■将不明原因发热(FUO)分类为分类病因(即,感染,非感染性炎症,肿瘤学,杂项,和未诊断的疾病)仍然不标准化,并且存在差异。随着一些疾病分类的变化,对研究进行系统回顾将有助于医生预测他们可能遇到的可能影响护理的疾病类型的频率.
■我们系统地回顾了在Medline(PubMed)上发表的FUO前瞻性研究,Embase,Scopus,和WebofScience数据库从1997年1月1日到2022年7月31日。我们进行了一项荟萃分析,以估计研究者确定的疾病类别选择与国际疾病分类确定的相关合并比例。第10版(ICD-10),方法论。
■研究者与ICD-10调整的非感染性炎症性疾病类别之间存在差异的患者比例为1.2%(95%CI,0.005-0.021;P<.001),其他类别的比例相似,为1.5%(95%CI,0.007-0.025;P<.001)。杂项和非感染性炎症性疾病类别在改变类别的患者比例中显示出显著的跨研究异质性。52.7%(P=.007)和51.0%(P=.010)I2,分别。
■通过ICD-10方法调整FUO相关诊断与使用5FUO类别系统时过度或低估疾病类别频率近似值的统计学显著风险相关。更好地反映机械理解的FUO诊断分类系统将有助于未来的研究,并增强异质种群和不同地理区域的可比性。我们提出了一种更新的FUO分类方案,简化了分类,符合目前对疾病机制的理解,并应促进经验决策,如有必要。
UNASSIGNED: Classifying fever of unknown origin (FUO) into categorical etiologies (ie, infections, noninfectious inflammatory, oncologic, miscellaneous, and undiagnosed disorders) remains unstandardized and subject to discrepancies. As some disease classifications change, a systematic
review of studies would help physicians anticipate the frequency of illness types they may encounter that could influence care.
UNASSIGNED: We systematically reviewed prospective FUO studies published across the Medline (PubMed), Embase, Scopus, and Web of Science databases from January 1, 1997, to July 31, 2022. We performed a meta-analysis to estimate associated pooled proportions between the investigator-determined choice of disease category and those determined by the International Classification of Diseases, 10th edition (ICD-10), methodology.
UNASSIGNED: The proportion of patients with a difference between the investigator and ICD-10-adjusted noninfectious inflammatory disorder category was 1.2% (95% CI, 0.005-0.021; P < .001), and the proportion was similar for the miscellaneous category at 1.5% (95% CI, 0.007-0.025; P < .001). The miscellaneous and noninfectious inflammatory disorders categories demonstrated significant across-study heterogeneity in the proportions of patients changing categories, with 52.7% (P = .007) and 51.0% (P = .010) I2 , respectively.
UNASSIGNED: Adjusting FUO-associated diagnoses by ICD-10 methodology was associated with a statistically significant risk of over- or underestimation of disease category frequency approximation when using a 5 FUO category system. An FUO diagnostic classification system that better reflects mechanistic understanding would assist future research and enhance comparability across heterogenous populations and different geographic regions. We propose an updated FUO classification scheme that streamlines categorizations, aligns with the current understanding of disease mechanisms, and should facilitate empirical decisions, if necessary.