{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:25:25Z","timestamp":1777861525449,"version":"3.51.4"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prolonged hospitalization for pyogenic liver abscess (PLA) burdens patients and health systems. We examined whether admission high-density lipoprotein cholesterol (HDL-C) predicts length of stay (LOS) and whether a simple HDL\u2013C-reactive protein (CRP) dual-threshold can flag patients at risk of prolonged stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed a prospective adult PLA cohort at a tertiary center (2018\u20132023;\n                      <jats:italic>n<\/jats:italic>\n                      = 138) and validated findings in MIMIC-IV ICU patients with liver abscess (\n                      <jats:italic>n<\/jats:italic>\n                      = 38) and in NHANES 2017\u20132020 (\n                      <jats:italic>n<\/jats:italic>\n                      = 9,226). Multivariable models related admission HDL-C to log-transformed LOS; model performance and calibration were assessed with internal resampling and external validation. We further evaluated a dual-threshold rule and conducted mediation analysis with CRP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Lower HDL-C independently associated with longer LOS. A nomogram combining HDL-C, abscess size, and sepsis performed well (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u22480.66; RMSE\u22486.4 d) and remained directionally consistent across external datasets. A dual-threshold (HDL-C &amp;lt; 1.03 mmol\/L and CRP &amp;gt; 1.0 mg\/dL) identified a high-risk subgroup with greater odds of prolonged stay. CRP mediated a small proportion of the HDL-C\u2013LOS association.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Admission HDL-C, particularly when interpreted together with CRP, may help identify PLA patients at increased risk of prolonged hospitalization at the time of admission. Patients with low HDL-C and high CRP may warrant closer monitoring, earlier evaluation for source control or drainage, and more proactive inpatient planning. Prospective implementation studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1708360","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:22:28Z","timestamp":1777522948000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing healthcare resources in pyogenic liver abscess: a dual-threshold HDL-CRP model for predicting hospitalization duration across multi-cohorts"],"prefix":"10.3389","volume":"13","author":[{"given":"Mingzhu","family":"Tao","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muye","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suling","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guichan","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]},{"name":"Department of Infection Disease, Maoming People\u2019s Hospital","place":["Maoming, China"]},{"name":"Center of Scientific Research, Maoming People\u2019s Hospital","place":["Maoming, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingchun","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaohang","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuwen","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University","place":["Guangzhou, China"]},{"name":"State Key Laboratory of Organ Failure Research","place":["Guangzhou, China"]},{"name":"Key Laboratory of Infectious Diseases Research in South China (Southern Medical University), Ministry of Education","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Key Laboratory for Prevention and Control of Major Liver Diseases","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Clinical Research Center for Viral Hepatitis","place":["Guangzhou, China"]},{"name":"Guangdong Institute of Hepatology","place":["Guangzhou, China"]},{"name":"Guangdong Provincial Research Center for Liver Fibrosis Engineering and Technology","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.1086\/425616","article-title":"Pyogenic liver abscess: recent trends in etiology and mortality.","volume":"39","author":"Rahimian","year":"2004","journal-title":"Clin Infect Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1136\/flgastro-2013-100371","article-title":"Pyogenic liver abscess.","volume":"5","author":"Webb","year":"2014","journal-title":"Frontline Gastroenterol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1038\/ajg.2009.614","article-title":"A population-based study of pyogenic liver abscesses in the united states: incidence, mortality, and temporal 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