{
  "abstract": "Background Pyogenic liver abscess (PLA) and colorectal cancer (CRC) have been increasingly recognized for their potential interrelationship. Studies from Southeast Asia have indicated this association, suggesting that CRC may be an underlying cause of cryptogenic PLA. This association is hypothesized to stem from the translocation of intestinal bacteria through compromised mucosal barriers caused by colorectal neoplasms.Methods Cross-sectional study from January 2013 to January 2024 within Sanford Health System. A total of 1,083 patients were diagnosed with liver abscesses, out of which 83 patients developed CRC. Data were collected on patient demographics, timing of CRC and PLA diagnoses, and microbiological findings from abscess cultures. Patients with biliary, gallbladder and post-surgical causes leading to liver abscess were excluded.Results The incidence rate of CRC in patients with PLA was significantly higher compared to the general population (p < 0.001). Timing of CRC diagnosis relative to PLA revealed that 15 patients (18.07%) were diagnosed with CRC within 6 months prior to PLA, 4 patients (4.82%) within 3 years of PLA diagnosis, 16 patients (19.28%) developed PLA after CRC diagnosis, and 8 patients (9.64%) developed PLA within 1 year post-CRC diagnosis. Using the Fine-Gray subdistribution hazard regression model, the hazard ratio (HR) for CRC incidence within the first year after PLA diagnosis was 2.95 (95% CI: 1.75-4.97, p < 0.001). For patients diagnosed with PLA within 6 months prior to CRC, the HR was 3.82 (95% CI: 2.18-6.68, p < 0.001). Microbiological analysis revealed that Bacteroides species and Streptococcus species were predominant in liver abscess cultures, each accounting for 10.34% of cases, followed by E. coli at 6.9%. The presence of Bacteroides species was particularly associated with a higher incidence of CRC (HR: 2.20, 95% CI: 1.35-3.60, p = 0.002). Using the Cox proportional hazards model, the HR for mortality in patients with both conditions was 1.75 (95% CI: 1.20-2.55, p = 0.004).Conclusion Our cross-sectional study reveals a significant association between PLA and the incidence of CRC within our healthcare system over a 10-year period. Patients with PLA demonstrated a notably higher risk of developing CRC, particularly within the first 6 months to 3 years following PLA diagnosis, with hazard ratios indicating a nearly threefold increase in risk. The predominant microorganisms identified in abscess cultures, specifically Bacteroides and Streptococcus species, were significantly associated with CRC incidence, underscoring potential microbial pathways in CRC pathogenesis. Additionally, the overall mortality rate was elevated among patients with both PLA and CRC. This association calls for increased awareness and thorough screening protocols including colonoscopy for patients with unexplained liver abscesses. Future research should focus on validating these findings",
  "authors": [
    {
      "affiliations": [
        "Norwalk Hospital/Yale School of Medicine, United States"
      ],
      "name": "Guneet Singh Sidhu"
    },
    {
      "affiliations": [
        "Sanford Health, Fargo, United States"
      ],
      "name": "Hussam Almasri"
    },
    {
      "affiliations": [
        "Norwalk Hospital/Yale School of Medicine, United States"
      ],
      "name": "John Bassett"
    }
  ],
  "title": "P68 Cryptogenic pyogenic liver abscess: a sentinel marker for colorectal cancer?",
  "uid": "244e46c4-bc70-58a3-83f7-d5a7c99a4bac"
}