A "Bone Marrow Score'' for Predicting Hematological Disease in Immunocompetent Patients With Fevers of Unknown Origin

被引：11

作者：

Wang, Hao-Yuan ^{[1
,2
]}

Yang, Ching-Fen ^{[2
,3
]}

Chiou, Tzeon-Jye ^{[2
,4
]}

Yang, Sheng-Hsiang ^{[2
,5
]}

Gau, Jyh-Pyng ^{[1
,2
]}

Yu, Yuan-Bin ^{[1
,2
]}

Liu, Chun-Yu ^{[1
,2
]}

Liu, Jin-Hwang ^{[1
,2
]}

Chen, Po-Min ^{[1
,2
]}

Hsu, Hui-Chi ^{[1
,2
,6
]}

Fung, Chang-Phone ^{[2
,7
]}

Tzeng, Cheng-Hwai ^{[1
,2
]}

Hsiao, Liang-Tsai ^{[1
,2
]}

机构：

[1] Taipei Vet Gen Hosp, Dept Med, Div Hematol & Oncol, Taipei 112, Taiwan

[2] Natl Yang Ming Univ, Sch Med, Fac Med, Taipei 112, Taiwan

[3] Taipei Vet Gen Hosp, Dept Pathol & Lab Med, Taipei 112, Taiwan

[4] Taipei Vet Gen Hosp, Dept Med, Div Transfus Med, Taipei 112, Taiwan

[5] Natl Yang Ming Univ Hosp, Dept Med, Div Hematol & Oncol, Yilan, Taiwan

[6] Taipei Vet Gen Hosp, Dept Med, Div Gen Med, Taipei 112, Taiwan

[7] Taipei Vet Gen Hosp, Dept Med, Div Infect Dis, Taipei 112, Taiwan

来源：

MEDICINE | 2014年 / 93卷 / 27期

关键词：

MILIARY TUBERCULOSIS; CLINICAL-SIGNIFICANCE; ADULTS; DIAGNOSIS; FERRITIN;

D O I：

10.1097/MD.0000000000000243

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Delayed diagnosis of hematological malignancies in immunocompetent patients with fever of unknown origin (FUO) remains an exhausting challenge for non-hematologist physicians. This retrospective cohort study aimed to establish a scoring system, "bone marrow (BM) score'', to identify FUO patients who require early bone marrow biopsy (BMB) to diagnose hematological disease. Two cohorts, comprising 85 (training) and 20 (validation) eligible immunocompetent patients, with FUOs diagnosed between January 1, 2006 and July 31, 2013, underwent BMBs and were enrolled in the study. Demographic, laboratory, imaging, diagnostic, and outcome data were collected and retrospectively analyzed. Factors associated with hematological etiologies diagnosed using BMBs in the training cohort were identified and scored according to the relative hazards. These were further validated using the validation cohort. For the training cohort, 29 of 85 (34.1%) patients had hematological etiologies diagnosed using BMB. Seven factors significantly predicted the diagnostic yield of hematological diseases in the BM and were scored, with the 6 points for leucoerythroblastic changes in peripheral blood smears, 5.5 for elevated ferritin level (> 1000 ng/mL), 4 for splenomegaly, 2 for thrombocytopenia, 1.5 for each of elevated lactate dehydrogenase levels and anemia, and 1 for neutropenia. When the cutoff value of the scoring system was set to 6, its sensitivity and specificity to diagnose hematological diseases in the BM of immunocompetent FUO patients were 93% and 58%, respectively. For the validation cohort, 7 of 20 (35%) patients had hematological disease, and all had BM scores higher than the cut-off, with the sensitivity and specificity at 100% and 77%, respectively. As immunocompetent FUO patients with hematological disease have poor prognoses, the "BMscore'' is valuable for non-hematologist physicians to identify immunocompetent FUO patients requiring early BMB.

引用

页数：7

共 27 条

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