Usefulness of the ESR

The Erythrocyte Sedimentation Rate (ESR or Sed Rate) is one of the most widely used laboratory tests throughout the world, the usefulness of which has been reported by many workers as a screening test for general illness,1-4 or as a marker that can reflect the severity of acute inflammatory disease.5

Monitoring disease and diagnosis
For many years the ESR has been used as part of the monitoring process for patients with temporal arteritis and it is accepted to be of some diagnostic value when taken into consideration with other factors in both this condition and rheumatoid disease.6-7 The test may also be used as an aid to monitor therapy in these conditions. In chronic renal disease, changes in the ESR appear to be due to alterations in fibrinogen concentrations and the constituents of uremic plasma, independent of the degree of anaemia.8

Prognosis maker
The ESR can also be used as a prognosis marker, as shown by a study of ischemic stroke, which indicated that a high ESR on admission was associated with clinical deterioration during the first 24 hours of stroke onset.9 Conversely patients with congestive heart failure who had higher ESR values, had better haemodynamic and clinical benefits. They also had better one and two year survival rates.10 A high ESR in patients with non-metastasising renal cell carcinoma has been shown to indicate a poor prognosis.11Another study monitoring early stage Hodgkin’s disease has shown that the ESR could identify a group of patients at high risk for relapse and subsequent death.12

References
1 Hardison, C. The Sedimentation Rate. Erythrocyte sedimentation rate; blood sedimentation rate. JAMA. 1968; 204: 257.
2 Pincherle G, Shanks J. Value of the erythrocyte sedimentation rate as a screening test. Br J Prev Soc Med. 1967; 21: 133 – 136.
3 Zacharski LR, Kyle RA. Significance of extreme elevation of erythrocyte sedimentation rate. JAMA. 1967; 202: 264 – 266.
4 Fincher RM, Page MI. Clinical significance of extreme elevation of the erythrocyte sedimentation rate. Arch Intern Med. 1986; 146: 1581-1583.
5 Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of ESR and C-reactive protein in assessing the severity of acute pelvic inflammatory disease. Am J Obstet Gynaecol. 1993; 169:1143 – 1149.
6 Beevers DG, Harpur JE, Turk KA. Giant cell arteritis – the need for prolonged treatment. J Chronic Dis. 1973; 26: 571-584.
7 Hamilton CR, Shelley WM, Tumulty PM. Giant cell arteritis: including temporal arteritis and polymyalgia rheumatica. Medicine (Baltimore). 1971; 50: 1-27..
8 Shusterman N, Kimmel PL, Kiechle FL, Williams S, Morrison G, Singer I. Factors influencing erythrocyte sedimentation in patients with chronic renal failure. Arch Intern Med. 1985; 145: 1796 – 1799.
9 Chamorro A, Vila N, Ascaso C, Saiz A, Montalvo J, Alonso P, Tolosa E. Early prediction of stroke severity. Role of the erythrocyte sedimentation rate. Stroke. 1995; 26: 573 – 576.
10 Haber HL, Leavey JA, Kessler PD et al. The erythrocyte sedimentation rate in congestive heart failure. N Eng J Med. 1991; 324: 353 – 358.
11 Hannisdal E, Bostad L, Grottum KA, Langmark F. Erythrocyte sedimentation rate as a prognostic factor in renal cell carcinoma. Eur J Surg Oncol. 1989; 15: 333 – 336.
12 Henry-Amar M, Friedman S, Hayat M et al. Erythrocyte sedimentation rate predicts early relapse and survival in early-stage Hodgkin disease. The EORTC Lymphoma Cooperative Group. Ann Intern Med. 1991; 114: 361 – 365.