Relationships between causes of fever of unknown origin and inflammatory markers: A multicenter collaborative retrospective study

Toshio Naito, Keito Torikai, Masafumi Mizooka, Fujiko Mitsumoto, Kenji Kanazawa, Shiro Ohno, Hiroyuki Morita, Akira Ukimura, Nobuhiko Mishima, Fumio Otsuka, Yoshio Ohyama, Noriko Nara, Kazunari Murakami, Kouichi Mashiba, Kenichiro Akazawa, Koji Yamamoto, Mika Tanei, Masashi Yamanouchi, Shoichi Senda, Susumu TazumaJun Hayashi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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. Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. Patients This study included 121 patients ?18 years old diagnosed with “classical FUO” (axillary temperature ?38.0? 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. 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 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. Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

Original languageEnglish
Pages (from-to)1989-1994
Number of pages6
JournalInternal Medicine
Volume54
Issue number16
DOIs
Publication statusPublished - Aug 15 2015

Fingerprint

Fever of Unknown Origin
Retrospective Studies
Blood Sedimentation
Calcitonin
Leukocyte Count
C-Reactive Protein
Hospital Medicine
Neoplasms
Communicable Diseases
Blood Proteins
Hospitalization
Differential Diagnosis
Outpatients
Temperature

Keywords

  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Procalcitonin
  • White blood cell

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Relationships between causes of fever of unknown origin and inflammatory markers : A multicenter collaborative retrospective study. / Naito, Toshio; Torikai, Keito; Mizooka, Masafumi; Mitsumoto, Fujiko; Kanazawa, Kenji; Ohno, Shiro; Morita, Hiroyuki; Ukimura, Akira; Mishima, Nobuhiko; Otsuka, Fumio; Ohyama, Yoshio; Nara, Noriko; Murakami, Kazunari; Mashiba, Kouichi; Akazawa, Kenichiro; Yamamoto, Koji; Tanei, Mika; Yamanouchi, Masashi; Senda, Shoichi; Tazuma, Susumu; Hayashi, Jun.

In: Internal Medicine, Vol. 54, No. 16, 15.08.2015, p. 1989-1994.

Research output: Contribution to journalArticle

Naito, T, Torikai, K, Mizooka, M, Mitsumoto, F, Kanazawa, K, Ohno, S, Morita, H, Ukimura, A, Mishima, N, Otsuka, F, Ohyama, Y, Nara, N, Murakami, K, Mashiba, K, Akazawa, K, Yamamoto, K, Tanei, M, Yamanouchi, M, Senda, S, Tazuma, S & Hayashi, J 2015, 'Relationships between causes of fever of unknown origin and inflammatory markers: A multicenter collaborative retrospective study', Internal Medicine, vol. 54, no. 16, pp. 1989-1994. https://doi.org/10.2169/internalmedicine.54.3313
Naito, Toshio ; Torikai, Keito ; Mizooka, Masafumi ; Mitsumoto, Fujiko ; Kanazawa, Kenji ; Ohno, Shiro ; Morita, Hiroyuki ; Ukimura, Akira ; Mishima, Nobuhiko ; Otsuka, Fumio ; Ohyama, Yoshio ; Nara, Noriko ; Murakami, Kazunari ; Mashiba, Kouichi ; Akazawa, Kenichiro ; Yamamoto, Koji ; Tanei, Mika ; Yamanouchi, Masashi ; Senda, Shoichi ; Tazuma, Susumu ; Hayashi, Jun. / Relationships between causes of fever of unknown origin and inflammatory markers : A multicenter collaborative retrospective study. In: Internal Medicine. 2015 ; Vol. 54, No. 16. pp. 1989-1994.
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abstract = "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. Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. Patients This study included 121 patients ?18 years old diagnosed with “classical FUO” (axillary temperature ?38.0? 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. 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 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. Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.",
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T1 - Relationships between causes of fever of unknown origin and inflammatory markers

T2 - A multicenter collaborative retrospective study

AU - Naito, Toshio

AU - Torikai, Keito

AU - Mizooka, Masafumi

AU - Mitsumoto, Fujiko

AU - Kanazawa, Kenji

AU - Ohno, Shiro

AU - Morita, Hiroyuki

AU - Ukimura, Akira

AU - Mishima, Nobuhiko

AU - Otsuka, Fumio

AU - Ohyama, Yoshio

AU - Nara, Noriko

AU - Murakami, Kazunari

AU - Mashiba, Kouichi

AU - Akazawa, Kenichiro

AU - Yamamoto, Koji

AU - Tanei, Mika

AU - Yamanouchi, Masashi

AU - Senda, Shoichi

AU - Tazuma, Susumu

AU - Hayashi, Jun

PY - 2015/8/15

Y1 - 2015/8/15

N2 - 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. Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. Patients This study included 121 patients ?18 years old diagnosed with “classical FUO” (axillary temperature ?38.0? 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. 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 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. Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

AB - 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. Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. Patients This study included 121 patients ?18 years old diagnosed with “classical FUO” (axillary temperature ?38.0? 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. 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 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. Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

KW - C-reactive protein

KW - Erythrocyte sedimentation rate

KW - Procalcitonin

KW - White blood cell

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