Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?

Full 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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Author information

Author/s: Metalidis, Christoph (C); Knockaert, Daniël C (DC); Bobbaers, Herman (H); Vanderschueren, Steven (S);

Affiliation: Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.

Journal and publication information

Publication Type: Journal Article

Journal: European journal of internal medicine (Eur J Intern Med), published in Netherlands. (Language: eng)

Reference: 2008-Jul; vol 19 (issue 5) : pp 345-9

Dates: Created 2008/06/13; Completed 2008/07/25;

PMID: 18549937, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Albumins - metabolism
C-Reactive Protein - metabolism
Causality
Comorbidity
Female
Hemoglobins - metabolism
Humans
Liver Function Tests

Liver Function Tests
Male
Mental Disorders - diagnosis; epidemiology
Middle Aged
Neoplasms - diagnosis; epidemiology
Predictive Value of Tests
Prognosis
Prospective Studies
Weight Loss

Associated Chemicals: Albumins (0) ; Hemoglobins (0) ; C-Reactive Protein (9007-41-4)

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