Markedly elevated erythrocyte sedimentation rates: consideration of clinical implications in a hospital population

Area of Science:

• Clinical Medicine
• Diagnostic Pathology
• Laboratory Hematology

Background:

• Very high erythrocyte sedimentation rates (ESRs) are frequently observed in clinical practice.
• The diagnostic utility of markedly elevated ESRs, particularly in patients with existing multisystem disease, requires further evaluation.

Purpose of the Study:

• To assess the clinical significance and diagnostic contribution of very high Westergren erythrocyte sedimentation rates (ESRs > 100 mm/hr).

Main Methods:

• Prospective study of 100 male patients with ESR > 100 mm/hr at a VA Medical Center.
• Follow-up for up to six months with interviews of ESR-requesting physicians.
• Analysis of diagnoses associated with elevated ESRs and their impact on clinical decision-making.

Main Results:

• A total of 162 diagnoses associated with elevated ESRs were identified in 90 patients.
• Infections were the most common diagnoses (43 patients), followed by rheumatologic disease (30), renal disease (25), and malignancy (16).
• In 16 patients, a diagnosis was made that was not initially apparent, but physicians did not attribute this to the high ESR guiding their diagnosis.

Conclusions:

• Markedly elevated ESRs in patients with established serious multisystem disease often contribute little new diagnostic information.
• The clinical significance of very high ESRs may be overestimated when requested in the context of already diagnosed complex conditions.
• Further research is needed to clarify the role of ESR in guiding diagnosis for specific patient populations.