C-reactive protein and erythrocyte sedimentation rate: Continuing role for erythrocyte sedimentation rate
Author(s)
Gurmukh Singh
ABSTRACT
Background: Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) tests are often done to detect or monitor patients with suspected inflammatory disorders. The objective of the study was to ascertain if the manual ESR test added value to the information available from automated CRP results alone. Methods: In this retrospective, observational study at a safety-net hospital, the ESR and CRP values were compared in 4527 instances when both tests were done. In 150 instances, involving 97 patients; when ESR was >60 mm/hr and CRP was ≤1.0 mg/dL, the medical records were reviewed to discern the cause of disparity between the ESR and CRP results and to assess the utility of continued use of the ESR test. Results: Review of medical records did not reveal an explanation for elevated ESR in 20 patients with normal CRP results. In the remaining 77 (79%) patients, an inflammatory disorder was noted despite a normal CRP value; in 27 (28%) patients, the disorder was osteomyelitis. Presence of skin necrosis was also a prominent factor in the discrepant results. Conclusions: ESR has value in detecting inflammatory disorders that may not be obvious by clinical examination or CRP results. ESR has a particularly useful role in patients with suspected bone lesions and osteomyelitis.
Background: Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) tests are often done to detect or monitor patients with suspected inflammatory disorders. The objective of the study was to ascertain if the manual ESR test added value to the information available from automated CRP results alone. Methods: In this retrospective, observational study at a safety-net hospital, the ESR and CRP values were compared in 4527 instances when both tests were done. In 150 instances, involving 97 patients; when ESR was >60 mm/hr and CRP was ≤1.0 mg/dL, the medical records were reviewed to discern the cause of disparity between the ESR and CRP results and to assess the utility of continued use of the ESR test. Results: Review of medical records did not reveal an explanation for elevated ESR in 20 patients with normal CRP results. In the remaining 77 (79%) patients, an inflammatory disorder was noted despite a normal CRP value; in 27 (28%) patients, the disorder was osteomyelitis. Presence of skin necrosis was also a prominent factor in the discrepant results. Conclusions: ESR has value in detecting inflammatory disorders that may not be obvious by clinical examination or CRP results. ESR has a particularly useful role in patients with suspected bone lesions and osteomyelitis.
Cite this paper
Singh, G. (2014) C-reactive protein and erythrocyte sedimentation rate: Continuing role for erythrocyte sedimentation rate. Advances in Biological Chemistry, 4, 5-9. doi: 10.4236/abc.2014.41002.
Singh, G. (2014) C-reactive protein and erythrocyte sedimentation rate: Continuing role for erythrocyte sedimentation rate. Advances in Biological Chemistry, 4, 5-9. doi: 10.4236/abc.2014.41002.
References
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http://dx.doi.org/10.1016/B978-1-4377-0974-2.00030-0 [2] Bedell, S.E. and Bush, B.T. (1985) Erythrocyte sedimentation rate. From folklore to facts. American Journal of Medicine, 78, 1001-1009.
http://dx.doi.org/10.1016/0002-9343(85)90224-4 [3] Simon, L., Gauvin, F., Amre, D.K., et al. (2004) Serum procalcitonin and C-reactive protein as markers of bacterial infection: A systematic review and meta-analysis. Clinical Infectious Diseases, 39, 206-217.
http://dx.doi.org/10.1086/421997 [4] Woloshin, S. and Schwartz, L.M. (2006) Distribution of C-reactive protein values in the United States. The New England Journal of Medicine, 352, 1611-1613.
http://dx.doi.org/10.1056/NEJM200504143521525 [5] “User manual for ESR STATTM PLUS—Blood analyzer,” Hema Technologies, Inc. [6] Dasgupta, B., Cimmino, M.A., Maradit-Kremers, H., et al. (2012) 2012 provisional classification for polymyalgia rheumatica: A European League against Rheumatism/ American College of Rheumatology collaborative initiative. Annals of the Rheumatic Diseases, 71, 484-492.
http://dx.doi.org/10.1136/annrheumdis-2011-200329 [7] Ridker, P.M. and Libby, P. (2007) Risk factors for atherothrombotic disease. In: Libby, P., Bonow, R.O., Mann, D.L. and Zipes, D.P., Eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th Edition, Saunders Elsevier, Philadelphia, Chapter 39. [8] Almirall, J., Bolibar, I., Toran, P., et al. (2004) Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest, 125, 1335-1342.
http://dx.doi.org/10.1378/chest.125.4.1335 [9] Yudkin, J.S., Stehouwer, C.D., Emeis, J.J., et al. (1999) C-reactive protein in healthy subjects: Association with obesity, insulin resistance, and endothelial dysfunction: A potential role for cytokines originating from adipose tissue? Arteriosclerosis, Thrombosis, and Vascular Biology, 19, 972-978.
http://dx.doi.org/10.1161/01.ATV.19.4.972 [10] Hasleman, B. (2000) Laboratory investigations useful in the evaluation of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). Clinical and Experimental Rheumatology, 18, S29-S31. [11] Costenbader, K.H., Chibnick, L.B. and Schur, P.H. (2007) Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: Clinical significance. Clinical and Experimental Rheumatology, 25, 746-749. [12] Kermani, T.A., Schmidt, J., Crowson, C.S., et al. (2012) Utility of erythrocyte sedimentation rate and C-reactive protein for diagnosis of giant cell arteritis. Seminars in Arthritis and Rheumatism, 41, 866-871.
http://dx.doi.org/10.1016/j.semarthrit.2011.10.005 [13] Walvick, M.D. and Walvick, M.P. (2011) Giant cell arteritis: Laboratory predictors of a positive temporal artery biopsy. Ophthalmology, 118, 1201-1204.
http://dx.doi.org/10.1016/j.ophtha.2010.10.002 [14] Husain, T.M. and Kim, D.H. (2002) C-reactive protein and erythrocyte sedimentation rate in orthopedics. The University of Pennsylvania Orthopaedic Journal, 15, 13-16. [15] Remaley, A.T., Rifai, N. and Warnick, R. (2012) Lipid, lipoproteins, apolipoproteins and other cardiovascular risk factors. In: Burtis, C.A., Ashwood, E.R. and Bruns, D.E., Eds., Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 5th Edition, Elsevier, Philadelphia, Chapter 27. [16] Brigden, M. (1998) The erythrocyte sedimentation rate. Still a helpful test when used judiciously. Postgraduate Medicine, 103, 257-262.
http://dx.doi.org/10.3810/pgm.1998.05.493 [17] Katz, P.R., Karuza, J., Gutman, S.I., et al. (1990) A comparison between erythrocyte sedimentation rate (ESR) and selected acute-phase proteins in the elderly. American Journal of Clinical Pathology, 94, 637-640. [18] Saadeh, C. (1998) The erythrocyte sedimentation rate: Old and new clinical applications. Southern Medical Journal, 91, 220-225.
http://dx.doi.org/10.1097/00007611-199803000-00001 [19] Zlonis, M. (1993) The mystique of the erythrocyte sedimentation rate: A reappraisal of one of the oldest laboratory tests still in use. Clinics in Laboratory Medicine, 13, 787-800. [20] Cantini, F., Salvarni, C., Oliveri, I., et al. (2000) Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: A prospective follow-up study. Seminars in Arthritis and Rheumatism, 30, 17-24.
http://dx.doi.org/10.1097/00007611-199803000-00001 [21] Salvarini, C., Cantini, F., Niccoli, L., et al. (2005) Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: A prospective followup study. Arthritis & Rheumatism, 53, 33-38.
http://dx.doi.org/10.1002/art.20901
[1] Vajpayee, N., Graham, S.S. and Bem, S. (2011) Basic examination of blood and bone marrow. In: McPherson, R.A. and Pincus, M.R., Eds., Henry’s Clinical Diagnosis and Management by Laboratory Methods, Elsevier Saunders, Philadelphia, Chapter 30, 509-535.
http://dx.doi.org/10.1016/B978-1-4377-0974-2.00030-0 [2] Bedell, S.E. and Bush, B.T. (1985) Erythrocyte sedimentation rate. From folklore to facts. American Journal of Medicine, 78, 1001-1009.
http://dx.doi.org/10.1016/0002-9343(85)90224-4 [3] Simon, L., Gauvin, F., Amre, D.K., et al. (2004) Serum procalcitonin and C-reactive protein as markers of bacterial infection: A systematic review and meta-analysis. Clinical Infectious Diseases, 39, 206-217.
http://dx.doi.org/10.1086/421997 [4] Woloshin, S. and Schwartz, L.M. (2006) Distribution of C-reactive protein values in the United States. The New England Journal of Medicine, 352, 1611-1613.
http://dx.doi.org/10.1056/NEJM200504143521525 [5] “User manual for ESR STATTM PLUS—Blood analyzer,” Hema Technologies, Inc. [6] Dasgupta, B., Cimmino, M.A., Maradit-Kremers, H., et al. (2012) 2012 provisional classification for polymyalgia rheumatica: A European League against Rheumatism/ American College of Rheumatology collaborative initiative. Annals of the Rheumatic Diseases, 71, 484-492.
http://dx.doi.org/10.1136/annrheumdis-2011-200329 [7] Ridker, P.M. and Libby, P. (2007) Risk factors for atherothrombotic disease. In: Libby, P., Bonow, R.O., Mann, D.L. and Zipes, D.P., Eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th Edition, Saunders Elsevier, Philadelphia, Chapter 39. [8] Almirall, J., Bolibar, I., Toran, P., et al. (2004) Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest, 125, 1335-1342.
http://dx.doi.org/10.1378/chest.125.4.1335 [9] Yudkin, J.S., Stehouwer, C.D., Emeis, J.J., et al. (1999) C-reactive protein in healthy subjects: Association with obesity, insulin resistance, and endothelial dysfunction: A potential role for cytokines originating from adipose tissue? Arteriosclerosis, Thrombosis, and Vascular Biology, 19, 972-978.
http://dx.doi.org/10.1161/01.ATV.19.4.972 [10] Hasleman, B. (2000) Laboratory investigations useful in the evaluation of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). Clinical and Experimental Rheumatology, 18, S29-S31. [11] Costenbader, K.H., Chibnick, L.B. and Schur, P.H. (2007) Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: Clinical significance. Clinical and Experimental Rheumatology, 25, 746-749. [12] Kermani, T.A., Schmidt, J., Crowson, C.S., et al. (2012) Utility of erythrocyte sedimentation rate and C-reactive protein for diagnosis of giant cell arteritis. Seminars in Arthritis and Rheumatism, 41, 866-871.
http://dx.doi.org/10.1016/j.semarthrit.2011.10.005 [13] Walvick, M.D. and Walvick, M.P. (2011) Giant cell arteritis: Laboratory predictors of a positive temporal artery biopsy. Ophthalmology, 118, 1201-1204.
http://dx.doi.org/10.1016/j.ophtha.2010.10.002 [14] Husain, T.M. and Kim, D.H. (2002) C-reactive protein and erythrocyte sedimentation rate in orthopedics. The University of Pennsylvania Orthopaedic Journal, 15, 13-16. [15] Remaley, A.T., Rifai, N. and Warnick, R. (2012) Lipid, lipoproteins, apolipoproteins and other cardiovascular risk factors. In: Burtis, C.A., Ashwood, E.R. and Bruns, D.E., Eds., Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 5th Edition, Elsevier, Philadelphia, Chapter 27. [16] Brigden, M. (1998) The erythrocyte sedimentation rate. Still a helpful test when used judiciously. Postgraduate Medicine, 103, 257-262.
http://dx.doi.org/10.3810/pgm.1998.05.493 [17] Katz, P.R., Karuza, J., Gutman, S.I., et al. (1990) A comparison between erythrocyte sedimentation rate (ESR) and selected acute-phase proteins in the elderly. American Journal of Clinical Pathology, 94, 637-640. [18] Saadeh, C. (1998) The erythrocyte sedimentation rate: Old and new clinical applications. Southern Medical Journal, 91, 220-225.
http://dx.doi.org/10.1097/00007611-199803000-00001 [19] Zlonis, M. (1993) The mystique of the erythrocyte sedimentation rate: A reappraisal of one of the oldest laboratory tests still in use. Clinics in Laboratory Medicine, 13, 787-800. [20] Cantini, F., Salvarni, C., Oliveri, I., et al. (2000) Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: A prospective follow-up study. Seminars in Arthritis and Rheumatism, 30, 17-24.
http://dx.doi.org/10.1097/00007611-199803000-00001 [21] Salvarini, C., Cantini, F., Niccoli, L., et al. (2005) Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: A prospective followup study. Arthritis & Rheumatism, 53, 33-38.
http://dx.doi.org/10.1002/art.20901