Erythrocyte Sedimentation Rate, Markedly Elevated

9/22/00 (Schultz)

Group: Friday Interns

RE: A 34 year old male with 2 weeks of fatigue, headache, fever, and cough

Question: What is the significance of a markedly elevated erythrocite sedimentation rate?

Link Directly to Fulltext Article at Publisher

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Unique Identifier: 98180655

Authors: Saadeh C.

Institution: Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo 79106, USA.

Abstract: BACKGROUND: The erythrocyte sedimentation rate (ESR) is a simple and inexpensive laboratory test. It is commonly used to assess the acute phase response. METHODS: A review of the recent literature was done to evaluate the role of the ESR and its importance in different clinical conditions both inflammatory and noninflammatory. RESULTS: Despite the critical role cytokines have in inflammatory conditions, the ESR still maintains its important role in the diagnosis and follow-up of rheumatoid arthritis and temporal arteritis. Recently, ESR has been reported to be of clinical significance in sickle cell disease, osteomyelitis, and, surprisingly, in noninflammatory conditions such as stroke, coronary artery disease, and prostate cancer. Erythrocyte sedimentation rate measured by the Westergren method is marginally affected by age, race, and blood storage. CONCLUSION: Despite its importance in many clinical conditions, ESR should be used only as a clinical guide to aid the diagnosis, management, and follow-up of these different clinical situations. [References: 42]

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Unique Identifier: 96297547

Authors: Lluberas-Acosta G. Schumacher HR Jr.

Institution: Jacquelyn McClure Lupus Center, Atlanta, Georgia, USA.

Abstract: In order to evaluate the clinical significance of very high erythrocyte sedimentation rates (ESRs) we studied 100 consecutive men in a VA Medical Center whose Westergren ESR was more than 100mm/hr. All were followed for up to six months and the ESR-requesting physicians were interviewed. A total of 162 diagnoses known to be associated with an elevated ESR were present in the 90 patients available for follow up. As in most previous series on very high ESRs, infections (seen in 43 patients) were the most common diagnoses. Other diagnoses included: malignancy (16), rheumatologic disease (30), other inflammatory diseases (seven), renal disease (25), and miscellaneous problems (38). Evaluation of 16 patients led to a diagnosis that had not initially been apparent--the ESR-requesting physician did not consider that a high ESR was instrumental in guiding him towards any of these delayed diagnoses. Most of the markedly elevated ESRs in this patient population, requested in the context of already evident serious multisystem disease, contributed little diagnostic information.

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Unique Identifier: 86268179

Authors: Fincher RM. Page MI.

Abstract: Charts of 1006 consecutive outpatients were reviewed to ascertain the cause of extreme elevation of the erythrocyte sedimentation rate (ESR) (greater than or equal to 100 mm/h) and the sensitivity of marked ESR elevation in patients with disorders commonly reported to cause ESR elevation. Prevalence of ESRs of 100 mm/h or more was 4.2%. Infection was the most common cause (33%), with malignant neoplasms and renal disease each responsible for 17% and inflammatory disorders for 14%. Only 1% of all other patients had ESRs of 100 mm/h or more. An ESR of 100 mm/h or more had low sensitivity: 36% among patients with infection, 25% among those with malignant neoplasms, and 21% among patients with noninfectious inflammatory disorders. Specificity was high, both for individual disease categories (96% for malignant neoplasms and 97% for infection) and as a "sickness" index (greater than 99%). The positive predictive value for an identifiable cause of marked ESR elevation was 90%.

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Unique Identifier: 78075049

Authors: Wyler DJ.

Abstract: To reevaluate the diagnostic significance of a markedly elevated erythrocyte sedimentation rate (ESR), the clinical diagnosis associated with an ESR of 100 mm/hr or greater was retrospectively analyzed in 200 patients at the Massachusetts General Hospital. In contrast to previously reported experiences in the the American literature suggesting a high frequency (58 percent) of malignant disease in such patients, the present study found infections to be the most frequently associated diseases (35 percent), while malignant disease accounted for only 15 percent of the patients. Review of the foreign literature similarly suggested infection rather than malignancy as a major association with markedly elevated ESRs. It is concluded that an ESR greater than or equal to 100 mm/hr has little diagnostic specificity and should not of itself dictate evaluation for occult malignancy in most patients.