Summary
The present study aimed to establish a list of parameters indicative of pathogen invasion and develop a predictive model to distinguish the etiologies of fever of unknown origin (FUO) into infectious and non-infectious causes. From January 2014 to September 2017, 431 patients with FUO were prospectively enrolled in the study population. This study established a list of 26 variables from the following 4 aspects: host factors, epidemiological factors, behavioral factors, and iatrogenic factors. Predefined predicted variables were included in a multivariate logistic regression analysis to develop a predictive model. The predictive model and the corresponding scoring system were developed using data from the confirmed diagnoses and 9 variables were eventually identified. These factors were incorporated into the predictive model. This model discriminated between infectious and non-infectious causes of FUO with an AUC of 0.72, sensitivity of 0.71, and specificity of 0.63. The predictive model and corresponding scoring system based on factors concerning pathogen invasion appear to be reliable screening tools to discriminate between infectious and non-infectious causes of FUO.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore), 1961,40:1–30
Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med, 1994,96(3):200–209
Horowitz HW. Fever of unknown origin or fever of too many origins? N Engl J Med, 2013,368(3):197–199
Hu Y, Lu H, Zhang Y, et al. Fever of unknown origin: revisit of 142 cases in a tertiary Chinese hospital. Biosci Trends, 2008,2(1):44–46
Vanderschueren S, Knockaert D, Adriaenssens T, et al. From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med, 2003,163(9):1033–1041
Cunha BA. Fever of unknown origin: focused diagnostic approach based on clinical clues from the history, physical examination, and laboratory tests. Infect Dis Clin North Am, 2007,21(4):1137–1187
Bleeker-Rovers CP, Vos FJ, de Kleijn EM, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore), 2007,86(1):26–38
Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther, 2013,11(8):805–815
Efstathiou SP, Pefanis AV, Tsiakou AG, et al. Fever of unknown origin: discrimination between infectious and non-infectious causes. Eur J Intern Med, 2010,21(2):137–143
Arvaniti V, D'Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality fourfold and should be used in determining prognosis. Gastroenterology, 2010,139(4):1246–1256
Huelsenbeck JP, Hillis DM, Nielsen R. A likelihoodratio test of monophyly. Syst Biol, 1996,45(4):546–558
Kim SE, Kim UJ, Jang MO, et al. Diagnostic use of serum ferritin levels to differentiate infectious and noninfectious diseases in patients with fever of unknown origin. Dis Markers, 2013,34(3):211–218
Li L, Zhang JZ, Zhao MZ, et al. Applied value of monitoring serum hepcidin in differential diagnosis of infection versus tumor fevers. J Huazhong Univ Sci Technol Med Sci, 2017,37(2):253–256
Si-Tahar M, Touqui L, Chignard M. Innate immunity and inflammation—two facets of the same anti-infectious reaction. Clin Exp Immunol, 2009,156(2):194–198
Akgul Y, Word RA, Ensign LM, et al. Hyaluronan in cervical epithelia protects against infection-mediated preterm birth. J Clin Invest, 2014,124(12):5481–5489
Yu Q, Yuan L, Deng J, et al. Lactobacillus protects the integrity of intestinal epithelial barrier damaged by pathogenic bacteria. Front Cell Infect Microbiol, 2015,5:26
Yamaguchi T, Yamada H. Role of mechanical injury on airway surface in the pathogenesis of Pseudomonas aeruginosa. Am Rev Respir Dis, 1991,144(5):1147–1152
Al Dahouk S, Nockler K, Hensel A, et al. Human brucellosis in a nonendemic country: a report from Germany, 2002 and 2003. Eur J Clin Microbiol Infect Dis, 2005,24(7):450–456
Deshpande A, Smith GW, Smith AJ. Biofouling of surgical power tools during routine use. J Hosp Infect, 2015,90(3):179–185
Maugars Y, Albert JD, Bard H, et al. Prevention of iatrogenic infections in interventional rheumatology: Optimal measures but adapted to each risk. Joint Bone Spine, 2016,83(3):250–253
Higa JT, Gluck M, Ross AS. Duodenoscope-Associated Bacterial Infections: A Review and Update. Curr Treat Options Gastroenterol, 2016,14(2):185–193
Mulders-Manders C, Simon A, Bleeker-Rovers C. Fever of unknown origin. Clin Med (Lond), 2015,15(3):280–284
Ergonul O, Willke A, Azap A, et al. Revised definition of 'fever of unknown origin': limitations and opportunities. J Infect, 2005,50(1):1–5
Bryan CS, Ahuja D. Fever of unknown origin: is there a role for empiric therapy? Infect Dis Clin North Am, 2007,21(4):1213–1220
Berjohn CM, Fishman NO, Joffe MM, et al. Treatment and Outcomes for Patients with Bacteremic Pneumococcal Pneumonia. Medicine (Baltimore), 2008,87(3):160–166
Cinel I, Dellinger RP. Advances in pathogenesis and management of sepsis. Curr Opin Infect Dis, 2007,20(4):345–352
Clec'h C, Timsit JF, De Lassence A, et al. Efficacy of adequate early antibiotic therapy in ventilator-associated pneumonia: influence of disease severity. Intensive Care Med, 2004,30(7):1327–1333
Acknowledgement
We would like to thank all the physicians at the hospitals around the country for their participation and data collection. This project would not have been possible without their contributions.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wu, Zh., Xing, My., Wei, S. et al. Establishment of a Predictive Model Related to Pathogen Invasion for Infectious Diseases and Its Diagnostic Value in Fever of Unknown Origin. CURR MED SCI 38, 1025–1031 (2018). https://doi.org/10.1007/s11596-018-1979-x
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11596-018-1979-x