Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score

doi:10.1016/S0953-6205(02)00032-8

European Journal of Internal Medicine

Volume 13, Issue 4, June 2002, Pages 240-245

https://doi.org/10.1016/S0953-6205(02)00032-8 Get rights and content

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.

Introduction

Involuntary weight loss (IWL) is a frequent complaint that causes concern to both the patient and the attending physician because of the possibility of a severe underlying disease. The best clinical approach to IWL remains unclear, especially in the absence of specific clinical clues [1]. A few studies analyzed this problem, most of them in the 1980s [2], [3], [4], [5], [6].

We undertook this study with the following objectives: (1) to evaluate the underlying clinical disorders in patients presenting with IWL; (2) to define a clinical protocol for the study of IWL; and (3) to develop a clinical prediction rule that might help in the management of these patients.

Section snippets

Setting

Fundación Hospital Alcorcón is a public general hospital in the southwest of Madrid that serves about 250 000 inhabitants. Our internal medicine department has an outpatient clinic where nearly 1400 new patients are seen every year.

Study protocol

In March 1998 we defined a diagnostic protocol for the study of involuntary weight loss (IWL) adapted from Foster [7] (Table 1, Table 2). From March 1998 to December 2000, all patients referred to our clinic with IWL as the main clinical complaint were included in

Results

Of the 91 patients with IWL seen at our internal medicine clinic, 78 (86%) were included in the study. The 13 patients who were not included because they did not have enough follow-up to achieve a diagnosis did not differ in sex or age from the patients who were included. Fifty-one percent of the patients were women, and their mean age was 59±19 years.

The primary care physician referred 85% of the patients. Eighteen patients (23%) were hospitalized for study due to a deterioration in their

Discussion

In general, weight loss occurs because of decreased caloric intake, alterations in energy metabolism, or loss of calories in the urine or feces. Different abnormalities in energy metabolism have been described and multiple factors contributing to weight loss may be present in a particular patient with cancer, AIDS, or in elderly patients [1], [9]. The precise mechanisms underlying weight loss are currently being elucidated and probably involve the action of different hormones and cytokines [1],

Acknowledgements

We thank Alejandra Perez del Real for her helpful technical assistance.

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Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy
2019, Medicina Clinica
Los objetivos del estudio han sido analizar la epidemiología, el pronóstico y los factores predictivos de enfermedad maligna de la pérdida de peso involuntaria aislada (PPIA) y conocer la efectividad de una unidad de diagnóstico rápido en la evaluación del proceso.
Estudio prospectivo observacional realizado en el período de 2006-2015 de todos los pacientes evaluados de PPIA en la unidad de diagnóstico rápido. Se analizaron variables demográficas, clínicas, diagnósticas y evolutivas. Mediante un análisis de regresión logística se identificaron los factores predictivos de enfermedad maligna y factores pronósticos.
De los 533 pacientes registrados, el 55,1% tenían una edad ≥ 65 años. Los diagnósticos fueron: trastornos orgánicos no neoplásicos en 214 pacientes (40,2%), trastornos psiquiátricos en 144 (27%), cáncer en 81 (15,2%) y causa desconocida en 94 (17,6%). En el 66,7% de los pacientes con cáncer existía el aumento de algún marcador tumoral sérico (MTS). La edad > 60 años (OR: 2,71; IC 95%: 1,27-5,77; p = 0,01), el género masculino (OR: 3,23; IC 95%: 1,52-6,87; p = 0,002), el aumento de un MTS (OR: 2,38; IC 95%: 1,17-4,8; p = 0,016) y más de un MTS (OR: 6,51; IC 95%: 2,62-16,13; p = 0,000) se identificaron como factores predictivos de enfermedad maligna. La mortalidad fue del 14,2%, asociándose como factor pronóstico el diagnóstico de cáncer (OR: 47,61; IC 95%: 20,76-109;19; p = 0,000).
La PPIA es un síndrome clínico que requiere un estudio protocolizado secuencial y un seguimiento. Los MTS se han identificado como factores predictivos de enfermedad maligna.
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.
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.
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.
IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy.
Involuntary weight loss
2014, Medical Clinics of North America
Citation Excerpt :
Estimates of the incidence of involuntary weight loss vary. The yearly incidence in case series from referral centers varies between 0.6% and 7.3% per year.20,22,24,35,36 These estimates depend on the particular patient populations and referral patterns, as well as the definition of involuntary weight loss used.
Initial study of patients with constitutional syndrome in primary care
2012, FMC Formacion Medica Continuada en Atencion Primaria
Evaluating diagnostic strategy of older patients with unexplained unintentional body weight loss: A hospital-based study
2011, Archives of Gerontology and Geriatrics
Citation Excerpt :
In general, causes of UUWL can be classified into organic (malignancy and non-malignant diseases), neuropsychiatric and idiopathic entities. Among these underlying etiologies, cancer is always of great concerns and it accounted for 6–38% of all patients with UUWL (Marton et al., 1981; Thompson and Morris, 1991; Lankisch et al., 2001; Bilbao-Garay et al., 2002; Hernandez et al., 2003a,b; Vanderschueren et al., 2005; Chen et al., 2010). In this study, the prevalence of cancer was 16.9%, and it of benign organic diseases 33.8%, which were similar to the previous report (Lankisch et al., 2001).
Unexplained unintentional weight loss (UUWL) is a common health problem in older adults, and raises significant diagnostic challenges. Currently, there is no consensus or guideline to help physicians approach these patients. The main purpose of this study is to evaluate physicians’ behaviors in evaluating elderly patients with UUWL and to compare the diagnostic strategy of internists and geriatricians. From January of 2008 to December of 2009, medical records of all elderly patients admitted to Taipei Veterans General Hospital with UUWL were obtained for study. All diagnostic procedures used during admissions were evaluated and the final diagnosis for each patient was obtained. Overall, data of 136 patients (mean age: 79.8 ± 6.3 years, 80.9% males) were obtained for study with their mean weight loss of 8.6 ± 6.4 kg. Among them, 79 (58.1%) patients were admitted to the geriatric evaluation and management unit (GEMU) and 57 (41.9%) patients were admitted to the general medical wards. There were no statistically significant differences in terms of age, sex, mean age and average weight loss between these two groups. After extensive diagnostic effort, the most common diagnostic entity was benign organic disease (33.8%), followed by unknown (25.7%), neuropsychiatric disorder (23.5%), and malignancy (16.9%). Tumor markers are commonly used, including carcinoembryonic antigen (CEA) (80.9%), prostate specific antigen (PSA) (81.8%), and carbohydrate 19-9 (CA 19-9) (65.4%). Imaging studies were also commonly used diagnostic tools, including gastrointestinal endoscopy (70.6%), colonoscopy (42.6%) and computerized tomography (44.1%). Compared with internists, geriatricians were more likely to order PSA testing (70.5% vs. 89.4%, p = 0.021). In contrast, internists were more likely to order CA-199 (75.4%% vs. 58.2%, p = 0.045), and to arrange gastrointestinal endoscopy than geriatricians (82.4% vs. 62.0%%, p = 0.013). In conclusion, cancer accounts for only 16.9% of all elderly patients with UUWL in this study, tumor markers are very commonly used for screening of occult cancer. Compared with internists, geriatricians are more likely to order PSA and to establish neuropsychiatric diagnosis, and internists are more prone to order carbohydrate (CA 19-9) and gastrointestinal endoscopy.
Relationship Between Body Mass Index and Mortality in Adults on Maintenance Hemodialysis: A Systematic Review
2010, Journal of Renal Nutrition
Citation Excerpt :
Participants who were overweight or obese at a young age and those who lost weight between age 21 and study entry had an increased mortality irrespective of their BMI category at a young age.79 Weight loss is a known risk factor for mortality in the elderly, and mortality rates of 9% to 38% have been observed within one to two and a half years after weight loss.80–82 Unintentional weight loss may reflect severity of underlying diseases such as CVD, cancer, or infections, all common causes of death in the studies reported in this systematic review.
The primary objective of this systematic review was to determine the relationship between body mass index (BMI) and all-cause and cardiovascular mortality.
Systematic review of primarily observational studies.
Adult patients from all gender, race, or ethnic groups on maintenance hemodialysis.
Medline, Science Citation Index, Academic Search Premier, Cochrane Library, and Embase electronic databases covering the period 1966 to December 2008 were searched with the help of a qualified librarian. Reference lists of included papers and collections also were searched. Each study was reviewed by 2 independent reviewers who also performed the data extraction from full papers. Differences between reviewers were resolved by consensus or by a third reviewer in the case of disagreements. The quality of studies selected for inclusion in the systematic review was also assessed by 2 independent reviewers.
BMI and mortality.
Eighteen studies (60%) reported a significant inverse relationship between all-cause mortality and BMI. This inverse relationship was more prevalent in older patients, larger retrospective studies, and studies that did not adjust for inflammation. On the other hand, 57% of the 7 studies reporting on cardiovascular mortality found no significant relationship with BMI.
This systematic review shows evidence of an inverse relationship between BMI and all-cause mortality in adult patients on maintenance HD, especially in older patients, but the relationship with cardiovascular mortality is less clear.
Reason for consultation: Weight loss
2018, Semergen
La pérdida de peso es un motivo frecuente de consulta que abarca múltiples posibilidades diagnósticas. El objetivo de este trabajo es estudiar las características de los pacientes que acuden a consulta por pérdida de peso y establecer la relación de esta con las neoplasias.
Se analizaron datos demográficos, pérdida de peso cuantificada, sintomatología acompañante y diagnóstico de los pacientes que acuden a consulta por este motivo, durante el año 2015.
Se incluyeron 226 pacientes, de los cuales el 44,2% presentaba una pérdida de peso ≥ 5% en los 6 meses previos. El diagnóstico más frecuente en este grupo fueron las neoplasias, mientras que en el resto de los pacientes fueron las enfermedades digestivas. Se establece relación entre una pérdida de peso ≥ 5% y la presencia de neoplasias.
Una pérdida de peso superior al 5% en los 6 meses previos se asocia con la presencia de enfermedades neoplásicas, lo que exige un estudio diagnóstico exhaustivo.
Unintentional weight loss is frequent reason to visit a doctor and it has multiple diagnostic possibilities. The objective of this study is to examine the background of the patients who seek consultation for weight loss and to establish the relationship between weight loss and neoplasia.
An analysis was performed on the demographic data, quantified weight loss, accompanying symptomatology, and diagnosis of patients who sought medical advice for unintentional weight loss during the year 2015.
A total of 226 patients were included, of whom 44.2% of them had an intentional weight loss ≥ 5% in 6 months. The most frequent diagnosis in this group was a neoplasia, whereas in the rest of patients the most common diagnosis was a gastrointestinal disease. In light of this study we can conclude that there is a relationship between unintentional weight loss ≥ 5% and the presence of neoplasia.
An unintentional weight loss greater than 5% in the previous 6 months is associated with the presence of neoplastic diseases, and therefore requires further diagnostic study.

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Original articleAssessing clinical probability of organic disease in patients with involuntary weight loss: a simple score

Abstract

Introduction

Section snippets

Setting

Study protocol

Results

Discussion

Acknowledgements

Med Clin North Am

Rev Med Interne

Involuntary weight loss: diagnostic and prognostic significance

Ann Intern Med

Unintentional weight loss: a retrospective analysis of 154 cases

Arch Intern Med

Unexplained weight loss in the ambulatory elderly

J Am Geriatr Soc

Involuntary weight loss as a clinical problem

Rev Invest Clin

Gain and loss in weight

Original article
Assessing clinical probability of organic disease in patients with involuntary weight loss: a simple score