Related Experiment Videos
Leucocyte count as an alternative to ESR in general practice?
G J Dinant1, A Knottnerus, J Van Wersch
1University of Limburg, The Netherlands.
Insights
The erythrocyte sedimentation rate (ESR) better distinguishes serious inflammatory diseases and malignancies than leucocyte counts in general practice. Leucocyte counts are not a clinically valuable alternative to ESR for diagnosing new patient complaints.
Area of Science:
- General Practice
- Clinical Diagnostics
- Biomarker Analysis
Background:
- Differentiating serious inflammatory diseases and malignancies from benign conditions is crucial in general practice.
- The erythrocyte sedimentation rate (ESR) and leucocyte count are commonly used diagnostic markers.
- Evaluating the comparative diagnostic utility of these markers is essential for optimizing patient care.
Purpose of the Study:
- To compare the diagnostic discrimination ability of leucocyte count versus ESR for identifying inflammatory diseases and malignancies.
- To assess the clinical utility of leucocyte count as an alternative to ESR in general practice settings.
Main Methods:
- Prospective study involving 151 patients presenting with new complaints to nine general practitioners.
- ESR and leucocyte count were measured for each patient.
- Follow-up diagnoses were determined after three months to compare with initial test results.
Main Results:
- ESR demonstrated superior discriminating ability compared to leucocyte count.
- ESR achieved a sensitivity of 53%, specificity of 84%, positive predictive value of 29%, and negative predictive value of 93%.
- Receiver Operating Characteristic analysis confirmed ESR's better performance irrespective of reference values.
Conclusions:
- Leucocyte count determination is not a clinically significant alternative to ESR for diagnostic purposes in general practice.
- ESR remains a more valuable biomarker for discriminating between serious and benign conditions in this setting.
Abstract:
We investigated the ability of the leucocyte count to discriminate between "inflammatory diseases and malignancies" on the one hand and other, often harmless and self-limiting diseases on the other, and compared this ability with that of the erythrocyte sedimentation rate (ESR) in general practice. In cooperation with nine general practitioners (GP) we prospectively followed 151 patients who were seen by their GP because of a new complaint for which the GP wanted to know their ESR. ESR and one leucocyte count measurement (Technicon H6000) were performed at the local hospital laboratory. The patients were seen again after three months, to determine the follow-up diagnoses. By comparing the test results with the follow-up diagnoses, ESR was found to have a better discriminating ability than the leucocyte count test (ESR: sensitivity = 53%, specificity = 84%, positive predictive value = 29%, negative predictive value = 93%, Odds Ratio = 5.73). Using Receiver Operating Characteristic analysis, this conclusion could be shown to be independent of the chosen reference values. We conclude that the determination of the leucocyte count is not a clinically interesting alternative to ESR.