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Torné Cachot J, Baucells Azcona JM, Blanch Falp J, García Pont J, Camell Ilari H. Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy. Med Clin (Barc) 2019; 152:384-390. [PMID: 30297253 DOI: 10.1016/j.medcli.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The aims of the study were to analyse the epidemiology, prognostic and predictive factors of malignant disease on isolated involuntary weight loss (IIWL) and to know the effectiveness of the quick diagnosis unit in the evaluation of the process. MATERIAL AND METHODS Prospective observational study realised from 2006 to 2015 of all patients who were evaluated with IIWL in the quick diagnosis unit. Demographic, clinical, diagnostic and evolutive variables were analysed. Through the analysis of logistic regression, predictive factors of malignant disease and prognostic factors were identified. RESULTS Of the 533 registered patients, 55.1% were≥65 years old. The diagnostics were: non-neoplastic organic disorders in 214 patients (40.2%), psychiatric disorders in 144 (27%), cancer in 81 (15.2%) and unknown cause in 94 (17.6%). In 66.7% of the patients with cancer, there was an increase of serum tumour markers (STM). Being over 60 (OR: 2.57; 95% CI: 1.27-5.77; P=.01) %), male (OR: 3.23; 95% CI: 1.52-6.87; P=0.002), increase of an STM (OR: 2.38; 95% CI: 1.17-4.8; P=0.016) and more than one STM (OR: 6.51; 95% CI: 2.62-16.13; P=0.000) were identified as predictive factors of malignancy. Mortality was 14.2%; the diagnosis of cancer (OR: 47.61; 95% CI: 20.76-109.19; P=0.000) was identified as a prognostic factor. CONCLUSIONS IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy.
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Affiliation(s)
- Joaquim Torné Cachot
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España.
| | - José Manuel Baucells Azcona
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
| | - Jesús Blanch Falp
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
| | - Javier García Pont
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
| | - Helena Camell Ilari
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
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Braquet P, Mercier G, Reynes J, Jeandel C, Pinzani V, Guilpain P, Rivière S, Le Quellec A. [Diagnostic value of selective anorexia in pathological weight loss]. Rev Med Interne 2015; 37:84-90. [PMID: 26302696 DOI: 10.1016/j.revmed.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/18/2015] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The diagnostic value of selective anorexia is debated. Some authors have suggested an association between meat aversion and cancer, but most do not use it as a diagnostic tool. We aimed to characterize anorexia of different diseases to search for an association between selective aversions and diagnostic groups. METHODS All the patients admitted to three departments of a teaching hospital were included consecutively for 22months if they had more than 10 % weight loss in less than one year. Patients were excluded if history taking was not reliable, or if they suffered from anorexia nervosa. We compiled diagnoses at discharge and validated them six months later. We used logistic regression to identify independent factors associated with selective anorexia. RESULTS Inclusion criteria were met in 106patients (female 44 %, median age 65years). Most frequent diagnoses were: cancer (36 %), infection (35 %), digestive diseases (19 %), non organic diseases (21 %). Recent selective anorexia was found in 46 % of the cases. It was significantly associated with female gender (P=0.002), marginally with young age (P=0.069) and long duration of weight loss (P=0.079). Opioid use at admission was negatively associated with selective anorexia (P=0.001). No specific diagnostic category was found to be associated. CONCLUSION Selective anorexia does not appear to be a useful symptom to investigate pathological weight loss. It behaves more like a non-specific reactivation by current disease of earlier latent personal food aversions.
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Affiliation(s)
- P Braquet
- Équipe « médecine interne ; maladies multi-organiques », département de médecine interne, CHRU de Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - G Mercier
- Département de l'information médicale, CHRU, 34295 Montpellier, France
| | - J Reynes
- Département des maladies infectieuses et tropicales, CHRU, 34295 Montpellier, France
| | - C Jeandel
- Département de gérontologie, CHRU Centre-Balmès, 34295 Montpellier, France
| | - V Pinzani
- Centre régional de pharmacovigilance, CHRU, 34295 Montpellier, France
| | - P Guilpain
- Équipe « médecine interne ; maladies multi-organiques », département de médecine interne, CHRU de Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - S Rivière
- Équipe « médecine interne ; maladies multi-organiques », département de médecine interne, CHRU de Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - A Le Quellec
- Équipe « médecine interne ; maladies multi-organiques », département de médecine interne, CHRU de Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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Abstract
Involuntary weight loss remains an important and challenging clinical problem, with a high degree of morbidity and mortality. Because of the frequency of finding a serious underlying diagnosis, clinicians must be thorough in assessment, keeping in mind a broad range of possible causes. Although prediction scores exist, they have not been broadly validated; therefore, clinical judgment remains ever essential.
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Affiliation(s)
- Christopher J Wong
- Division of General Internal Medicine, Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354760, Seattle, WA 98105, USA.
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Baicus C, Rimbas M, Baicus A, Caraiola S. Cancer and involuntary weight loss: failure to validate a prediction score. PLoS One 2014; 9:e95286. [PMID: 24762986 PMCID: PMC3999093 DOI: 10.1371/journal.pone.0095286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
Background Many patients who have involuntary weight loss have cancer. The Hernandez prediction rule includes 5 variables (elevated levels of alkaline phosphatase and lactate dehydrogenase, low albumin, high white blood cell count, and age >80 years). The purpose of this study was to evaluate the validity of the prediction rule. Methods We prospectively evaluated 290 consecutive inpatients and outpatients who had involuntary weight loss. Clinical, hematologic, and biochemical parameters were determined. There were 259 patients who had follow-up at 6 months to determine the cause of involuntary weight loss, and 31 other patients were lost to follow-up. The 5 variables were introduced into a regression logistic model with cancer as a dependent variable. Results Cancer was diagnosed in 72 of the 290 patients (25%) who had involuntary weight loss. Bivariate analysis showed that serum albumin, C-reactive protein, erythrocyte sedimentation rate, alkaline phosphatase, iron, lactate dehydrogenase, white blood cell count, hemoglobin, and ferritin levels were associated with cancer (range of area under the receiver operating characteristic curve, 0.589 to 0.688). Multivariate analysis showed that albumin, erythrocyte sedimentation rate, iron, white blood cell count, and lactate dehydrogenase levels were associated with cancer. When dichotomized, only low albumin (odds ratio, 2.6, CI [1.3–5.2]) and high alkaline phosphatase (odds ratio, 2.3, CI [1.7–4.7]) were associated with cancer. The area under the receiver operating characteristic curve of the 5-variable prediction rule was only 0.70 (95% confidence interval, 0.61–0.78). The negative predictive value of this model with 3 variables (age >60 y, alkaline phosphatase, and albumin level) increased from 85% to 95% when all tests were negative. Conclusions In patients who had involuntary weight loss, those who have cancer are likely to have ≥1 abnormal laboratory test. The 5-variable prediction rule had a significantly lower accuracy than originally reported. Further evaluation of the 3-variable modification of the prediction rule may be useful.
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Affiliation(s)
- Cristian Baicus
- Colentina University Hospital, Departments of Internal Medicine and Gastroenterology, Bucharest, Romania
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- * E-mail:
| | - Mihai Rimbas
- Colentina University Hospital, Departments of Internal Medicine and Gastroenterology, Bucharest, Romania
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anda Baicus
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- I. Cantacuzino National Institute of Research and Development in Microbiology-Immunology, Bucharest, Romania
| | - Simona Caraiola
- Colentina University Hospital, Departments of Internal Medicine and Gastroenterology, Bucharest, Romania
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Metalidis C, Knockaert DC, Bobbaers H, Vanderschueren S. Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance? Eur J Intern Med 2008; 19:345-9. [PMID: 18549937 DOI: 10.1016/j.ejim.2007.09.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Involuntary weight loss frequently poses a diagnostic challenge. Patient and physician alike want to exclude malignant and other major organic illness. The present study aimed to evaluate whether a negative baseline evaluation (consisting of clinical examination, standard laboratory examination, chest X-ray, and abdominal ultrasound) lowers the probability of evolving organic illness in patients with significant unexplained weight loss. METHODS Prospective observational study of 101 consecutive patients presenting to a general internal medicine department of a university hospital with an unexplained unintentional weight loss of at least 5% within 6-12 months. Laboratory tests of interest included C-reactive protein, albumin, haemoglobin, and liver function tests. RESULTS Weight loss of the 101 patients [age (mean, interquartile range): 64 (51-71) years, 46% male] averaged 10 (7-15) kg. Organic causes were found in 57 patients (56%), including malignancy in 22 (22%). In 44 patients without obvious organic cause for the weight loss (44%), a psychiatric disorder was implicated in 16 (16%) and no cause was established in 28 (28%), despite vigorous effort and follow-up of at least 6 months. Baseline evaluation was entirely normal in none of the 22 patients (0%) with malignancy, in 2 of the 35 (5.7%) with non-malignant organic disease, and in 23 of the 44 (52%) without physical diagnosis. Additional testing, oftentimes extensive, after a normal baseline evaluation led to one additional physical diagnosis (lactose intolerance). CONCLUSION In patients presenting with substantial unintentional weight loss, major organic and especially malignant diseases seem highly unlikely when a baseline evaluation is completely normal. In this setting, a watchful waiting approach may be preferable to undirected and invasive testing.
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Affiliation(s)
- Christoph Metalidis
- Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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Vanderschueren S, Geens E, Knockaert D, Bobbaers H. The diagnostic spectrum of unintentional weight loss. Eur J Intern Med 2005; 16:160-164. [PMID: 15967329 DOI: 10.1016/j.ejim.2005.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Revised: 10/07/2004] [Accepted: 01/28/2005] [Indexed: 11/25/2022]
Abstract
Significant and documented involuntary weight loss in adults frequently poses a diagnostic challenge to the clinician. We summarize published series on the etiologies and the outcomes of involuntary weight loss and use these data to formulate a proposal for a diagnostic work-up. Simple, non-invasive screening tests, embarking from thorough history-taking and clinical examination, are advocated first. Additional testing should be directed towards areas of concern raised by this initial evaluation. If a well-thought-out baseline examination is reassuring and fails to provide further clues, a strategy of watchful waiting with close clinical follow-up is preferred to a blind pursuit of additional, more invasive, or expensive investigations.
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Affiliation(s)
- Steven Vanderschueren
- Department of General Internal Medicine, University Hospital Gasthuisberg, KULeuven, Herestraat 49, B-3000 Leuven, Belgium
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Bilbao-Garay J, Barba R, Losa-García JE, Martín H, García de Casasola G, Castilla V, González-Anglada I, Espinosa A, Guijarro C. Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score. Eur J Intern Med 2002; 13:240-245. [PMID: 12067819 DOI: 10.1016/s0953-6205(02)00032-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND: Involuntary weight loss (IWL) is a frequent complaint with a difficult diagnosis. Any one of a number of different diseases may be the source of the symptom. However, there is no universal clinical protocol that can help physicians study this complex syndrome. METHODS: In March 1998, we defined a diagnostic protocol for the study of IWL. IWL was defined as an involuntary and documented weight loss of at least 5% of the usual body weight in the previous 3 months. We analyzed 78 consecutive patients with IWL who came to our clinic between March 1998 and December 2000. RESULTS: An organic disease was found in 56% of cases; cancer, metabolic and digestive diseases were the most common entities. Psychiatric problems were found in 33% of cases. After extensive study, an idiopathic group of 11% was identified. The variables that were independently predictive of a final diagnosis of organic disease were: age>50 years (OR: 8.6, CI 95%: 1.7-43.6), psychiatric symptoms (OR: 0.2, CI 95%: 0.1-0.8), smoking (OR: 14.3, CI 95% 2.3-74), the presence of guide symptoms (OR: 8.0, CI 95%: 1.8-34.4), and anemia (OR: 3.1, CI 95%: 2.5-387). Sixteen percent of the patients died, more often those suffering from organic diseases. Based on multivariate regression coefficients, a clinical risk score was established. CONCLUSIONS: IWL is a complex and frequent syndrome with a 16% rate of mortality during the first year. A protocol based on clinical data can help in the management of IWL. Our clinical prediction rule may help physicians to identify those patients with IWL who are likely to have an underlying organic disease.
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Affiliation(s)
- J Bilbao-Garay
- Unidad de Medicina Interna, Fundación Hospital Alcorcón, C/Budapest no. 1, 28922 Alcorcón, Madrid, Spain
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Abstract
Unintentional weight loss is a problem encountered frequently in clinical practice. Weight loss and low body weight have potentially serious clinical implications. Although a nonspecific observation, weight loss is often of concern to both patients and physicians. There are multiple potential etiologies and special factors to consider in selected groups, such as older adults. A rational approach to these patients is based on an understanding of the relevant biologic, psychological, and social factors identified during a thorough history and physical examination. The goal of this article is to discuss the clinical importance, review potential pathophysiology, and discuss specific etiologies of unintentional weight loss that will enable the clinician to formulate a practical stepwise approach to patient evaluation and management.
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Affiliation(s)
- E P Bouras
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Fla 32224, USA
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Fauchais AL, Puisieux F, Bulckaen H, Salomez-Garnier F, Dewailly P. [Unexplained weight loss in the elderly: role of gastric fibroscopy, study of a cohort of 77 patients with a 13-month follow-up]. Rev Med Interne 2001; 22:11-9. [PMID: 11218294 DOI: 10.1016/s0248-8663(00)00281-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE In case of unexplained weight loss, chest X-ray, abdominal ultrasonography and gastroscopy are usually recommended. However, gastroscopy is not usually performed in elderly patients. METHODS We evaluated 77 patients (mean age: 80 +/- 8 years) hospitalized in our geriatric unit between January 1995 and May 1997 for unexplained weight loss. All patients underwent chest X-ray, abdominal ultrasonography and gastroscopy. RESULTS These investigations led to diagnosis in respectively 17, 15 and 46 patients. The etiology of weight loss was unique in 47 patients, while in 30 other patients at least two or three causes could be described. Gastroscopy appeared to be the most useful test, as it allowed description of eight cases of cancer, 29 cases of peptic ulcer, two cases of candidosis, and one case of actinomycosis in patients who did not present any clinical sign. CONCLUSION Sixty-five patients were followed-up for a mean period of 13 +/- 21 month; 33 patients died. The condition of 23 patients improved either slightly or definitely. Simple investigations led to diagnosis in 95% of the cases. However, 42% of the patients died within 3 months. Gastroscopy appears to be the most valuable test, leading to diagnosis in more than half of the cases. With adapted treatment, the condition of 75% of the patients with gastro-intestinal lesions improved.
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Affiliation(s)
- A L Fauchais
- Service de médecine interne et gériatrie, hôpital gériatrique Les Bateliers, CHRU, rue des Bateliers, 59800 Lille, France
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Schwenk A. [What should be done in weight loss of unknown origin?]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1998; 93:719-25. [PMID: 10024839 DOI: 10.1007/bf03044808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
DIFFERENTIAL DIAGNOSIS Involuntary weight loss is associated with increased mortality and morbidity. Differential diagnosis includes more than 50 disease entities; therefore the diagnostic strategy is determined by additional symptoms. THE SYNDROME OF "CONSUMPTION", i.e. weight loss as an isolated symptom or together with malaise, may indicate tumors (lung, pancreas, kidney cancer, malignant lymphoma), infections (tuberculosis, HIV), immunologic diseases (lupus erythematosus, vasculitis), hyperthyroidism, extraintestinal Crohn's disease, or psychogenic disease (depression, psychogenic eating disorders). CONCLUSION Recognition of the underlying disease is often delayed by a lack of awareness for weight changes, both by physicians and by patients. Nutritional counselling and treatment should be initiated in time.
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Affiliation(s)
- A Schwenk
- Klinik 1 für Innere Medizin, Universität zu Köln.
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