{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:56:12Z","timestamp":1787874972430,"version":"build-2784847793"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pyogenic liver abscess (PLA) is a life\u2014threatening liver bacterial infection causing suppurative lesions. In Asia, hypervirulent <jats:italic>Klebsiella pneumoniae<\/jats:italic> (hvKP) is the main PLA pathogen, linked to invasive syndromes. Severe <jats:italic>Klebsiella pneumoniae<\/jats:italic> liver abscess (KPLA) manifestations, called invasive KPLA syndrome (IKPLAS), have acute onset, rapid progression and non-specific symptoms, often leading to poor prognosis if untreated. This study aimed to find risk factors and create a validated nomogram for predicting invasive syndrome in KPLA patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed clinical data from 529 KPLA patients treated at Chengde Medical University Affiliated Hospital between August 1, 2014, and November 30, 2024. By using the 7:3 stratified random sampling method, the patients were assigned to two cohorts: derivation (<jats:italic>n<\/jats:italic> = 370) and validation (<jats:italic>n<\/jats:italic> = 159). Univariate and multivariate logistic regression analyses were performed to identify risk factors for invasive KPLA syndrome (IKPLAS). A predictive nomogram was constructed and evaluated for discrimination and clinical utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 529 enrolled patients, 33 patients (6.2%) developed IKPLAS (IKPLAS group), while the remaining 496 patients were included in the non-invasive group (NIKPLAS group). Both groups showed significant differences (<jats:italic>P<\/jats:italic> &amp;lt; 0.05) in the incidence of viral hepatitis, biliary disease, type 2 diabetes mellitus (T2DM), vomiting, pulmonary infection, and septic shock; C-reactive protein level; abscess diameter; presence of a gas-containing abscess; and Sequential Organ Failure Assessment (SOFA) score. Multivariate analysis identified the following factors as independent predictors: viral hepatitis, T2DM, abscess diameter, presence of a gas-containing abscess, and SOFA score. The nomogram showed excellent calibration (Hosmer\u2013Lemeshow \u03c7<jats:sup>2<\/jats:sup> = 4.171, <jats:italic>P<\/jats:italic> = 0.841) with area under the receiver operating characteristic curve values of 0.961 (derivation cohort) and 0.899 (validation cohort). The clinical utility of the nomogram was confirmed by decision curve analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Viral hepatitis, T2DM, abscess diameter, presence of a gas-containing abscess, and SOFA score are the predictive factors of IKPLAS. The developed nomogram provides reliable risk stratification for patients with KPLA and can be applied clinically to predict IKPLAS cases.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1663407","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T05:30:43Z","timestamp":1758173443000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Development and validation of a predictive model for invasive syndrome in patients with Klebsiella pneumoniae liver abscess"],"prefix":"10.3389","volume":"12","author":[{"given":"Liyong","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihao","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xidong","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhua","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1097\/MEG.0000000000002906","article-title":"Summary of clinical features of 1800 cases of pyogenic liver abscess","volume":"37","author":"Tian","year":"2025","journal-title":"Eur J Gastroenterol Hepatol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"167905","DOI":"10.1016\/j.bbadis.2025.167905","article-title":"Comprehensive transcriptome profiling in sepsis induced by pyogenic liver abscess","volume":"1871","author":"Sun","year":"2025","journal-title":"Biochim Biophys Acta Mol Basis Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e23170","DOI":"10.7759\/cureus.23170","article-title":"Large solitary pyogenic liver abscesses: a review of their management at a Tertiary Care Hospital","volume":"14","author":"Prasad","year":"2022","journal-title":"Cureus."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1007\/s10620-019-05851-9","article-title":"Risk factors, management, and outcomes of pyogenic liver abscess in a US safety net hospital","volume":"65","author":"Mukthinuthalapati","year":"2020","journal-title":"Dig Dis Sci."},{"key":"B5","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.jgar.2023.09.020","article-title":"Emergence of colistin-heteroresistant and carbapenem-resistant hypervirulent Klebsiella pneumoniae","volume":"35","author":"Wang","year":"2023"},{"key":"B6","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1016\/j.jinf.2021.05.021","article-title":"Rate and risk factors for breakthrough SARS-CoV-2 infection after vaccination","volume":"2","author":"Butt","year":"2021","journal-title":"J Infect."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e21537","DOI":"10.1016\/j.heliyon.2023.e21537","article-title":"Pyogenic liver abscess associated with Klebsiella oxytoca: mimicking invasive liver abscess syndrome","volume":"9","author":"Iwadare","year":"2023","journal-title":"Heliyon."},{"key":"B8","doi-asserted-by":"publisher","first-page":"642484","DOI":"10.3389\/fmicb.2021.642484","article-title":"Virulence factors in hypervirulent Klebsiella pneumoniae","volume":"12","author":"Zhu","year":"2021"},{"key":"B9","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1038\/s41579-022-00720-1","article-title":"Tackling the emerging threat of antifungal resistance to human health","volume":"9","author":"Fisher","year":"2022","journal-title":"Nat Rev Microbiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"612.e1","DOI":"10.1016\/j.cmi.2021.11.010","article-title":"Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine breakthrough infections: a multicentre cohort study","volume":"28","author":"Chia","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e073538","DOI":"10.1136\/bmj-2022-073538","article-title":"Transparent reporting of multivariable prediction models for individual prognosis or diagnosis: checklist for systematic reviews and meta-analyses (TRIPOD-SRMA)","volume":"381","author":"Snell","year":"2023","journal-title":"BMJ."},{"key":"B12","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12873-025-01176-1","article-title":"Construction and evaluation of a triage assessment model for patients with acute non-traumatic chest pain: mixed retrospective and prospective observational study","volume":"25","author":"Zhou","year":"2025","journal-title":"BMC Emerg Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.2147\/IDR.S502175","article-title":"A comprehensive overview of Klebsiella pneumoniae: resistance dynamics, clinical manifestations, and therapeutic options","volume":"18","author":"Jin","year":"2025","journal-title":"Infect Drug Resist."},{"key":"B14","doi-asserted-by":"publisher","first-page":"976","DOI":"10.3390\/pathogens11090976","article-title":"Demographics, radiological findings, and clinical outcomes of Klebsiella pneumonia vs. non-Klebsiella pneumoniae pyogenic liver abscess: a systematic review and meta-analysis with trial sequential analysis","volume":"11","author":"Chan","year":"2022","journal-title":"Pathogens"},{"key":"B15","doi-asserted-by":"publisher","first-page":"956","DOI":"10.3760\/cma.j.cn112137-20231019-00813","article-title":"Establishment and verification of invasion syndrome prediction model in patients with diabetes complicated with Klebsiella pneumoniae liver abscess","volume":"104","author":"Feng","year":"2024","journal-title":"Zhonghua Yi Xue Za Zhi."},{"key":"B16","doi-asserted-by":"publisher","first-page":"370","DOI":"10.3390\/bios14080370","article-title":"Using AuNPs-DNA walker with fluorophores detects the hepatitis virus rapidly","volume":"14","author":"Sun","year":"2024","journal-title":"Biosensors"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e093335","DOI":"10.1136\/bmjopen-2024-093335","article-title":"Incidence rate and associated patient characteristics of liver disease in Wales 2004\u20132022: a retrospective population-scale observational study","volume":"15","author":"Gao","year":"2025","journal-title":"BMJ Open."},{"key":"B18","doi-asserted-by":"publisher","first-page":"104468","DOI":"10.1016\/j.bjid.2024.104468","article-title":"Dysregulation in the microbiota by HBV and HCV infection induces an altered cytokine profile in the pathobiome of infection","volume":"29","author":"Padilha","year":"2025","journal-title":"Braz J Infect Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"946628","DOI":"10.3389\/fimmu.2022.946628","article-title":"The gut-liver axis in immune remodeling of hepatic cirrhosis","volume":"13","author":"Guan","year":"2022","journal-title":"Front Immunol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"25286","DOI":"10.1038\/s41598-024-76270-8","article-title":"Nucleos(t)ide analogues potentially activate T lymphocytes through inducing interferon expression in hepatic cells and patients with chronic hepatitis B","volume":"14","author":"Ho","year":"2024","journal-title":"Sci Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2706","DOI":"10.1111\/jgh.15512","article-title":"Gut-liver-axis: barrier function of liver sinusoidal endothelial cell","volume":"36","author":"Wang","year":"2021","journal-title":"J Gastroenterol Hepatol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"100676","DOI":"10.1016\/j.aohep.2022.100676","article-title":"Gut microbiota dysbiosis in patients with hepatitis B virus-related cirrhosis","volume":"27","author":"Shu","year":"2022","journal-title":"Ann Hepatol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.16288\/j.yczz.23-167","article-title":"Comparison of clinical and microbiological characteristics of community-acquired hypervirulent Klebsiella pneumoniae liver abscess in diabetic and non-diabetic patients","volume":"45","author":"Ye","year":"2023","journal-title":"Yi Chuan."},{"key":"B24","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/j.mrgentox.2021.503437","article-title":"Mechanisms underlying the pathophysiology of type 2 diabetes: from risk factors to oxidative stress, metabolic dysfunction, and hyperglycemia","author":"Lima","year":"2022","journal-title":"Mutat Res Genet Toxicol Environ Mutagen"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e0003123","DOI":"10.1128\/spectrum.00031-23","article-title":"Glucose induces resistance to polymyxins in high-alcohol-producing Klebsiella pneumoniae via increasing capsular polysaccharide and maintaining intracellular ATP","volume":"11","author":"Fan","year":"2023","journal-title":"Microbiol Spectr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"898592","DOI":"10.3389\/fmed.2022.898592","article-title":"Endothelial glycocalyx degradation in critical illness and injury","volume":"9","author":"Patterson","year":"2022","journal-title":"Front Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e03838","DOI":"10.1128\/mbio.03838-24","article-title":"Capsular polysaccharide enables Klebsiella pneumoniae to evade phagocytosis by blocking host-bacteria interactions","volume":"16","author":"Liu","year":"2025","journal-title":"mBio"},{"key":"B28","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s12020-022-03043-6","article-title":"Changes of Th17 cells, regulatory T cells, Treg\/Th17, IL-17 and IL-10 in patients with type 2 diabetes mellitus: a systematic review and meta-analysis","volume":"76","author":"Zi","year":"2022","journal-title":"Endocrine."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00330-025-11460-0","article-title":"Vascular penetration sign: dual-phase enhanced CT manifestations of atypical liver abscess caused by Klebsiella pneumoniae","volume":"35","author":"Yuan","year":"2025","journal-title":"Eur Radiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.7507\/1002-1892.202001097","volume":"34","author":"Sun","year":"2020","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12941-019-0343-8","article-title":"Klebsiella pneumoniae: an increasing threat to public health","volume":"19","author":"Effah","year":"2020","journal-title":"Ann Clin Microbiol Antimicrob."},{"key":"B32","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1186\/s12866-024-03600-1","article-title":"Co-existence of antibiotic resistance and virulence factors in carbapenem resistant Klebsiella pneumoniae clinical isolates from Alexandria, Egypt","volume":"24","author":"El-Kholy","year":"2024","journal-title":"BMC Microbiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"41","DOI":"10.24908\/pocus.v9i1.16854","article-title":"Gas forming pyogenic liver abscess diagnosed by point of care ultrasound","volume":"9","author":"Chin","year":"2024","journal-title":"Pocus J."},{"key":"B34","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/s13755-024-00331-5","article-title":"Real-time estimated Sequential Organ Failure Assessment (SOFA) score with intervals: improved risk monitoring with estimated uncertainty in health condition for patients in intensive care units","volume":"13","author":"He","year":"2025","journal-title":"Health Inf Sci Syst."},{"key":"B35","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1111\/crj.13218","article-title":"A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis-3)","volume":"14","author":"Yang","year":"2020","journal-title":"Clin Respir J."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.3390\/microorganisms9061282","article-title":"From Klebsiella pneumoniae colonization to dissemination: an overview of studies implementing murine models","volume":"9","author":"Joseph","year":"2021","journal-title":"Microorganisms."},{"key":"B37","doi-asserted-by":"publisher","first-page":"449","DOI":"10.2147\/IDR.S451013","article-title":"Interactions and implications of Klebsiella pneumoniae with Human Immune responses and metabolic pathways: a comprehensive review","volume":"17","author":"Bai","year":"2024","journal-title":"Infect Drug Resist"},{"key":"B38","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1186\/s12879-023-08235-7","article-title":"Machine learning models for prediction of invasion Klebsiella pneumoniae liver abscess syndrome in diabetes mellitus: a singled centered retrospective study","volume":"23","author":"Feng","year":"2023","journal-title":"BMC Infect Dis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"03000605231180053","DOI":"10.1177\/03000605231180053","article-title":"Clinical manifestations, diagnosis, treatment, and outcome of pyogenic liver abscess: a retrospective study","volume":"51","author":"Wang","year":"2023","journal-title":"J Int Med Res."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.2147\/DMSO.S452280","article-title":"Prognostic value of hemoglobin concentration on renal outcomes with diabetic kidney disease: a retrospective cohort study","volume":"17","author":"Chen","year":"2024","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B41","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/joim.13007","article-title":"Hypervirulent Klebsiella pneumoniae - clinical and molecular perspectives","volume":"287","author":"Choby","year":"2020","journal-title":"J Intern Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1007\/s00264-021-05072-8","article-title":"Haematogenous Klebsiella pneumoniae osteomyelitis","volume":"45","author":"Chien","year":"2021","journal-title":"Int Orthop."},{"key":"B43","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.eimce.2024.12.008","article-title":"Hypervirulent Klebsiella pneumoniae: epidemiology outside Asian countries, antibiotic resistance association, methods of detection and clinical management","volume":"43","author":"Garc\u00eda-Cobos","year":"2025","journal-title":"Enferm Infecc Microbiol Clin (Engl Ed)."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1663407\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T05:30:46Z","timestamp":1758173446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1663407\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":43,"alternative-id":["10.3389\/fmed.2025.1663407"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1663407","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]},"article-number":"1663407"}}