Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
Eur J Intern Med. 2010 Apr;21(2):137-43. doi: 10.1016/j.ejim.2009.11.006. Epub 2009 Dec 6.
The present study aimed to develop and evaluate a simple diagnostic model that could aid physicians to discriminate between infectious and non-infectious causes of fever of unknown origin (FUO).
DESIGN/SETTING/SUBJECTS: Patients with classical FUO were studied in two distinct, prospective, observational phases. In the derivation phase that lasted from 1992 to 2000, 33 variables regarding demographic characteristics, history, symptoms, signs, and laboratory profile were recorded and considered in a logistic regression analysis using the diagnosis of infection as a dependent variable. In the validation phase, the discriminatory capacity of a score based on the derived predictors of infection was calculated for FUO patients assessed from 2001 to 2007.
Data from 112 individuals (mean age 56.5+/-11.2 years) were analyzed in the derivation cohort. The final diagnoses included infections, malignancies, non-infectious inflammatory diseases, and miscellaneous conditions in 30.4%, 10.7%, 33% and 5.4% of subjects, whereas 20.5% of cases remained undiagnosed. C-reactive protein>60 mg/L (odds ratio 6.0 [95% confidence intervals 2.5, 9.8]), eosinophils<40/mm(3) (4.1 [2.0, 7.3]) and ferritin<500 microg/L (2.5 [1.3, 5.2]) were independently associated with diagnosis of infection. Among the 100 patients of the validation cohort, the presence of > or =2 of the above factors predicted infection with sensitivity, specificity, and positive and negative predictive values of 91.4%, 92.3%, 86.5%, and 95.2%, respectively.
The combination of C-reactive protein, ferritin and eosinophil count may be useful in discriminating infectious from non-infectious causes in patients hospitalised for classical FUO.
本研究旨在开发并评估一种简单的诊断模型，以帮助医生鉴别发热待查（FUO）的感染性和非感染性病因。
设计/设置/研究对象：在两个不同的、前瞻性的观察性阶段中对具有典型 FUO 的患者进行了研究。在从 1992 年到 2000 年持续的推导阶段中，记录了 33 个变量，这些变量涉及人口统计学特征、病史、症状、体征和实验室特征，并使用感染诊断作为因变量进行了逻辑回归分析。在验证阶段，计算了基于感染预测因子的得分对 2001 年至 2007 年评估的 FUO 患者的鉴别能力。
在推导队列中分析了 112 名个体（平均年龄 56.5+/-11.2 岁）的数据。最终诊断包括感染、恶性肿瘤、非感染性炎症性疾病和各种情况，分别占 30.4%、10.7%、33%和 5.4%，而 20.5%的病例仍未确诊。C 反应蛋白>60mg/L（比值比 6.0 [95%置信区间 2.5, 9.8]）、嗜酸性粒细胞<40/mm(3)（4.1 [2.0, 7.3]）和铁蛋白<500μg/L（2.5 [1.3, 5.2]）与感染诊断独立相关。在验证队列的 100 名患者中，存在>或=2 个上述因素预测感染的敏感性、特异性、阳性和阴性预测值分别为 91.4%、92.3%、86.5%和 95.2%。
在因典型 FUO 住院的患者中，C 反应蛋白、铁蛋白和嗜酸性粒细胞计数的组合可能有助于鉴别感染性和非感染性病因。
