CLINICAL PRESENTATION OF (SUBCLINICAL) JAUNDICE - THE EURICTERUS PROJECT IN THE NETHERLANDS

Background: From a primary clinical database, rue wanted to obtain ins ight in disease distribution and clinical presentation of adult jaundi ced patients in a Western country. Materials and Methods: As part of t he Euricterus project, 24 Dutch general and academic hospitals in a pe riod of 2 years gathered prospectively 702 patients on a standard prof orma. Patient aged 16 years or more (median 61) and with a serum bilir ubin of 20mmol/l or more (median 83) were included. The final diagnosi s was established within 3 months. Results: Pancreatic or biliary carc inoma(20%), gallstone disease(13%) and alcoholic liver cirrhosis(10%) were the 3 most frequent diagnoses. Imaging(79%), clinical course(63%) and chemistry/serology(57%) were the most used ascertaining methods. Pancreatic or biliary carcinoma and gallstone disease were more common and age higher in, general hospitals (p=0.0001), and 'immunological' liver disease, non-alcoholic cirrhosis and hepatocellular carcinoma(HC C) more common in academic hospitals (p=0.001). Patients aged 90 years or older (13%) had pancreatic or biliary carcinoma, liver metastases or heart failure and patients with age less than 20 (0.9%) had acute v iral hepatitis, nonalcoholic active liver disease or HCC. Risk factors were more apparent(p<0.02) in those aged less than 61 years. Feeling unwell(78%), dark urine(67%) and anorexia(57%) were the 3 most frequen t symptoms; the 3 most frequent signs were liver enlarged(39%), lookin g ill(29%) and appearing wasted(23%). Conclusions: Through Euricterus, fresh clinical knowledge has emerged of symptomatology, age stratific ation and hospital preponderance of (sub)clinical jaundice in this cou ntry. This is important both for teaching and in preparing clinical st udies.