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関連論文:
img  45:  Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study.
 
著者: Toshio Naito, Mika Tanei, Nobuhiro Ikeda, Toshihiro Ishii, Tomio Suzuki, Hiroyuki Morita, Sho Yamasaki, Jun'ichi Tamura, Kenichiro Akazawa, Koji Yamamoto, Hiroshi Otani, Satoshi Suzuki, Motoo Kikuchi, Shiro Ono, Hiroyuki Kobayashi, Hozuka Akita, Susumu Tazuma, Jun Hayashi
雑誌名: BMJ Open. 2019 Nov 19;9(11):e032059. doi: 10.1136/bmjopen-2019-032059. Epub 2019 Nov 19.
Abstract/Text OBJECTIVE: To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients.
DESIGN: Multicentre prospective study.
SETTING: Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan.
PARTICIPANTS: Patient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017.
INTERVENTION: Japanese standard diagnostic examinations.
OUTCOME MEASURES: Data collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis.
RESULTS: The most frequent age group was 65-79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified.
CONCLUSIONS: Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PMID 31748308  BMJ Open. 2019 Nov 19;9(11):e032059. doi: 10.1136/bmjopen-2019-032059. Epub 2019 Nov 19.
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