A Retrospective Study Of Etiology And Clinical Feature Of FUO In Adult

Objective To analysis the etiology of FUO in adult in Anhui province in recent 5 years,investigate the differentia of clinical features between different entities,evaluate diagnostic value of early test of common inflammatory factor,improve the diagnostic ability in clinical work,reduce the inconsequence use of medical resource.Methods1.A retrospective analysis was made in 381 adult cases that according to the diagnostic criterion of FUO, who hospitalized or treated in department of infectious in the First Affiliated Hospital of Anhui Medical University during January 2010 to December2014. Based on the discharge diagnosis they were divided into infectious diseases group, rheumatic autoimmune disease group, tumor diseases group,miscellaneous groups and undiagnosed group.2.The basic informations of each group were compared and analyzed,such as sex ratio,age groups,fever day,temperature,etiology and diagnostic method;the levels of PCT、hs-CRP、NC、ESR and SF were compared and analyzed as the factors above in the top 3 groups.3.To compare the etiology of FUO in children and adult in Anhui province,to compare the etiology and diagnostic level between different regions of China during the same period by refer to the pertinent literatures since 2010.Results1.381 cases of FUO in adult,including 195 male cases(52%) and 186 female cases(48%),aged 16 to 93 years old,the average age of 52.3±2.4 years,the fever days last 16 to 450 days,an average of 41 days,the temperature of 38.3 to 41.7℃,an average of39.4℃. The maximum ratio of male was in infection disease group(56.22%),while the highest proportion of female(62.75%) and the highest temperature(39.49±0.55℃)appeared in the rheumatic autoimmune disease group,while the average age of neoplastic disease group was maximum and it has the top fever days;there were statistical differences in the 4 indices of sex ratio,age groups,fever day,temperature between each groups(P<0.05).2.339 cases were discharged with definitive diagnosis,the diagnosis rate was88.98%,for 217 cases,infectious disease was still the highest and accounting for64.01%,rheumatic autoimmune disease accounting for 15.04% with 51 cases,35 cases of neoplastic disease accounting for 10.32%,and there were 36 cases of miscellaneous diseases accounting for 10.62%.118 cases were diagnosed by detection the blood,secretions,body fluids and(or) pathogen,the proportion was 34.81%;69 cases were diagnosed by imagine examination,the proportion was 21.35%;21 cases of bone marrow biopsy accounting for 6.19%;53 cases of lymph nodes and(or) other pathological biopsy accounting for 15.63%;78 cases as the results of diagnostic treatment or experimental treatment,accounting for 23.01%.3.Bacterial infections accounted for 47.46% in infection diseases(103 cases,including mycobacterium tuberculosis in 17 cases and brucalla in 2 cases),virus infections accounted for 40.55%(88 cases,including new Bunia virus in 53 cases and Burkitt’s lymphoma virus in 7 cases);adult Steele diseases and nodular vasculitis or aorto-arteritis accounted for 25.49% in rheumatic autoimmune diseases(both were 13cases);lymphoma accounted for 60% in neoplastic diseases(21 cases);drug fever accounted for 47.22% in miscellaneous diseases(17 cases).4.Hs-CRP level was the highest in rheumatic group while it was the lowest in infection group. Top level of NC was in infected group, and the higher level was in tumor group. Each level of hs-CRP and NC were compared by LSD method, difference between groups had statistical significance, P < 0.05; ROC curve display that PCT、NC only has statistical significance in the diagnosis of infectious diseases, and the area under the curve(AUC) of NC was maximum in infection group; the AUC of hs-CRP was similar to in the infection group and the rheumatic group; ESR only had a statistically significant and reasonable accuracy in the rheumatic group; while SF has statistical significance in the diagnosis of rheumatic and neoplastic diseases, but the AUC was maximum in the rheumatic group.Conclusion1.In recent 5 years,the etiology of FUO in adult were nearly 100 in Anhui province,the diagnosis ratio reached 88.98% and is in the middle level in China.2.In the local area,the leading cause of etiology of FUO in adult is infectious diseases,mainly to bacterial infection and new Bunia virus infection,rheumatic autoimmune disease in second,the overall incidence rate of tumor diseases was decreased while the incidence rate of lymphoma was increased.3.There were statistical differences in the 4 fundamental factors of sex ratio,age groups,fever day,temperature and the 5 inflammatory factors between each groups.Early test of PCT, hs-CRP, NC, ESR and SF has important promoting function for finding different etiological agent in adult FUO patients. Comprehensive analysis of these 5 indices may be better for FUO diagnosis.