Related Experiment Video
Updated: Aug 16, 2026
Erythrocyte Sedimentation Rate: A Physics-Driven Characterization in a Medical Context
Published on: March 24, 2023
Higher erythrocyte sedimentation rate is associated with accelerated white matter lesion progression
Anshum A Patel1, Hans Mautong2, Sai K Vallamchetla1
1Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.
Background:
The erythrocyte sedimentation rate (ESR) is a non-specific marker of systemic inflammation. White matter lesions (WMLs), appeared as hyperintensities on T2-weighted and FLAIR MRI, reflect chronic microvascular ischemia of cerebral white matter. Inflammation has been implicated in the pathogenesis and progression of WML. We hypothesized that higher ESR levels are associated with greater WML progression.
Methods:
We retrospectively screened 2356 patients aged ≥40 years or older who underwent serial MRI brain at least one year apart between 2011 and 2015 at the Mayo Clinic 1,377 patients with an available baseline ESR measurement were included in the analysis. ESR was annual rate of of WMH progression stratified into quartiles; high ESR was defined as values >23 mm/hr (Q4), whereas low ESR was defined as values ranging from 0 to 23 mm/hr (Q1-Q3). . The primary outcome was the annualized change in WML volume (cc/year). Univariate and multivariable linear regression analyses assessed the association between ESR and WML progression.
Results:
Of the 1377 patients meeting the inclusion criteria, 54.2% were female, and the median age was 69 (IQR 60-76) years. The annual rate of WMH progression was faster in high-ESR group than in the low-ESR group (median 0.93 cc/year vs. 0.76 cc/year, p = 0.010). In univariate regression analysis, high ESR was significantly associated with greater WML progression (β = 0.42, p = 0.013). After multivariable adjustment, including baseline WML volume, upper-quartile ESR remained independently associated with greater annualized WML progression (β = 1.23; 95% CI 0.17-2.28; p = 0.023).
Conclusion:
Elevated ESR independently predicts WML progression, suggesting that systemic inflammation may contribute to the progression of cerebral small vessel disease.
Insights
Elevated erythrocyte sedimentation rate (ESR) is linked to faster white matter lesion (WML) progression in adults. This suggests systemic inflammation may drive the worsening of cerebral small vessel disease.
Area of Science:
- Neurology
- Inflammation research
- Medical imaging
Background:
- Erythrocyte sedimentation rate (ESR) is a non-specific marker of systemic inflammation.
- White matter lesions (WMLs) on MRI indicate chronic microvascular ischemia.
- Inflammation is suspected to play a role in WML pathogenesis and progression.
Purpose of the Study:
- To investigate the association between ESR levels and the progression of WMLs.
- To determine if higher ESR predicts increased WML volume change over time.
Main Methods:
- Retrospective analysis of 1377 patients (≥40 years) with serial brain MRIs.
- ESR levels were stratified into quartiles; high ESR was defined as >23 mm/hr.
- Linear regression models assessed the association between ESR and annualized WML volume change.
Main Results:
- Patients with high ESR showed a faster annual rate of WML progression (0.93 cc/year) compared to those with low ESR (0.76 cc/year).
- High ESR was significantly associated with greater WML progression in univariate analysis.
- Even after multivariable adjustment, upper-quartile ESR independently predicted greater annualized WML progression (β=1.23, p=0.023).
Conclusions:
- Elevated ESR is an independent predictor of WML progression.
- These findings suggest systemic inflammation contributes to the progression of cerebral small vessel disease.
