Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy

Cachot, Joaquim Torné; Azcona, José Manuel; Falp, Jesús Blanch; Pont, Javier García; Ilari, Helena Camell

doi:10.1016/j.medcle.2019.03.008

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…These differences may be due to the inclusion of hospitalized patients in the other studies [ 17 , 23 ] (evaluated outside the RDU) or, in the case of studies of IWL performed in RDUs, the inclusion of patients with other specific symptoms [ 15 ]. Consistent with other published series, malignancies were more frequent in men [ 10 , 15 , 24 ] and in older patients [ 3 , 10 , 15 , 24 ].…”

Section: Discussionsupporting

confidence: 91%

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Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit

et al. 2021

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Background Numerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL. Methods A single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months. Results Seven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1–21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2–68.2). Conclusions Almost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.

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Section: Discussionsupporting

confidence: 91%

“…The most frequent cause of IWL in our sample was non-malignant organic disease (44.5%). Previous studies have found similar rates for non-malignant organic disease, ranging from 33.8% to 50.7% [ 3 , 7 , 15 , 18 – 20 , 24 – 26 ].…”

Section: Discussionmentioning

confidence: 75%

Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit

et al. 2021

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Serious disease risk among patients with unexpected weight loss: a matched cohort of over 70 000 primary care presentations

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Smith

et al. 2022

J cachexia sarcopenia muscle

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Background Unexpected weight loss (UWL) in patients consulting in primary care presents dilemmas for management because of the broad differential diagnoses associated with UWL. Research on the risks of serious disease among patients with UWL to date has largely taken place in secondary care, limiting generalizability to primary care patients. In this study, we use a large matched cohort study to estimate the risks of 12 serious diseases among patients presenting to primary care with UWL where this was recorded, stratified by age and sex, in order to inform a rational clinical approach to patients presenting with UWL. Methods This was a retrospective matched cohort study using electronic health records (EHRs) from the UK Clinical Practice Research Datalink (CPRD). Each patient with UWL (ascertained from EHR coding) was matched to five patients without UWL and followed until the earliest of a diagnosis of the serious disease, date of death, exit from the CPRD database, or end of the study. Observed absolute risks of the 12 serious diseases were estimated as probabilities, and hazard ratios (HRs) were estimated with Cox proportional hazards models. Results Between 2000 and 2012, 70 193 patients in CPRD had at least one record of UWL and were matched with 295 579 patients without UWL. Patients with UWL had significantly higher risk of nearly all serious diseases examined compared with patients without. HRs ranged from 1.43 for congestive heart failure [95% confidence interval (CI): 1.27-1.62] to 9.70 for malabsorption (95% CI: 6.81-13.82). The absolute risks of any given serious disease were relatively low (<6% after 1 year). The magnitude and rank order of absolute risks varied by age and sex. Depression was the most common diagnosis among women aged <80 with UWL (3.74% of women aged <60 and 2.46% of women aged 60-79), whereas diabetes was the most common in men <60 with UWL (2.96%) and cancer was the most common in men aged 60 and over with UWL (3.79% of men aged 60-70 and 5.28% of men aged ≥80). Conclusions This analysis provides new evidence to patients and clinicians about the risks of serious disease among patients presenting with UWL in primary care. Depending on age and sex, the results suggest that workup for UWL should include screening for diabetes, thyroid dysfunction, depression, and dementia. If performed in a timely manner, this workup could be used to triage patients eligible for cancer pathway referral.

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Unintentional weight loss: what radiologists need to know and what clinicians want to know

et al. 2021

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Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy

Cited by 4 publications

References 26 publications

Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit

Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit

Serious disease risk among patients with unexpected weight loss: a matched cohort of over 70 000 primary care presentations

Unintentional weight loss: what radiologists need to know and what clinicians want to know

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