# Risk factors for invasive Klebsiella pneumoniae liver abscess syndrome: a meta-analysis

## TL;DR

This study identifies multiple risk factors for a severe liver infection caused by Klebsiella pneumoniae, helping to improve prevention and early detection.

## Contribution

The study provides a comprehensive meta-analysis identifying new and significant risk factors for invasive Klebsiella pneumoniae liver abscess syndrome.

## Key findings

- Smoking, alcohol consumption, and diabetes are significantly linked to increased IKPLAS risk.
- Hepatic abscess in the left lobe and phlebitis are strongly associated with IKPLAS.
- The K1 serotype and hypervirulent phenotype of Klebsiella pneumoniae are significant risk factors.

## Abstract

Invasive Klebsiella pneumoniae liver abscess syndrome (IKPLAS) is a life-endangering condition. This meta-analysis sought to identify factors that could potentially serve as risk factors for IKPLAS.

Eight databases were retrieved. The Newcastle-Ottawa Scale and AHRQ criteria were utilized to assess the studies for quality. Stata software was used for pooling the effect size odds ratio (OR) and for subgroup analysis, sensitivity analysis, and regression analysis. Publication bias was examined leveraging funnel plots and Egger’s test.

A total of 18 studies (cross-sectional, cohort, case-control studies) were included, with 3,133 patients. The meta-analysis revealed that the following factors were linked to a significantly elevated risk of IKPLAS: history of smoking or alcohol consumption (OR = 1.61, 95% CI: 1.05, 2.45, p = 0.028), diabetes (OR = 1.93, 95% CI: 1.49, 2.51, p<0.001), liver disease (OR = 1.66, 95% CI: 1.01, 2.73, p = 0.044), elevated sequential organ failure assessment (SOFA) score (OR = 1.71, 95% CI: 1.27, 2.30, p<0.001), septic shock (OR = 3.30, 95% CI: 1.70, 6.37,p<0.001), hepatic abscess in the left lobe (OR = 1.51, 95% CI: 1.02, 2.24, p = 0.039), phlebitis (OR = 21.01, 95% CI: 10.24, 43.11, p<0.001), procalcitonin (PCT) (OR = 1.01, 95% CI: 1.01, 1.02, p<0.001), fasting blood glucose (FBG) (OR = 1.21, 95% CI: 1.11, 1.32, p<0.001), prothrombin time (PT) (OR = 1.15, 95% CI: 1.01, 1.30, p = 0.032), total bilirubin (OR = 1.02, 95% CI: 1.01, 1.02, p<0.001), hypervirulent phenotype (OR = 2.17, 95% CI: 1.15, 4.10, p = 0.017), K1 serotype (OR = 4.79, 95% CI: 1.79, 12.76, p = 0.002). No other risk factors were found.

This study identified multiple risk factors significantly associated with IKPLAS, providing evidence for risk assessment and prevention strategies.