结构化诊断方案临床经验分享：华北地区一家三甲医院 320 例发热待查的前瞻性研究。

Structured diagnostic scheme clinical experience sharing: a prospective study of 320 cases of fever of unknown origin in a tertiary hospital in North China.

机构信息

Department of Infectious Diseases, The Second Hospital of Hebei Medical University, Shijiazhuang, China.

Department of Critical Care Medicine, Shiyan Renmin Hospital, Shiyan, China.

出版信息

BMC Infect Dis. 2023 Jul 7;23(1):452. doi: 10.1186/s12879-023-08436-0.

DOI:10.1186/s12879-023-08436-0

PMID:37420165

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10327337/

Abstract

BACKGROUND

There has been little research on the long-term clinical outcomes of patients discharged due to undiagnosed fevers of unknown origin (FUO). The purpose of this study was to determine how fever of unknown origin (FUO) evolves over time and to determine the prognosis of patients in order to guide clinical diagnosis and treatment decisions.

METHODS

Based on FUO structured diagnosis scheme, prospectively included 320 patients who hospitalized at the Department of Infectious Diseases of the Second Hospital of Hebei Medical University from March 15, 2016 to December 31,2019 with FUO, to analysis the cause of FUO, pathogenetic distribution and prognosis, and to compare the etiological distribution of FUO between different years, genders, ages, and duration of fever.

RESULTS

Among the 320 patients, 279 were finally diagnosed through various types of examination or diagnostic methods, and the diagnosis rate was 87.2%. Among all the causes of FUO, 69.3% were infectious diseases, of which Urinary tract infection 12.8% and lung infection 9.7% were the most common. The majority of pathogens are bacteria. Among contagious diseases, brucellosis is the most common. Non-infectious inflammatory diseases were responsible for 6.3% of cases, of which systemic lupus erythematosus(SLE) 1.9% was the most common; 5% were neoplastic diseases; 5.3% were other diseases; and in 12.8% of cases, the cause was unclear. In 2018-2019, the proportion of infectious diseases in FUO was higher than 2016-2017 (P < 0.05). The proportion of infectious diseases was higher in men and older FUO than in women and young and middle-aged (P < 0.05). According to follow-up, the mortality rate of FUO patients during hospitalization was low at 1.9%.

CONCLUSIONS

Infectious diseases are the principal cause of FUO. There are temporal differences in the etiological distribution of FUO, and the etiology of FUO is closely related to the prognosis. It is important to identify the etiology of patients with worsening or unrelieved disease.

摘要

背景

对于因不明原因发热（FUO）而出院的患者的长期临床结局，研究甚少。本研究旨在确定发热原因不明（FUO）的演变过程，并确定患者的预后，以指导临床诊断和治疗决策。

方法

根据 FUO 结构化诊断方案，前瞻性纳入 2016 年 3 月 15 日至 2019 年 12 月 31 日期间在河北医科大学第二医院感染科住院的 FUO 患者 320 例，分析 FUO 的病因、病原体分布及预后，并比较不同年份、性别、年龄及发热时间 FUO 的病因分布。

结果

320 例患者中，最终通过各种检查或诊断方法明确诊断 279 例，诊断率为 87.2%。FUO 病因中感染性疾病占 69.3%，其中以尿路感染（12.8%）和肺部感染（9.7%）最常见，病原体以细菌为主。传染性疾病中以布鲁菌病最常见，非感染性炎症性疾病占 6.3%，其中以系统性红斑狼疮（SLE）（1.9%）最常见，肿瘤性疾病占 5%，其他疾病占 5.3%，仍有 12.8%病因不明。2018-2019 年 FUO 中感染性疾病所占比例高于 2016-2017 年（P<0.05），男性及老年 FUO 中感染性疾病比例高于女性及中青年（P<0.05）。随访期间 FUO 患者住院期间死亡率较低，为 1.9%。