Dr. Katsnelson
Clinical question: Is there an association between pyogenic liver abscess (PLA) and subsequent incidence of diagnosed colorectal cancer (CRC) and if so, should early screening for colorectal cancer be recommended for all patients after a diagnosis of PLA?
Background: It is postulated that CRC can compromise the mucosal barrier and allow for bacterial invasion into the portal system; therefore, certain infectious diseases, such as streptococcal or anaerobic bacteremia and pyogenic liver abscess may have an association with the incidence of CRC. Data from Southeast Asia suggests that patients with PLA have higher rates of asymptomatic CRC (seven-fold higher compared with patients without PLA). Despite this, no professional guidelines exist to recommend CRC screening for all patients diagnosed with PLA.
Study design: A patient-level, matched, retrospective, cohort study
Setting: 127 Veterans Affairs (VA) hospitals
Synopsis: 8,286 patients with PLA and 23,201 patient-level matched controls were compared from 127 VA hospitals between 2003 and 2020. PLA was classified as either cryptogenic or secondary when the patient had known risk factors or diagnosis code of cholangitis or cholecystitis within 30 days of PLA diagnosis. Most patients were male (96.5%) and white (68%). Over a 10-year follow-up period, the primary outcome assessed was CRC diagnosis. After analysis, a statistically significantly higher proportion of all patients with cryptogenic PLA were diagnosed with CRC compared to controls (1.9% versus 0.8%, P <0.001) within three years of incidence of PLA (HR, 2.51; 95% CI, 1.93 to 3.26 at one year; and HR, 1.41; 95% CI, 1.05 to 1.89 at three years). Limitations of this study included the inability to control for risk factors including smoking or CRC family history, along with limitations on extrapolation of the data given the VA population of the study.
Bottom line: It may be beneficial for patients with cryptogenic PLA to be screened for colorectal cancer within three years of incidence of PLA, especially in patients who have not been screened previously according to guidelines.
Citation: Suzuki H, Kidder I, et al. Incidence of colorectal cancer in patients diagnosed with pyogenic liver abscess. JAMA Netw Open. 2023;6(12):e2348218. doi:10.1001/jamanetworkopen.2023.48218
Dr. Marcella Katsnelson is an academic hospitalist in the division of hospital medicine, and health sciences assistant professor of medicine at the University of California, San Diego