Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, Laboratory of clinical infectious and inflammatory disorders, KU Leuven, Leuven, Belgium.
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine Baltimore, Maryland, USA.
Eur J Intern Med. 2022 Dec;106:103-110. doi: 10.1016/j.ejim.2022.10.002. Epub 2022 Oct 17.
Evidence suggests that the symptom duration may affect the occurrence of certain fever (FUO) and inflammation (IUO) of unknown origin associated conditions. It is unclear if this could potentially guide diagnostic evaluations. We examined the association between symptom duration and diagnostic and prognostic outcomes in FUO/IUO.
We retrospectively analyzed a cohort of adult patients meeting criteria for FUO/IUO from a tertiary care center in Belgium between 2000 and 2019. The association between symptom duration and outcomes of interest were estimated by Cox proportional hazards models.
Among 602 patients who met criteria for FUO/IUO (mean age 54 years, 43% female), 132 (22%) and 68 (11%) had symptoms for 3-12 months and >12 months, respectively. There were no significant differences in diagnosis or all-cause mortality between a symptom duration of <3 months and 3-12 months. In contrast, those who had a symptom duration of >12 months were less likely to receive a final diagnosis (aHR 0.42, 95% CI 0.30-0.60), in particular a diagnosis of infectious disorders (aHR 0.29, 95% CI 0.12-0.74), malignancies (aHR 0.11, 95% CI 0.03-0.46), and miscellaneous conditions (aHR 0.22, 95% CI 0.07-0.71), but no significant differences were seen in noninfectious inflammatory disorders (aHR 0.74, 95% CI 0.48-1.15) or all-cause mortality (aHR 0.55, 95% CI 0.19-1.54).
The symptom duration may be used to guide the diagnostic workup among patients with FUO and IUO, in particular those with longstanding symptoms.
有证据表明，症状持续时间可能会影响某些不明原因发热（FUO）和炎症（IUO）相关疾病的发生。目前尚不清楚这是否可能有助于指导诊断评估。我们研究了症状持续时间与 FUO/IUO 患者的诊断和预后结局之间的关系。
我们回顾性分析了 2000 年至 2019 年期间比利时一家三级护理中心符合 FUO/IUO 标准的成年患者队列。采用 Cox 比例风险模型估计症状持续时间与感兴趣结局之间的关系。
在符合 FUO/IUO 标准的 602 名患者中（平均年龄 54 岁，43%为女性），分别有 132 名（22%）和 68 名（11%）患者的症状持续时间为 3-12 个月和>12 个月。症状持续时间<3 个月和 3-12 个月之间的诊断或全因死亡率无显著差异。相比之下，症状持续时间>12 个月的患者获得最终诊断的可能性较低（aHR 0.42，95%CI 0.30-0.60），尤其是诊断为感染性疾病（aHR 0.29，95%CI 0.12-0.74）、恶性肿瘤（aHR 0.11，95%CI 0.03-0.46）和其他疾病（aHR 0.22，95%CI 0.07-0.71），但在非感染性炎症性疾病（aHR 0.74，95%CI 0.48-1.15）或全因死亡率（aHR 0.55，95%CI 0.19-1.54）方面无显著差异。
症状持续时间可用于指导 FUO 和 IUO 患者的诊断评估，尤其是症状持续时间较长的患者。
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