TY - JOUR
T1 - Investigator-Determined Categories for Fever of Unknown Origin (FUO) Compared with International Classification of Diseases–10 Classification of Illness
T2 - A Systematic Review and Meta-analysis with a Proposal for Revised FUO Classification
AU - Wright, William F.
AU - Wang, Jiangxia
AU - Auwaerter, Paul G.
N1 - Funding Information:
W.F.W. and P.G.A. had full access to all the data in the study and took responsibility for the integrity and data analysis accuracy. We thank the Johns Hopkins Harrison Library Director, Linda Gorman, MLS, for her contributions to the database collection search for this work. This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Johns Hopkins ICTR, NCATS, or NIH. This publication was also made possible by support from the Johns Hopkins Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases.
Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Background. 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. Methods. 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. Results. 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. Conclusions. 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.
AB - Background. 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. Methods. 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. Results. 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. Conclusions. 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.
KW - International Classification of Diseases
KW - fever
KW - fever of unknown origin
KW - pyrexia
KW - pyrexia of unknown origin
UR - http://www.scopus.com/inward/record.url?scp=85153767692&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85153767692&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofad104
DO - 10.1093/ofid/ofad104
M3 - Article
C2 - 36949875
AN - SCOPUS:85153767692
SN - 2328-8957
VL - 10
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 3
M1 - ofad104
ER -