Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
J Cachexia Sarcopenia Muscle. 2022 Dec;13(6):2661-2668. doi: 10.1002/jcsm.13056. Epub 2022 Sep 3.
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.
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.
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).
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.
在初级保健中就诊的患者出现意外体重减轻（UWL），由于与 UWL 相关的广泛鉴别诊断，管理存在困境。迄今为止，关于 UWL 患者中严重疾病风险的研究主要发生在二级保健中，这限制了其在初级保健患者中的普遍性。在这项研究中，我们使用大型匹配队列研究来估计记录在案的 UWL 患者中 12 种严重疾病的风险，按年龄和性别分层，以便为 UWL 患者提供合理的临床方法。
这是一项使用英国临床实践研究数据链接（CPRD）电子健康记录（EHR）进行的回顾性匹配队列研究。每位 UWL 患者（从 EHR 编码中确定）与 5 名无 UWL 的患者匹配，并随访至严重疾病的最早诊断、死亡日期、退出 CPRD 数据库或研究结束。观察到的 12 种严重疾病的绝对风险作为概率进行估计，使用 Cox 比例风险模型估计风险比（HR）。
在 2000 年至 2012 年期间，CPRD 中有 70193 名患者至少有一次 UWL 记录，并与 295579 名无 UWL 的患者相匹配。与无 UWL 的患者相比，UWL 患者几乎所有严重疾病的风险都显著更高。HR 范围从充血性心力衰竭的 1.43（95%置信区间（CI）：1.27-1.62）到吸收不良的 9.70（95%CI：6.81-13.82）。任何特定严重疾病的绝对风险相对较低（<1 年后的 6%）。绝对风险的大小和等级顺序因年龄和性别而异。对于<80 岁的女性，抑郁症是 UWL 最常见的诊断（<60 岁的女性中占 3.74%，60-79 岁的女性中占 2.46%），而对于<60 岁的男性，糖尿病是最常见的诊断（2.96%），对于 60 岁及以上的男性，癌症是最常见的诊断（60-70 岁的男性中占 3.79%，≥80 岁的男性中占 5.28%）。
这项分析为出现 UWL 的初级保健患者的患者和临床医生提供了有关严重疾病风险的新证据。根据年龄和性别，结果表明 UWL 的检查应包括糖尿病、甲状腺功能减退症、抑郁症和痴呆的筛查。如果及时进行，这种检查可以用于对有资格接受癌症途径转诊的患者进行分诊。
