Influence of laboratory and radiographic parameters on the clinical presentation and outcome of surgically treated patients with primary brain abscesses.

BACKGROUND

Brain abscesses can lead to severe clinical outcomes, including death. Most studies on brain abscesses focus either on patient cohorts including postsurgical/posttraumatic abscesses. This study aimed to assess the clinical presentation and postoperative outcomes in a homogeneous group of patients with primary, pyogenic brain abscesses who underwent surgical treatment.

METHODS

We retrospectively analyzed consecutive patients with pyogenic brain abscesses treated surgically at our center from 2008 to 2023. The primary endpoint was a modified Rankin Scale (mRS) score of ≥ 3 at discharge. Secondary endpoint was preoperative clinical status (mRS ≥ 3). We statistically correlated clinical, radiographic, and microbiological parameters with these endpoints.

RESULTS

A total of 60 patients (36.7% female) with a mean age of 48.5 ± 20.8 years were included in this study. Six patients (10.0%) had an unfavorable postoperative outcome, including two deaths (3.3%). Significant risk factors for poor outcomes included preoperative disturbance of consciousness (DOC) (p = 0.012) and elevated preoperative C-reactive protein (CRP) levels (p = 0.002). Larger abscess volume (37.4 mL vs. 16.1 mL, p = 0.065) and shorter mean distance to the ventricles (3 mm vs. 11.42 mm, p = 0.086) trended toward significance. The length of intensive care unit (ICU) stay was significantly longer for patients with unfavorable outcomes (p = 0.001). Upon admission, eighteen patients (30.0%) had an mRS score of ≥ 3. Elevated leukocyte count was identified as a significant risk factor for poor preoperative status (p = 0.007). Median clinical performance, measured by mRS, improved throughout the treatment course and during follow-up from 2 to 0.

CONCLUSIONS

Preoperative DOC and elevated CRP levels were identified as predictors of unfavorable outcomes. Elevated leukocyte count was a predictor for poor preoperative status.