Diagnostic utility of clinical and epidemiologic features in fever of unknown origin

Year 2019, , 928 - 938, 04.11.2019

Victor Roca Campañá , Rosa Eugenia Jiménez Paneque Héctor Manuel Rodríguez Silva

https://doi.org/10.18621/eurj.441463

Abstract

Objectives:
To assess the diagnostic utility of clinical features in the major
diagnostic categories of Fever of unknown origin (FUO).

Methods: One hundred and thirty-three
patients meeting the classic criteria of FUO were included in the study. A
structured diagnostic protocol was used in all cases. Sensitivity, specificity,
positive and negative predictive values (PPV and NPVs), and likelihood ratios
of positive and negative tests (LR+ and LR-) were estimated with 95% confidence
intervals (95% CIs) for all clinical findings.

Results: Clinical and
epidemiologic features with best diagnostic utility indexes for the three major
diagnostic categories were: weight loss of 15 pounds or more (sensitivity,
68.4%, 95% CI: 52.33-84.52), pallor of the skin and mucous membranes
(sensitivity, 65.7%, 95% CI: 49.39-82.19), prior medical history
of cancer (PPV, 63.6%, 95% CI: 30.66-96.61; LR+, 4.38, 95% CI: 1.36-14.09),
lymphadenopathy (LR+, 2.2, 95% CI: 1.11-4.74), for neoplasms;
arthritis (PPV, 72%, 95% CI: 51.84-93.61), prior family history
of collagen diseases (PPV, 100%, 95% CI: 91.67-100.00), neurologic disorder (LR+,
5.1, 95% CI: 1.37-19.68), myalgia (LR+, 4.1, 95%
CI: 1.45-11.88) and skin lesions (LR+, 3.0, 95% CI: 1.51-6.22) for noninfectious
inflammatory diseases;  weight loss of 15
pounds or more (sensitivity, 50%, 95% CI: 27.91-72.09), epidemiological
history of previous tuberculosis or tuberculosis exposure (LR+, 9.0, 95% CI: 1.76-46.77), and jaundice (LR+, 2.73, 95% CI: 0.7-10.63) for infections.

Conclusions: We identified clinical data
emerging from the anamnesis and physical examination that may help to guide the
diagnostic process in FUO.

Keywords

Fever of unknown origin, clinical features, diagnostic utility

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