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

Yıl 2019, Cilt: 5 Sayı: 6, 928 - 938, 04.11.2019

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

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

Öz

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.

Anahtar Kelimeler

Fever of unknown origin, clinical features, diagnostic utility

Kaynakça

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