Clinical Significance of Extreme Elevation of the Erythrocyte Sedimentation Rate: Diagnoses and Survival in 681 Patients in a Portuguese Hospital.

Resumo

Introduction: We aimed to study the association between extreme erythrocyte sedimentation rate (ESR) elevations (>100 mm/h), and the distribution of disease categories, diseases, age, sex, C-reactive protein levels and five-year survival.

Methods: a retrospective study of all patients with extreme ESR values examined at a Portuguese hospital, from January 1, 2008, through December 31, 2012. Independent variables included disease categories, subcategories, age, sex, and CRP level. Living status and date of death were determined
using the Portuguese Electronic Prescription System.

Results: An ESR above 100 mm/h was found in 681 patients (1.5% of all determinations). The leading diagnosis category was infection (461, 65.1%), followed by malignancy (107, 15.1%), and inflammatory/autoimmune (85, 12.0%). The most
prevalent disease was pneumonia (227, 33.3% of all patients). Infection was less likely in outpatients (20.7%), as was malignancy in females (11.4%). Five-year mortality was 70.3%, higher in patients with malignancy (83%) and lower in patients with inflammatory/autoimmune disease (45.9%).

Conclusion: We found that almost all patients with an extreme ESR elevation have an identifiable etiology, with infection observed in nearly two-thirds and pneumonia being the most common disease in one-third of all patients. Infection was less likely in outpatients, as was malignancy in females. The ESR and CRP levels correlated poorly in patients with extremely elevated ESRs. The five-year mortality rate was 70.3%, with survival being significantly lower in patients with malignancy, and higher in those with inflammatory/autoimmune disease. These findings may enhance the diagnostic and prognostic evaluation of patients with extreme elevations in ESR.