Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care
<p>Background: Multiple myeloma is a haematological cancer characterised by numerous non-specific symptoms leading to diagnostic delay in a large proportion of patients.</p><p> Aim: To identify which blood tests are useful in suggesting or excluding a diagnosis of myeloma.</p&g...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
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Royal College of General Practitioners
2018
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| _version_ | 1826261938082938880 |
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| author | Koshiaris, C Van Den Bruel, A Oke, J Nicholson, B Shephard, E Braddick, M Hamilton, W |
| author_facet | Koshiaris, C Van Den Bruel, A Oke, J Nicholson, B Shephard, E Braddick, M Hamilton, W |
| author_sort | Koshiaris, C |
| collection | OXFORD |
| description | <p>Background: Multiple myeloma is a haematological cancer characterised by numerous non-specific symptoms leading to diagnostic delay in a large proportion of patients.</p><p> Aim: To identify which blood tests are useful in suggesting or excluding a diagnosis of myeloma.</p><p> Design and setting: A matched case–control study set in UK primary care using routinely collected data from the Clinical Practice Research Datalink.</p><p> 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).</p><p> 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).</p><p> 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.</p> |
| first_indexed | 2024-03-06T19:28:27Z |
| format | Journal article |
| id | oxford-uuid:1c9cd9b3-e168-4522-8029-c7cc32048d82 |
| institution | University of Oxford |
| last_indexed | 2024-03-06T19:28:27Z |
| publishDate | 2018 |
| publisher | Royal College of General Practitioners |
| record_format | dspace |
| spelling | oxford-uuid:1c9cd9b3-e168-4522-8029-c7cc32048d822022-03-26T11:06:31ZEarly detection of multiple myeloma in primary care using blood tests: a case–control study in primary careJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:1c9cd9b3-e168-4522-8029-c7cc32048d82Symplectic Elements at OxfordRoyal College of General Practitioners2018Koshiaris, CVan Den Bruel, AOke, JNicholson, BShephard, EBraddick, MHamilton, W<p>Background: Multiple myeloma is a haematological cancer characterised by numerous non-specific symptoms leading to diagnostic delay in a large proportion of patients.</p><p> Aim: To identify which blood tests are useful in suggesting or excluding a diagnosis of myeloma.</p><p> Design and setting: A matched case–control study set in UK primary care using routinely collected data from the Clinical Practice Research Datalink.</p><p> 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).</p><p> 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).</p><p> 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.</p> |
| spellingShingle | Koshiaris, C Van Den Bruel, A Oke, J Nicholson, B Shephard, E Braddick, M Hamilton, W Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care |
| title | Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care |
| title_full | Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care |
| title_fullStr | Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care |
| title_full_unstemmed | Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care |
| title_short | Early detection of multiple myeloma in primary care using blood tests: a case–control study in primary care |
| title_sort | early detection of multiple myeloma in primary care using blood tests a case control study in primary care |
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