Clinical Features And Prognostic Factors In Patients With Unexplained Fever And Diabetes

Objective:To explore the clinical features and prognostic factors of Fever of Unknown Origin(FUO)complicated diabetes mellitus,in order to provide ideas for clinical diagnosis and treatment.Methods:a total of 607 patients with fever of unknown origin admitted to the second hospital of Hebei Medical University from January to December2018 were selected and divided into FUO non-diabetic group and FUO diabetic group;The age,gender,duration of fever,etiology distribution,diagnosis time,diagnosis method and treatment outcome of the two groups were retrospectively analyzed and compared,and the clinical characteristics and prognostic factors of patients with unexplained fever and diabetes mellitus were studied.All the above data were collected by consulting the electronic medical record system of the second hospital of Hebei Medical University.The counting data were expressed as percentage(%),and the continuous variables were expressed as mean ± The standard deviation was expressed by t-test or chi square test.The indicators with P < 0.05 were included in multivariate logistic regression analysis.All data were processed by spss26.0 software.Results:(1)Among the 607 patients with unexplained fever,311 were non-diabetic patients with FUO,and 296 were patients with FUO complicated with diabetes.Among them,312 were males and 295 were females,with a male-to-female ratio of 1.06:1,and the age distribution was 15-91 years old.The average age is(54.35±18.41)years,mainly middle-aged and elderly.The course of fever is mainly concentrated in 3 weeks to 3 months.(2)Among the607 FUO patients in this study,469 were finally diagnosed,accounting for77.27%.The etiology of FUO patients was 406 cases of infectious diseases(66.89%),26 cases of autoimmune system diseases(4.29%),22 cases of neoplastic diseases(3.62%),15 cases of other diseases(2.47%),and 138 cases of undiagnosed(22.73%).Compared with the distribution of the main causes of the FUO non-diabetic group and the diabetes group,the difference in the distribution of infectious diseases,autoimmune diseases,and other diseases between the FUO diabetes group and the non-diabetic group was statistically significant(P<0.05).The proportion of infectious diseases in the FUO diabetes group was higher than that of the non-diabetic group,while the distribution of autoimmune system diseases and other diseases was lower than the non-diabetic group.(3)The distribution of the top three departments of the FUO non-diabetic group and the diabetes group for the first admission is basically the same,namely: Infectious Diseases Department,General Medicine Department,and Respiratory Medicine Department.(4)Among the469 patients with a final diagnosis,the diagnosis time was mainly 2-8 days after admission,and the average diagnosis time was(6.36±4.854)days.The diagnosis time of the FUO diabetes group was significantly longer than that of the non-diabetic group,with statistics Academic significance(P<0.01).There was a statistically significant difference between the FUO diabetes group and the non-diabetic group in the application of serology and/or etiology,treatment response and/or clinical diagnosis,imaging,and immunological diagnosis(P<0.05).The proportion of diagnosed by serology and(or)etiology,treatment response and(or)clinical manifestations in the FUO diabetes group was higher than that in the non-diabetic group.The ratio of confirmed diagnosis by imaging and immunological examination was lower than that of the non-diabetic group.(5)Among the 607 patients with unexplained fever,497(81.88%)were cured or improved after treatment,and 110(18.12%)were unhealed or transferred.The improvement rate of FUO non-diabetic patients is higher than that of the diabetes group,with statistics.Learning significance(P=0.048).(6)Glycated hemoglobin ≥7.0% and diabetic complications are independent risk factors that affect the treatment outcome of patients with unexplained fever and diabetes.Conclusions:(1)The age of patients in the FUO combined diabetes group was significantly higher than that of the non-diabetic group,the diagnosis time was longer than that of the non-diabetic group,and the treatment improvement rate was lower than that of the non-diabetic group.(2)For FUO patients with diabetes,in addition to the application of conventional examination methods,attention should be paid to combining detailed medical history collection and special examination methods,including 18 F FDG-PET/CT,tissue biopsy,etc.(3)The independent risk factors that affect the treatment outcome of patients with unexplained fever and diabetes include:Hb A1 c level and diabetes complications.For patients with poor blood sugar control,the dosage of hypoglycemic drugs should be adjusted in time to delay the occurrence of complications and improve The prognosis of FUO patients with diabetes.