Comparison of diagnostic spectrum between inflammation of unknown origin and fever of unknown origin: A systematic review and meta-analysis.

BACKGROUND: Patients with inflammation of unknown origin (IUO) and fever of unknown origin (FUO) are commonly considered a single population. Differences in underlying causes between both groups may steer the diagnostic work-up. METHODS: PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched from July 2009 through December 2023. Studies including both FUO and IUO patients with a sample size of ≥20 were considered. The primary outcome was the difference in the rate of patients affected by predefined diagnostic categories according to meeting FUO or IUO criteria. Data were pooled using random-effects models. RESULTS: A total of 8 studies met criteria for inclusion, with a total of 1452 patients (466 with IUO and 986 with FUO). The median rate of IUO patients among the included studies was 32 % (range 25-39 %). Patients with IUO had a lower likelihood of infection (OR 0.59 [95 % CI; 0.36-0.95]; I2 0 %). There were no significant differences in the rate of noninfectious inflammatory disorders, malignancies, miscellaneous disorders, or remaining undiagnosed. Comparison of diagnostic subgroups revealed that IUO patients were less likely to have systemic autoinflammatory disorders (OR 0.17 [95 % CI, 0.05-0.58]; I2 42 %) and more likely to have vasculitis (OR 2.04 [95 % CI, 1.23-3.38]; I2 21 %) and rheumatoid arthritis or spondylarthritis (OR 3.52 [95 % CI, 1.16-10.69]; I2 0 %). CONCLUSION: Based on our findings, there is little reason to assume that FUO and IUO patients would benefit from a different initial diagnostic approach.

Classic fever of unknown origin: analysis of a cohort of 87 patients according to the definition with qualitative study criterion. / Fiebre de origen desconocido clásica: análisis de una cohorte de 87 pacientes según la definición con criterio de estudio cualitativo.

OBJECTIVES: The aim of this study was to evaluate the characteristics of fever of unknown origin (FUO) according to the definition with qualitative study criterion and of patients without diagnosis. MATERIALS AND METHODS: Prospective observational study performed from 2009 to 2017 of all patients who were diagnosed with FUO according to the extended definition with qualitative study criterion. Demographic, clinical, diagnostic and evolving variables were evaluated. RESULTS: Of the 87 patients registered, 17.3% presented criteria of inflammation of unknown origin (IUO). The diagnoses were: non-infectious inflammatory diseases (NIID) in 19 patients (21.8%), infections in 15 (17.2%), miscellaneous in 14 (16.1%), malignant diseases in 13 (15%) and without diagnosis in 26 (29.9%). In 17.6% of the cases, a potentially diagnostic clue (PDC) was identified. The patients without diagnosis were characterized by a lower number of total PDC (5.9±3.3 vs. 8.7±3.4; P=.000), fewer clinical signs (.4±.6 vs. .9±.8; P=.001), a smaller number of tests in the previous study (2.7±2.1 vs. 4.6±2; P=.000), a shorter diagnostic interval (14.6±7.7 days vs. 21.4±9.5 days; P=.029) and less alteration of erythrocyte sedimentation rate (52.3±41.3mm/h vs. 89.8±42.7mm/h; P=.000), haemoglobin (12.9±1.7g/dl vs. 11.7±1.6g/dl; P=.003) and albumin (36.9±6.4g/l vs. 33.2±7.2g/l; P=.025). 18F-fluorodeoxyglucose positron-emission tomography combined with computed tomography (18F-FDG-PET/TC) proved to be helpful in 37% of the cases. Mortality was 6.8%. CONCLUSIONS: The definition of FUO with qualitative study criterion incorporates a diagnostic protocol that provides clear benefits in terms of cost-effectiveness.

Respuesta: Réplica al artículo «Pérdida de peso involuntaria aislada: epidemiologia y factores predictivos de malignidad» / Reply: Reply to the article «Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy»

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Pérdida de peso involuntaria aislada: epidemiología y factores predictivos de malignidad / Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy

Fundamento y objetivos: Los objetivos del estudio han sido analizar la epidemiología, el pronóstico y los factores predictivos de enfermedad maligna de la pérdida de peso involuntaria aislada (PPIA) y conocer la efectividad de una unidad de diagnóstico rápido en la evaluación del proceso. Material y métodos: Estudio prospectivo observacional realizado en el período de 2006-2015 de todos los pacientes evaluados de PPIA en la unidad de diagnóstico rápido. Se analizaron variables demográficas, clínicas, diagnósticas y evolutivas. Mediante un análisis de regresión logística se identificaron los factores predictivos de enfermedad maligna y factores pronósticos. Resultados: De los 533 pacientes registrados, el 55,1% tenían una edad≥65 años. Los diagnósticos fueron: trastornos orgánicos no neoplásicos en 214 pacientes (40,2%), trastornos psiquiátricos en 144 (27%), cáncer en 81 (15,2%) y causa desconocida en 94 (17,6%). En el 66,7% de los pacientes con cáncer existía el aumento de algún marcador tumoral sérico (MTS). La edad>60 años (OR: 2,71; IC 95%: 1,27-5,77; p=0,01), el género masculino (OR: 3,23; IC 95%: 1,52-6,87; p=0,002), el aumento de un MTS (OR: 2,38; IC 95%: 1,17-4,8; p=0,016) y más de un MTS (OR: 6,51; IC 95%: 2,62-16,13; p=0,000) se identificaron como factores predictivos de enfermedad maligna. La mortalidad fue del 14,2%, asociándose como factor pronóstico el diagnóstico de cáncer (OR: 47,61; IC 95%: 20,76-109;19; p=0,000). Conclusiones: La PPIA es un síndrome clínico que requiere un estudio protocolizado secuencial y un seguimiento. Los MTS se han identificado como factores predictivos de enfermedad maligna

Background and objectives: The aims of the study were to analyse the epidemiology, prognostic and predictive factors of malignant disease on isolated involuntary weight loss (IIWL) and to know the effectiveness of the quick diagnosis unit in the evaluation of the process. Material and methods: Prospective observational study realised from 2006 to 2015 of all patients who were evaluated with IIWL in the quick diagnosis unit. Demographic, clinical, diagnostic and evolutive variables were analysed. Through the analysis of logistic regression, predictive factors of malignant disease and prognostic factors were identified. Results: Of the 533 registered patients, 55.1% were≥65 years old. The diagnostics were: non-neoplastic organic disorders in 214 patients (40.2%), psychiatric disorders in 144 (27%), cancer in 81 (15.2%) and unknown cause in 94 (17.6%). In 66.7% of the patients with cancer, there was an increase of serum tumour markers (STM). Being over 60 (OR: 2.57; 95% CI: 1.27-5.77; P=.01) %), male (OR: 3.23; 95% CI: 1.52-6.87; P=0.002), increase of an STM (OR: 2.38; 95% CI: 1.17-4.8; P=0.016) and more than one STM (OR: 6.51; 95% CI: 2.62-16.13; P=0.000) were identified as predictive factors of malignancy. Mortality was 14.2%; the diagnosis of cancer (OR: 47.61; 95% CI: 20.76-109.19; P=0.000) was identified as a prognostic factor. Conclusions: IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy

Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy. / Pérdida de peso involuntaria aislada: epidemiología y factores predictivos de malignidad.

BACKGROUND AND OBJECTIVES: The aims of the study were to analyse the epidemiology, prognostic and predictive factors of malignant disease on isolated involuntary weight loss (IIWL) and to know the effectiveness of the quick diagnosis unit in the evaluation of the process. MATERIAL AND METHODS: Prospective observational study realised from 2006 to 2015 of all patients who were evaluated with IIWL in the quick diagnosis unit. Demographic, clinical, diagnostic and evolutive variables were analysed. Through the analysis of logistic regression, predictive factors of malignant disease and prognostic factors were identified. RESULTS: Of the 533 registered patients, 55.1% were≥65 years old. The diagnostics were: non-neoplastic organic disorders in 214 patients (40.2%), psychiatric disorders in 144 (27%), cancer in 81 (15.2%) and unknown cause in 94 (17.6%). In 66.7% of the patients with cancer, there was an increase of serum tumour markers (STM). Being over 60 (OR: 2.57; 95% CI: 1.27-5.77; P=.01) %), male (OR: 3.23; 95% CI: 1.52-6.87; P=0.002), increase of an STM (OR: 2.38; 95% CI: 1.17-4.8; P=0.016) and more than one STM (OR: 6.51; 95% CI: 2.62-16.13; P=0.000) were identified as predictive factors of malignancy. Mortality was 14.2%; the diagnosis of cancer (OR: 47.61; 95% CI: 20.76-109.19; P=0.000) was identified as a prognostic factor. CONCLUSIONS: IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy.

Una década de una unidad de diagnóstico rápido / A decade of a quick diagnosis unit

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Hepatotoxicidad asociada a hierbas y suplementos dietéticos / Hepatotoxicity associated with herbal and dietary supplements

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Marcadores tumorales séricos en pacientes asintomáticos / Serum tumour markers in asymptomatic patients

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