RISK FACTORS THAT CAN PREDICT ADRENAL INSUFFICIENCY AMONG PATIENTS WITH FEVER OF UNKNOWN ORIGIN

Abstract

INTRODUCTION
Adrenal insufficiency is one of the causes of fever of unknown origin (FUO). The purpose of this study is to find out risk factors that can predict adrenal insufficiency in FUO patients so that guidelines can be made to recommend the adrenocorticotropic hormone (ACTH) stimulation test.

METHODOLOGY
This study was conducted retrospectively in a tertiary hospital with 846 beds in South Korea. All adult inpatients (age ≥19 years) who have requested a consult with the department of infectious disease for FUO between 1 July 2019 and 30 June 2020 were included in the study. Among them, those who underwent an ACTH stimulation test and had a fever of 37.8℃ or higher within 48 hours of the ACTH stimulation test were included in the study subjects.

RESULTS
A total of 202 FUO patients were enrolled and 61 (30.1%)were diagnosed with adrenal insufficiency. In a multivariate analysis, use of immunosuppressant within 3 months (OR 6.06, 95% CI: 1.82–20.13, p = 0.003), use of corticosteroid within 3 months (OR 8.23, 95% CI: 1.35–50.17, p = 0.022), sodium ≥136.7 (OR 3.43, 95% CI:1.49–7.88, p = 0.004), and calcium ≥8.4 (OR 0.31, 95% CI: 0.14-0.71, p = 0.005) were proven to be factors that can predict adrenal insufficiency in FUO patients.

CONCLUSION
In FUO patients with immunosuppressive prescription or systemic steroid prescription within 3 months, or with high sodium levels or low calcium levels, an ACTH simulation test should be performed to discriminate adrenal insufficiency.