Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?
| Autor: | Christoph Metalidis, Daniel Knockaert, Herman Bobbaers, Steven Vanderschueren |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty medicine.medical_treatment Physical examination Comorbidity Organic disease Hemoglobins Liver Function Tests Predictive Value of Tests Weight loss Interquartile range Albumins Neoplasms Weight Loss Internal Medicine medicine Humans Prospective Studies Aged medicine.diagnostic_test business.industry Mental Disorders Middle Aged Prognosis medicine.disease Surgery Causality C-Reactive Protein Predictive value of tests Female medicine.symptom business Liver function tests Watchful waiting |
| Zdroj: | European Journal of Internal Medicine. 19:345-349 |
| ISSN: | 0953-6205 |
| DOI: | 10.1016/j.ejim.2007.09.019 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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