隐源性与非隐源性细菌性肝脓肿临床异质性分析及mNGS病原学诊断价值

doi:10.3969/j.issn.1006-5725.2026.17.014

Abstract

Abstract:

Objective This study aims to investigate the clinical characteristics， associated risk factors， and pathogen profiles of cryptogenic and non-cryptogenic pyogenic liver abscess （PLA）， and to evaluate the diagnostic performance of metagenomic next-generation sequencing （mNGS） for pathogen identification in PLA. Methods A retrospective analysis was performed on 167 patients diagnosed with pyogenic liver abscess admitted to our hospital between January 2020 and December 2025. Patients were stratified into the cryptogenic group （n = 105） and the non-cryptogenic group （n = 62） based on whether a definitive infectious source was identified. Baseline characteristics， laboratory results， and imaging features were compared between the two groups. Among 41 patients who underwent both examinations， we further evaluated the diagnostic performance of mNGS versus conventional bacterial culture. Results A total of 167 patients diagnosed with PLA were enrolled in this study. Compared with the non-cryptogenic group， patients in the cryptogenic group had a higher prevalence of diabetes mellitus， a higher neutrophil percentage， and elevated procalcitonin levels （all P < 0.05）. In contrast， biliary diseases， intra-abdominal malignancies， and multiple hepatic lesions were significantly more prevalent in the non-cryptogenic group （all P < 0.05）. Multivariate logistic regression analysis identified fever （OR = 3.778， 95%CI： 1.688 ⁃8.456）， diabetes mellitus （OR = 2.212， 95%CI： 1.043 ⁃ 4.691）， and elevated hemoglobin level （OR = 1.019， 95%CI： 1.002 ⁃ 1.036） as independent risk factors for cryptogenic PLA. Klebsiella pneumoniae was the most common predominant pathogen isolated in this cohort. Among the 41 patients who received both mNGS testing and conventional pathogen culture， mNGS achieved a significantly higher positive detection rate than conventional culture ［95.12% （39/41） vs. 73.17% （30/41）， P = 0.022］. Additionally， mNGS had a shorter turnaround time and superior detection performance for anaerobic bacteria and uncommon pathogens. Conclusions Cryptogenic and non-cryptogenic pyogenic liver abscesses demonstrate distinct clinical heterogeneity in underlying etiologies， clinical manifestations， inflammatory profiles， and lesion distribution. Etiology-based classification can facilitate early risk stratification and individualized clinical management. For patients with complicated pyogenic liver abscesses or unclear infectious sources， mNGS acts as a valuable adjunct to conventional microbiological testing， enabling accurate pathogen identification and targeted optimization of antimicrobial therapy.

Key words: liver abscess, cryptogenic infection, clinical features, imaging findings, etiology, metagenomic next-generation sequencing

CLC Number:

R575.4

Huimin Zheng, Fengqing Song, Mengchun Wu, Xiaoxing Tan, tao Yu, Jing Du. Heterogeneity analysis of cryptogenic and non-cryptogenic liver abscesses and the clinical value of mNGS in pathogen diagnosis[J]. The Journal of Practical Medicine, 2026, 42(17): 3150-3157.

Figures/Tables 7

Tab. 1

Comparison of clinical characteristics between cryptogenic and non-cryptogenic pyogenic liver abscess"

临床特征	隐源性肝脓肿（n = 105）	非隐源性肝脓肿（n = 62）	t/χ²值	P值
年龄（x ± s）/岁	58.22 ± 14.37	58.34 ± 12.97	-0.054	0.957
性别/［例（%）］			0.004	0.946
男	73（69.52）	42（67.74）
女	32（30.48）	20（32.26）
基础疾病/［例（%）］
糖尿病	41（39.05）	14（22.58）	4.786	0.029
高血压	24（22.86）	13（20.97）	0.081	0.776
胆道系统疾病	0（0.00）	44（70.97）	-	< 0.001^*
恶性肿瘤	3（2.86）	29（46.77）	48.540	< 0.001
肝外转移/［例（%）］	9（8.57）	2（3.23）	1.810	0.178
临床表现/［例（%）］
发热	91（86.67）	40（64.52）	11.311	0.001
腹痛	56（53.33）	35（56.45）	0.153	0.696
恶心呕吐	34（32.38）	11（17.74）	4.244	0.039
畏寒寒战	62（59.05）	29（46.77）	3.186	0.203
肝区叩痛	24（22.86）	12（19.35）	0.912	0.634
入住ICU/［例（%）］	22（20.95）	6（9.68）	3.551	0.06
SOFA（ $x ¯ ± s$ ）/分	7.82 ± 3.95	10.00 ± 4.52	-1.166	0.254
APACHEⅡ（ $x ¯ ± s$ ）/分	17.27 ± 8.03	24.83 ± 8.50	-2.201	0.054
预后/例			-	0.671^*
好转	102	59
预后不佳	3	3
治疗/例			-	0.003^*
药物保守治疗	13	3
药物+穿刺引流	90	50
药物+手术	2	9

Tab. 1

Tab.2

Comparison of laboratory examinations between cryptogenic and non-cryptogenic pyogenic liver abscess"

实验室检查	隐源性肝脓肿（n = 105）	非隐源性肝脓肿（n = 62）	Z/t值	P值
WBC/（×10⁹/L）	13.06（10.38，17.05）	13.79（9.87，18.26）	-0.14	0.885
N%/%	85.70（80.60，90.65）	81.55（75.38，88.03）	-2.60	0.009
LY%/%	7.60（4.85，11.60）	9.45（5.60，14.50）	-1.80	0.071
Hb（ $x ¯ ± s$ ）/（g/L）	112.54 ± 20.60	103.98 ± 21.70	2.54	0.012
Hct	0.34（0.30，0.39）	0.33（0.28，0.38）	-1.88	0.061
PLT/（×10⁹/L）	199.00（127.00，323.00）	282.00（126.25，365.00）	-1.45	0.146
ALT/（U/L）	46.00（25.00，79.00）	40.50（21.00，79.00）	1.42	0.157
AST/（U/L）	48.00（25.00，86.00）	41.50（24.00，58.00）	-1.04	0.299
ALP/（U/L）	139.00（94.00，217.00）	143.00（105.00，230.00）	-0.31	0.757
TBIL/（μmol/L）	17.10（11.60，26.50）	20.70（12.10，36.10）	-1.12	0.265
ALB（ $x ¯ ± s$ ）/（g/L）	29.37 ± 6.05	29.92 ± 8.70	-0.48	0.632
Urea/（mmol/L）	77.00（64.00，96.00）	69.50（58.00，97.00）	-1.04	0.299
Crea/（μmol/L）	5.80（4.10，8.00）	5.35（3.30，8.10）	-1.29	0.199
PCT/（ng/mL）	11.24（1.66，42.83）	3.05（0.42，31.8）	-2.36	0.018
病原学/例				< 0.001^*
单一	104	45
混合	1	17

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

References 27

[1]	Mahmoud A， Abuelazm M， Ahmed A A S， et al. Percutaneous catheter drainage versus needle aspiration for liver abscess management： An updated systematic review， meta-analysis， and meta-regression of randomized controlled trials［J］. Ann Transl Med， 2023， 11（5）： 190. doi：10.21037/atm-22-4663 .
[2]	Guo Yawen， Wang Hairui， Liu Zhaoyu， et al. Comprehensive analysis of the microbiome and metabolome in pus from pyogenic liver abscess patients with and without diabetes mellitus［J］. Front Microbiol， 2023， 14： 1211835. doi：10.3389/fmicb.2023. 1211835 .
[3]	Qu Tingting， Zhou Jiancang， Jiang Yan， et al. Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess in East China［J］. BMC Infect Dis， 2015， 15： 161. doi：10.1186/s12879-015-0899-7 .
[4]	Zhang Siqin， Zhang Xiucai， Wu Qing， et al. Clinical， microbiological， and molecular epidemiological characteristics of Klebsiella pneumoniae-induced pyogenic liver abscess in southeastern China［J］. Antimicrob Resist Infect Control， 2019， 8： 166. doi：10.1186/s13756-019-0615-2 .
[5]	Hou Fei， Qiao Yanting， Qiao Yuanyuan， et al. A retrospective analysis comparing metagenomic next-generation sequencing with conventional microbiology testing for the identification of pathogens in patients with severe infections［J］. Front Cell Infect Microbiol， 2025， 15： 1530486. doi：10.3389/fcimb.2025.1530486 .
[6]	Wang J L， Hsu C R， Wu C Y， et al. Diabetes and obesity and risk of pyogenic liver abscess［J］. Sci Rep， 2023， 13： 7922. doi：10.1038/s41598-023-34889-z .
[7]	Longworth S， Han J. Pyogenic liver abscess［J］. Clin Liver Dis， 2015， 6（2）： 51-54. doi：10.1002/cld.487 .
[8]	Wendt S， Bačák M， Petroff D， et al. Clinical management， pathogen spectrum and outcomes in patients with pyogenic liver abscess in a German tertiary-care hospital［J］. Sci Rep， 2024， 14（1）： 12972. doi：10.1038/s41598-024-63819-w .
[9]	Curran J， Mulhall C， Pinto R， et al. Antibiotic treatment durations for pyogenic liver abscesses： A systematic review［J］. J Assoc Med Microbiol Infect Dis Can， 2023， 8（3）： 224-235. doi：10.3138/jammi-2023-0004 .
[10]	Park J W， Kim J H， Jung J H， et al. A multicenter retrospective study on clinical characteristics and outcome of pyogenic liver abscess focusing multidrug-resistant organisms［J］. J Clin Med， 2022， 11（4）： 1114. doi：10.3390/jcm11041114 .
[11]	Shankar U， Bhandari P， PanchaL A， et al. Juxta-papillary duodenal diverticula are associated with pyogenic liver abscesses： A case control study［J］. BMC Gastroenterol， 2022， 22（1）： 52. doi：10.1186/s12876-022-02120-4 .
[12]	Yoo J J， Lee T K， Kyoung D S， et al. A population-based study of pyogenic liver abscess in Korea： Incidence， mortality and temporal trends during 2007-2017［J］. Liver Int， 2021， 41（11）： 2747-2758. doi：10.1111/liv.15034 .
[13]	Chen Jing， Zhang Minwei， Chen Jinlong， et al. Cryptogenic and non-cryptogenic liver abscess： A retrospective analysis of 178 cases revealed distinct characteristics［J］. J Int Med Res， 2018， 46（9）： 3824-3836. doi：10.1177/0300060518781256 .
[14]	Sahu V， Pipal D K， Singh Y， et al. Epidemiology， clinical features， and outcome of liver abscess： A single-center experience［J］. Cureus， 2022， 14（10）： e29812. doi：10.7759/cureus.29812 .
[15]	Gu Li， Wang Yue， Wang Han， et al. Analysis of clinical and microbiological characteristics of invasive Klebsiella pneumoniae liver abscess syndrome［J］. BMC Infect Dis， 2025， 25（1）： 626. doi：10.1186/s12879-025-10981-9 .
[16]	Sohrabi M， Alizade Naini M， RasekhI A， et al. Emergence of K1 ST23 and K2 ST65 hypervirulent Klebsiella pneumoniae as true pathogens with specific virulence genes in cryptogenic pyogenic liver abscesses Shiraz Iran［J］. Front Cell Infect Microbiol， 2022， 12： 964290. doi：10.3389/fcimb.2022.964290 .
[17]	Lin Han， Huang Zhenghaoyu， Guo Yonghong. Co-evolution of resistance and virulence in Klebsiella pneumoniae liver abscess： PLA-specific mechanisms and therapeutic dilemmas［J］. Front Cell Infect Microbiol， 2026， 16： 1767477. doi：10.3389/fcimb. 2026.1767477 .
[18]	Choby J E， Howard-Anderson J， WeisS D S. Hypervirulent Klebsiella pneumoniae–clinical and molecular perspectives［J］. J Intern Med， 2020， 287（3）： 283-300. doi：10.1111/joim.13007 .
[19]	Yang Fengzhen， Hou Lingyan， Rong Jincheng， et al. Epidemiological features of hypermucoviscous Klebsiella pneumoniae infection in a coastal city of China： Clinical and molecular perspectives［J］. Front Cell Infect Microbiol， 2026， 16： 1732291. doi：10.3389/fcimb.2026.1732291 .
[20]	Dai Piaopiao， Hu Dakang. The making of hypervirulent Klebsiella pneumoniae ［J］. J Clin Lab Anal， 2022， 36（12）： e24743. doi：10.1002/jcla.24743 .
[21]	Li Dongkai， Gai Wei， Zhang Jiahui， et al. Metagenomic next-generation sequencing for the microbiological diagnosis of abdominal sepsis patients［J］. Front Microbiol， 2022， 13： 816631. doi：10.3389/fmicb.2022.816631 .
[22]	Yunxiao Lyu， Wang Bin. Prognostic risk factors for pyogenic liver abscess caused by Klebsiella pneumoniae ［J］. BMC Gastroenterol， 2024， 24（1）： 298. doi：10.1186/s12876-024-03391-9 .
[23]	Li Na， Ma Xiaolong， Zhou Jiaqi， et al. Clinical application of metagenomic next-generation sequencing technology in the diagnosis and treatment of pulmonary infection pathogens： A prospective single-center study of 138 patients［J］. J Clin Lab Anal， 2022， 36（7）： e24498. doi：10.1002/jcla.24498 .
[24]	Song J S， Jung Y K， Kweon S， et al. Enhanced pathogen detection and gut microbiome alterations in pyogenic liver abscess： Insights from next-generation sequencing［J］. Gut Pathog， 2026， 18（1）： 16. doi：10.1186/s13099-026-00799-4 .
[25]	龙思萍，刘志礼，黄山虎，等. 宏基因二代测序在脊柱感染诊治中的应用进展［J］. 实用医学杂志， 2024， 40（1）： 119-122， 128. doi：10.3969/j.issn.1006-5725.2024.01.021 .
[26]	Huang Junfeng， Miao Qing， Cheng Jianwen， et al. Metagenomic next-generation sequencing versus traditional laboratory methods for the diagnosis and treatment of infection in liver transplantation［J］. Front Cell Infect Microbiol， 2022， 12： 886359. doi：10.3389/fcimb.2022.886359 .
[27]	Lin J C， Siu L K， Fung C P， et al. Impaired phagocytosis of capsular serotypes K1 or K2 Klebsiella pneumoniae in type 2 diabetes mellitus patients with poor glycemic control［J］. J Clin Endocrinol Metab， 2006， 91（8）： 3084-3087. doi：10.1210/jc.2005-2749 .

影像学	隐源性肝脓肿（n = 105）	非隐源性肝脓肿（n = 62）	χ²值	P值
脓肿数量			0.30	0.584
单个	85（80.95）	48（77.42）
多个	20（19.05）	14（22.58）
脓肿部位			7.71	0.021
右叶	82（78.10）	42（67.74）
左叶	19（18.10）	10（16.13）
左 + 右叶	4（3.81）	10（16.13）
脓肿大小			3.15	0.207
小	25（23.81）	8（12.90）
大	69（65.71）	45（72.58）
巨大	11（10.48）	9（14.52）

项目	传统培养阳性	传统培养阴性	合计
合计	30	11	41
mNGS阳性	28	11	39
mNGS阴性	2	0	2

指标	mNGS	传统培养	χ ²/Z值	P值
阳性检出率/［例（%）］	39（95.12）	30（73.17）	4.923	0.22
检出病原种类/种	21	5		-
检测时间［M（P₂₅，P₇₅ ）］/h	24.0（20.0，36.0）	90.0（70.0，126.0）	-5.463	< 0.01
厌氧菌检出/例	5	0		-
培养阴性而mNGS阳性/例	11	0		-
双阳性病例完全一致率/%	78.6	-		-
双阳性病例部分一致率/%	10.7	-		-
双阳性病例完全不一致率/%	10.7	-		-

病原一致性分类	例数	占比/%	典型案例
完全一致（检出菌相同）	22	78.6	mNGS 与培养均检出肺炎克雷伯菌
部分一致（mNGS 多检出菌）	3	10.7	培养检出肺炎克雷伯菌，mNGS 额外检出具核梭杆菌（厌氧菌）
完全不一致（无重叠菌）	3	10.7	培养检出大肠埃希菌，mNGS检出中间链球菌

变量	β	标准误	Wald χ ²	P值	OR值	95%CI
发热	1.329	0.411	10.462	0.001	3.778	1.688 ~ 8.456
糖尿病	0.794	0.384	4.286	0.038	2.212	1.043 ~ 4.691
血红蛋白	0.018	0.008	4.871	0.027	1.019	1.002 ~ 1.035

Heterogeneity analysis of cryptogenic and non-cryptogenic liver abscesses and the clinical value of mNGS in pathogen diagnosis

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