| アブストラクト | 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 AND SETTING: 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. |
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| ジャーナル名 | The British journal of general practice : the journal of the Royal College of General Practitioners |
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| 投稿日 | 2018/8/15 |
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| 投稿者 | Koshiaris, Constantinos; Van den Bruel, Ann; Oke, Jason L; Nicholson, Brian D; Shephard, Elizabeth; Braddick, Mick; Hamilton, William |
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| 組織名 | Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford.;University of Exeter Medical School, Exeter.;Chiddenbrook Surgery, Crediton, Devon. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30104326/ |
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