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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2014 ; 93
(27
): e243
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A "bone marrow score" for predicting hematological disease in immunocompetent
patients with fevers of unknown origin
#MMPMID25501092
Wang HY
; Yang CF
; Chiou TJ
; Yang SH
; Gau JP
; Yu YB
; Liu CY
; Liu JH
; Chen PM
; Hsu HC
; Fung CP
; Tzeng CH
; Hsiao LT
Medicine (Baltimore)
2014[Dec]; 93
(27
): e243
PMID25501092
show ga
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 cut-off 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 "BM score" is valuable for non-hematologist physicians
to identify immunocompetent FUO patients requiring early BMB.