A prospective multicenter study on fever of unknown origin - The yield of a structured diagnostic protocol
A prospective multicenter study on fever of unknown origin - The yield of a structured diagnostic protocol
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DOI：
10.1097/md.0b013e31802fe858
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发表时间：
2007-01-01
期刊：
影响因子：
1.6
通讯作者：
van der Meer, Jos W. M.
中科院分区：
文献类型：
--
作者：
Bleeker-Rovers, Chantal P.;Vos, Fidel J.;van der Meer, Jos W. M.
我们进行了一项前瞻性研究，以更新我们对不明原因发热(FUO)的认识，并探索结构化诊断方案的有效性。2003年12月至2005年7月，73名不明原因不明原因的患者从荷兰同一地区的I大学医院(n=40)和5家社区医院(n=33)招募。FUO被定义为一种持续3周、体温38.3摄氏度的发热性疾病，经标准化病史、体格检查和某些强制性检查后没有诊断。免疫功能低下的患者被排除在外。采用结构化诊断方案。大学医院的患者比转诊到社区医院的患者具有更多的二次转诊和更高的周期性发烧比例。感染占16%，肿瘤占7%，非感染性炎症性疾病占22%，其他原因占4%，未发现发热原因占51%(大学与社区医院之间无差异)。大学医院和社区医院之间的调查数量和类型没有差异。诊断的重要预测因素包括持续发热、持续发热180天、血沉升高、C反应蛋白或乳酸脱氢酶升高、白细胞减少、血小板增多、胸部计算机断层扫描(CT)异常和F-18-氟代脱氧葡萄糖正电子发射断层扫描(FDG-PET)异常。对于未来的FUO研究，建议纳入门诊患者，并使用一套强制性的调查，而不是与时间相关的标准。除早期行冷球蛋白和FDG-PET检查，后期行腹部和胸部CT、55岁及以上患者的颞动脉活检，可能还有骨髓活检外，其他检查不应作为筛查检查。
We conducted a prospective study to update our knowledge of fever of unknown origin (FUO) and to explore the utility of a structured diagnostic protocol. From December 2003 to July 2005, 73 patients with FUO were recruited from I university hospital (n = 40) and 5 community hospitals (n = 33) in the same region in The Netherlands. FUO was defined as a febrile illness of > 3 weeks' duration, a temperature of > 38.3 degrees C on several occasions, without a diagnosis after standardized history-taking, physical examination, and certain obligatory investigations. Immunocompromised patients were excluded. A structured diagnostic protocol was used. Patients from the university hospital were characterized by more secondary referrals and a higher percentage of periodic fever than those referred to community hospitals. Infection was the cause in 16%, a neoplasm in 7%, noninfectious inflammatory diseases in 22%, miscellaneous causes in 4%, and in 5 1 %, the cause of fever was not found (no differences between university and community hospitals). There were no differences regarding the number and type of investigations between university and community hospitals. Significant predictors for reaching a diagnosis included continuous fever; fever present for < 180 days; elevated erythrocyte sedimentation rate, C-reactive protein, or lactate dehydrogenase; leukopenia; thrombocytosis; abnormal chest computed tomography (CT); and abnormal F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). For future FUO studies, inclusion of outpatients and the use of a set of obligated investigations instead of a time-related criterion are recommended. Except for tests from the obligatory part of our protocol and cryoglobulins in an early stage, followed by FDG-PET, and in a later stage by abdominal and chest CT, temporal artery biopsy in patients aged 55 years or older, and possibly bone marrow biopsy, other tests should not be used as screening investigations.