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Utility of Routine Hematological and Inflammation Parameters for the Diagnosis of Cancer in Involuntary Weight Loss
  1. Cristian Baicus, MD, PhD*†,
  2. Simona Caraiola, MD*†,
  3. Mihai Rimbas, MD*†,
  4. Ruxandra Patrascu, MD, PhD*,
  5. Anda Baicus, MD, PhD,†‡
  1. From the *Departments of Internal Medicine and Gastroenterology, Colentina University Hospital, Carol Davila University of Medicine; †Clinical Research Unit RECIF (Réseau d' Epidémiologie Clinique International Francophone); and ‡"I. Cantacuzino" National Institute of Research and Development in Microbiology - Immunology, Bucharest, Romania.
  1. Received March 9, 2011, and in revised form April 25, 2011.
  2. Accepted for publication May 11, 2011.
  3. Reprints: Cristian Baicus, MD, PhD, 3rd Department of Internal Medicine, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, 020125 Bucharest, Romania. E-mail: cbaicus{at}
  4. This work was supported by the National Council of Scientific Research in Higher Education (CNCSIS - UEFISCSU), Romanian Ministry of Education and Research (grant number PNII - IDEI 10/2008).
  5. Grupul de Studiu al Scaderii Ponderale Involuntare (The Group for the Study of Involuntary Weight Loss): C. Baicus, C. Badea, E. Balanescu, M. Balea, S. Caraiola, G. Constantin, I. Constantinescu, L. Dimitriu, D. Georgescu, O. Ghizdavu, A. Haidar, M. Ghita, M. Iacob, R.A. Ionescu, P. Leru, A. Marian, R.B. Mateescu, A. Nanu, A. Nicolau, I. Nicolescu, D. Nitescu, R. Patrascu, V. Pompilian, M. Rimbas, S. Tanaseanu, G. Ticu, D. Ursica, Th. Voiosu, R. Voiosu, (Colentina Clinical Hospital), and A. Baicus ("I Cantacuzino" Institute).


Introduction A quarter of patients with involuntary weight loss (IWL) have cancer. Inflammation and anemia are associated with cancer, and recent studies showed that red blood cell distribution width (RDW) is a predictor of mortality, including cancer-related death. The aim of this study was to assess the ability of routine hematological and inflammation parameters to diagnose cancer in patients with IWL.

Materials and Methods A total of 253 consecutive patients with IWL admitted in a secondary care university hospital were included. Routine hematological and inflammatory parameters (hemoglobin level, mean corpuscular volume, RDW, serum iron level, erythrocyte sedimentation rate, C-reactive protein level, and ferritin level) were recorded for all patients. The investigative workup was not standardized, but the patients were followed up for 6 months to avoid misclassification concerning the final diagnosis.

Results All parameters, excepting mean cellular volume, were statistically associated with cancer. The areas under the curve were 0.708 (95% confidence interval [CI], 0.627-0.790) for C-reactive protein level, 0.690 (95% CI: 0.620-0.760) for erythrocyte sedimentation rate, 0.651 (95% CI, 0.566-0.735) for serum iron level, 0.607 (95% CI, 0.526-0.687) for hemoglobin level, 0.598 (95% CI, 0.518-0.679) for ferritin level, 0.594 (95% CI, 0.517-0.671) for RDW, and 0.561 (95% CI, 0.474-0.649) for mean cellular volume. In the multivariable analysis, only erythrocyte sedimentation rate remained associated with cancer.

Conclusions In patients with IWL, the hematological and inflammation parameters were statistically different in patients with cancer and in those without cancer. However, in clinical practice, they were modest diagnostic tests for cancer.

Key Words
  • cancer
  • involuntary weight loss
  • red cell distribution width
  • hemoglobin
  • erythrocyte indices
  • erythrocyte sedimentation rate
  • C-reactive protein
  • ferritin
  • area under curve
  • sensitivity
  • specificity

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