Patients With Fever Of Unknown Origin In Community Hospital:Clinical Features And Prognoses

BackgroundA large proportion of patients with fever of unknown origin（FUO）often present only with fever and lack characteristic clinical symptoms,thus making it difficult to confirm the diagnosis and being the refractory clinical disorders.At present,more than 200 diseases can cause FUO,with the rapid development of medical diagnosis and treatment technology,the diagnosis rate of FUO is becoming higher and faster,as well as the related guidelines are continuously updated.FUO can be divided into infectious diseases,connective tissue diseases,malignancies,other classes of diseases,and undetermined etiology diseases according to the etiology.However,the etiological,clinical features,and prognoses of FUO may differ over time,and at the inter-hospital level and its different diagnostic techniques,so it is necessary to further investigate the etiological composition,clinical features,and prognoses of FUO between the community hospital and the general tertiary hospital.The results provide a reference basis for improving the diagnosis and treatment of patients with FUO and prompt referral.ObjectiveTo analyze the etiological distribution,clinical features,and prognoses of patients with FUO in the community hospital and the general tertiary hospital,its results provide a reference basis for improving the diagnosis and treatment of patients with FUO and prompt referral.MethodsRetrospective screening of patients with fever in two hospitals.From January 1,2018 to December 31,2019,a total of 159 patients with FUO were screened in the community hospital（Zhuguang Street Community Health Service Center,Yuexiu District,Guangzhou）and the general tertiary hospital（the First Affiliated Hospital of Guangzhou Medical University）,including 68 cases in the community hospital and 91cases in the general tertiary hospital.The etiological distribution,clinical features,referral rates,demography,laboratory findings,and prognoses of FUO patients in the two hospitals were compared and analyzed.Results1.From January 1st,2018 to December 31st,2019,68 FUO patients were enrolled in the community hospital,91 FUO patients were enrolled in the general tertiary hospital.159 FUO patients were analyzed out in total.2.Etiological distribution:159 FUO patients were ranked from high to low according to the etiology and proportion:infectious disease group（108 cases,community 45.4%vs.triallelic 54.6%）,connective tissue disease group（20 cases,community 15.0%vs.triallelic 85.0%）,malignant tumor group（13 cases,community53.9%vs.triallelic 46.2%）,other diseases group（9 cases,community 66.7%vs.triallelic 85.0%）,and undetermined etiology group（9 cases,community 33.3%vs.triallelic 66.7%）.The community hospital was ranked as infectious disease group（72.1%）,malignant tumor group（10.3%）,other diseases group（8.8%）,connective tissue diseases group（4.4%）and undetermined etiology group（4.4%）according to the etiology and proportion;while according to the etiology and proportion,the general tertiary hospital was ranked as infectious disease group（64.8%）,connective tissue disease group（18.7%）,malignant tumor group（6.6%）,undetermined etiology group（6.6%）and other diseases group（3.3%）.Both the community hospital and the general tertiary hospital have infectious diseases as the primary cause.The proportions of infectious diseases,malignant tumors,and other diseases in the community hospital were higher than those in the general tertiary hospital,while the proportions of connective tissue diseases group and undetermined etiology group in the community hospital were lower than those in the general tertiary hospital.Except that the proportion of connective tissue disease in the general tertiary hospital was statistically different from that in the community hospital（P<0.05）,there was no statistical difference in any other type of etiology（P>0.05）.3.Clinical characteristics:mean age,the number of hypertensive subjects and diabetic subjects,respiratory rate,heart rate,severity score of pulmonary infection,the number of patients with skin rash,white blood cell count,neutrophil count,eosinophil count,and C-reactive protein level at admission were higher in the study subjects from the community hospital than those from the general tertiary hospital,as well as those were statistically different（P<0.05）.The community hospital study subjects had lower Sp O₂and hemoglobin levels at admission than those in the general tertiary hospital,and all had statistical differences（P<0.05）.4.Prognoses:the length of stay and 28-day mortality in the community hospital were higher than those in the general tertiary hospital（P<0.05）;twenty-two（32.4%）were referred to community hospitals for further diagnosis and treatment,while 10（11.0%）were referred to community hospitals for rehabilitation（P<0.05）.5.Diagnostic methods:imaging,etiology,and detailed physical examination were the main methods for the diagnosis of FUO in the community hospital,while molecular biology,imaging,and pathology were the main methods for the diagnosis of FUO in the general tertiary hospital.Conclusion1.FUO patients in the community hospital and the general tertiary hospital are all dominated by infectious diseases.2.Patients in the community hospital has imaging,etiology,and detailed physical examination as the main diagnostic methods.Moreover,the patients are older,have more underlying diseases,more severe clinical manifestations,and poorer clinical outcomes.3.Inter-hospital bidirectional referral rates need to be further improved.