Relationships between Causes of Fever of Unknown Origin and Inflammatory Markers: A Multicenter Collaborative Retrospective Study
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- Naito Toshio
- Department of General Medicine, Juntendo University School of Medicine, Japan
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- Torikai Keito
- General Internal Medicine, St. Marianna University School of Medicine, Japan
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- Mizooka Masafumi
- General Internal Medicine, Hiroshima University Hospital, Japan
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- Mitsumoto Fujiko
- General Internal Medicine, Kyushu University Hospital, Japan
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- Kanazawa Kenji
- General Internal Medicine, Kobe University Hospital, Japan
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- Ohno Shiro
- General Medicine, Nara Medical University, Japan
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- Morita Hiroyuki
- General Internal Medicine, Gifu University Graduate School of Medicine, Japan
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- Ukimura Akira
- General Medicine, Osaka Medical College, Japan
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- Mishima Nobuhiko
- General Internal Medicine, Kainan Hospital, Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
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- Otsuka Fumio
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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- Ohyama Yoshio
- Department of General Medicine, Gunma University Graduate School of Medicine, Japan
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- Nara Noriko
- General Medicine, Yokohama City University Medical Center, Japan
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- Murakami Kazunari
- Department of General Medicine, Oita University, Faculty of Medicine, Japan
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- Mashiba Kouichi
- Department of General Medicine, Kitakyushu Municipal Medical Center, Japan
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- Akazawa Kenichiro
- Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Japan
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- Yamamoto Koji
- General Medicine, Sumitomo Hospital, Japan
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- Tanei Mika
- Department of General Medicine, Juntendo University School of Medicine, Japan
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- Yamanouchi Masashi
- Department of General Medicine, Juntendo University School of Medicine, Japan
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- Senda Shoichi
- Department of Integrated Medicine, Kagawa University School of Medicine, Japan
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- Tazuma Susumu
- General Internal Medicine, Hiroshima University Hospital, Japan
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- Hayashi Jun
- Center of Kyusyu General Internal Medicine, Haradoi Hospital, Japan
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抄録
Objective Although inflammatory markers, such as the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and procalcitonin, are widely used to differentiate causes of fever of unknown origin (FUO), little is known about the usefulness of this approach. We evaluated relationships between the causes of classical FUO and the levels of inflammatory markers.<br> Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted.<br> Patients This study included 121 patients ≥18 years old diagnosed with "classical FUO" (axillary temperature ≥38.0°C at least twice over a ≥3-week period without elucidation of the cause on three outpatient visits or during three days of hospitalization) between January and December 2011.<br> Results The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for a WBC count of <4,000 /μL than for a WBC count of 4,000-8,000 /μL (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. In contrast, the concentrations of both serum CRP and procalcitonin appeared to be unrelated to the causative disease.<br> Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.<br>
収録刊行物
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- Internal Medicine
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Internal Medicine 54 (16), 1989-1994, 2015
一般社団法人 日本内科学会