APACHE II score is an effective prognostic tool for assessing disease severity and guiding treatment in ruptured liver abscess cases. PCD is favoured for stable patients, while surgical intervention is necessary for those with high APACHE II scores, failed drainage, or colonic involvement, emphasizing the importance of early risk stratification. This study has its limitations of being single centric with a sample size of 69 patients.