Clinical Features of Spontaneous Remission in the Classic Fever of Unknown Origin: A Retrospective Study |
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| Authors: | Changyi Liu Xiaoqing Liu Xiaochun Shi |
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| Institution: | 1. School of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;2. Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;3. Centre for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;4. Clinical Epidemiology Unit, International Epidemiology Network, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;1. Law School, Beijing Normal University, Beijing 100815, China;2. National Population Heath Data Center, Chinese Academy of Medical Sciences, Beijing 100730, China;3. School of Physical Education, Shandong University, Jinan 250061, China;1. School of Stomatology, Weifang Medical University, Weifang 261053, Shandong, China;2. Clinical Competency Training Center, Weifang Medical University, Weifang 261053, Shandong, China;1. State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China;2. Heart Center and Shanghai Institution of Pediatric Congenital Heart Diseases, Shanghai Children''s Medical Center, National Children''s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;3. Children''s Heart Center, The Second Affiliated Hospital and Yuying Children''s Hospital, Institute of Cardiovascular Development and Translational Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China |
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| Abstract: | ObjectiveTo summarize the clinical features of spontaneous remission in classic fever of unknown origin (FUO).MethodsMedical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively. Patients who were discharged without etiological diagnoses were followed for 2 years. The clinical features and outcomes of these patients were summarized. Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.ResultsAfter excluding 2 patients who lost to follow-up, the etiology of 119 FUO patients were as follows: infectious diseases in 30 (25.2%) cases, connective tissue diseases in 28 (23.5%) cases, tumor diseases in 8 (6.7%) cases, other diseases in 6 (5.0%) cases, and unknown diagnoses in 47 (39.5%) cases. Totally, 41 patients experienced spontaneous remission of fever (the median time from onset to remission was 9 weeks, ranging from 4 to 39 weeks). In patients with spontaneous remission in FUO, lymphadenopathy was less common clinical manifestation, the levels of inflammatory markers including leukocyte count, neutrophil count, neutrophil ratio, C-reactive protein, and ferritin were lower, and the proportion of CD8 positive T lymphocytes expressing CD38 was lower. Multivariate logistic regression analysis of factors with a P-value < 0.05 in univariate analysis shown that white blood cell count (OR: 0.545, 95%CI: 0.306-0.971, P = 0.039), neutrophil count (OR: 2.074, 95%CI: 1.004-4.284, P = 0.049), and proportion of neutrophils (OR: 0.928, 95%CI: 0.871-0.990, P = 0.022) were independent significant factors associated with spontaneous remission in FUO.ConclusionsThis study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously. Thus, for patients with stable clinical conditions, follow-up and observation could be the best choice. Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO. |
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| Keywords: | fever of unknown origin follow-up spontaneous remission diagnosis |
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