Predictors for spontaneous resolution of classical FUO in patients undergoing PET-CT

Yair Eynath*, Erez Halperin, Shira Buchrits, Anat Gafter-Gvili, Hanna Bernstine, Onofrio Catalano, Tomer Avni

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Spontaneous resolution is common in patients with classic fever of unknown origin (FUO). Identifying predictors of spontaneous resolution could reduce the usage of unnecessary, invasive tests or empirical therapy, and furthermore reduce patient anxiety. Identify predictors associated with spontaneous resolution of FUO. A single center, retrospective, cohort study. All hospitalized patients who underwent an [18F] FDG PET-CT scan for the investigation of classical FUO between 1/2012 and 1/2020 were included. We compared patients with spontaneous resolution of fever and clinical symptoms, to those who were diagnosed with a specific etiology of FUO (subdivided to infectious diseases, non-infectious inflammatory diseases (NIID), and malignancies). Epidemiologic characteristics as well as laboratory and PETCT study results were compared. Variables that were found to be associated with spontaneous resolution of FUO on univariate analysis (p < 0.1) were entered into a multivariable regression analysis. The results are reported as odds ratios (OR) and 95% confidence intervals (CI). A total of 303 patients were hospitalized for the investigation of classical FUO and underwent complete assessment. Fever resolved without a diagnosis in 84/303 patients (28%). Variables that were associated with spontaneous resolution of FUO on multivariable analysis included: no anemia, no hypoalbuminemia and no pathological FDG uptake on PET-CT. In 17.8% (15/84) of studies, PET-CT yielded false-positive results that led to additional unnecessary, invasive investigation. Patients without anemia or hypoalbuminemia, and those without uptake on PET-CT are more likely to have spontaneous resolution of classical FUO.

Original languageEnglish
Pages (from-to)367-374
Number of pages8
JournalInternal and Emergency Medicine
Volume18
Issue number2
DOIs
StatePublished - Mar 2023

Keywords

  • Anemia
  • FUO
  • Fever of unknown origin
  • Hypoalbuminemia
  • PET-CT
  • Remission

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