Early detection of multiple myeloma in primary care using blood tests: a case-control study in primary care.
Br J Gen Pract
; 68(674): e586-e593, 2018 Sep.
Article
em En
| MEDLINE
| ID: mdl-30104326
ABSTRACT
BACKGROUND:
Multiple myeloma is a haematological cancer characterised by numerous non-specific symptoms leading to diagnostic delay in a large proportion of patients.AIM:
To identify which blood tests are useful in suggesting or excluding a diagnosis of myeloma. DESIGN ANDSETTING:
A matched case-control study set in UK primary care using routinely collected data from the Clinical Practice Research Datalink.METHOD:
Symptom prevalence and blood tests were analysed up to 5 years before diagnosis in 2703 cases and 12 157 matched controls. Likelihood ratios (LR) were used to classify tests or their combinations as useful rule-in tests (LR+ = ≥5), or rule-out tests (LR- = ≤0.2).RESULTS:
Raised plasma viscosity (PV) had an LR+ = 2.0, 95% confidence interval [CI] = 1.7 to 2.3; erythrocyte sedimentation rate (ESR) 1.9, 95% CI = 1.7 to 2.0; and C-reactive protein (CRP) 1.2, 95% CI = 1.1 to 1.4. A normal haemoglobin had an LR- = 0.42, 95% CI = 0.39 to 0.45; calcium LR- = 0.81, 95% CI = 0.78 to 0.83; and creatinine LR- = 0.80, 95% CI = 0.77 to 0.83. The test combination with the lowest LR- was all normal haemoglobin with calcium and PV, which had an LR- = 0.06, 95% CI = 0.02 to 0.18, though the LR- for normal haemoglobin and PV together was 0.12 (95% CI = 0.07 to 0.23).CONCLUSION:
Plasma viscosity and ESR are better for both ruling in and ruling out the disease compared with C-reactive protein. A combination of a normal ESR or PV and normal haemoglobin is a simple rule-out approach for patients currently being tested in primary care.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Cuidados_paliativos
/
Geral
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Tipos_de_cancer
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Outros_tipos
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Testes Diagnósticos de Rotina
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Detecção Precoce de Câncer
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Mieloma Múltiplo
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Prevalence_studies
/
Risk_factors_studies
/
Screening_studies
Limite:
Aged
/
Female
/
Humans
/
Male
País/Região como assunto:
Europa
Idioma:
En
Revista:
Br J Gen Pract
Ano de publicação:
2018
Tipo de documento:
Article