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Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate

Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate Abstract • Charts of 1006 consecutive outpatients were reviewed to ascertain the cause of extreme elevation of the erythrocyte sedimentation rate (ESR) (≥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 (>99%). The positive predictive value for an identifiable cause of marked ESR elevation was 90%. (Arch Intern Med 1986;146:1581-1583) References 1. Zacharski LR, Kyle RA: Significance of extreme elevation of erythrocyte sedimentation rate. JAMA 1967;202:116-118.Crossref 2. Payne RW: Causes of the grossly elevated erythrocyte sedimentation rate. Practitioner 1968;200:415-417. 3. Hart GD, Soots M, Sullivan J: Significance of extreme elevation of erythrocyte sedimentation rate. Appl Ther 1970;12:12-13. 4. Cheah JS, Ransome GA: Significance of very high erythrocyte sedimentation rates (100 mm or above in one hour) in 360 cases in Singapore. J Trop Med Hyg 1971;74:28-30. 5. Wyler DJ: Diagnostic implications of markedly elevated erythrocyte sedimentation rate: A reevaluation. South Med J 1977;70:1428-1430.Crossref 6. Ford MJ, Innes JA, Parrish FM, et al: Significance of gross elevations of the erythrocyte sedimentation rate in a general medical unit. Eur J Clin Invest 1979;9:191-194.Crossref 7. Abengowe CV: Clinical importance of grossly increased erythrocyte sedimentation rate. Can Med Assoc J 1975;113:929-930. 8. Bedell SE, Bush BT: Erythrocyte sedimentation rate: From folklore to facts. Am J Med 1985;78:1001-1009.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360200151024
Publisher site
See Article on Publisher Site

Abstract

Abstract • Charts of 1006 consecutive outpatients were reviewed to ascertain the cause of extreme elevation of the erythrocyte sedimentation rate (ESR) (≥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 (>99%). The positive predictive value for an identifiable cause of marked ESR elevation was 90%. (Arch Intern Med 1986;146:1581-1583) References 1. Zacharski LR, Kyle RA: Significance of extreme elevation of erythrocyte sedimentation rate. JAMA 1967;202:116-118.Crossref 2. Payne RW: Causes of the grossly elevated erythrocyte sedimentation rate. Practitioner 1968;200:415-417. 3. Hart GD, Soots M, Sullivan J: Significance of extreme elevation of erythrocyte sedimentation rate. Appl Ther 1970;12:12-13. 4. Cheah JS, Ransome GA: Significance of very high erythrocyte sedimentation rates (100 mm or above in one hour) in 360 cases in Singapore. J Trop Med Hyg 1971;74:28-30. 5. Wyler DJ: Diagnostic implications of markedly elevated erythrocyte sedimentation rate: A reevaluation. South Med J 1977;70:1428-1430.Crossref 6. Ford MJ, Innes JA, Parrish FM, et al: Significance of gross elevations of the erythrocyte sedimentation rate in a general medical unit. Eur J Clin Invest 1979;9:191-194.Crossref 7. Abengowe CV: Clinical importance of grossly increased erythrocyte sedimentation rate. Can Med Assoc J 1975;113:929-930. 8. Bedell SE, Bush BT: Erythrocyte sedimentation rate: From folklore to facts. Am J Med 1985;78:1001-1009.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1986

References