Agreement between Erythrocyte Sedimentation Rate and C-Reactive Protein in Hospital Practice.
Summary of "Agreement between Erythrocyte Sedimentation Rate and C-Reactive Protein in Hospital Practice."
BACKGROUND:
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are frequently prescribed jointly. The usefulness of this practice is uncertain.
METHODS:
All patients with ESR and CRP measured at the same time in an academic tertiary hospital during a 1-year period were included. Concomitant measures of serum creatinine, hematocrit, and anti-Xa activity were recorded to study noninflammatory cause of increased ESR. Level of agreement between ESR and CRP was assessed with kappa coefficient, and their accuracy was determined in a medical chart review of 99 randomly selected patients with disagreement between both markers.
RESULTS:
Among 5777 patients, 35% and 58% had an elevated CRP and ESR, respectively. ESR and CRP were in agreement in 67% of patients (both elevated in 30%, both normal in 37%). A disagreement was observed in 33% (elevated ESR/normal CRP in 28%, normal ESR/elevated CRP in 5%). The kappa coefficient showed poor agreement (k=0.38) between both markers. Review of medical chart showed that 25 patients with elevated CRP and normal ESR had an active inflammatory disease (false-negative ESR). Conversely, 74 patients had elevated ESR and normal CRP-32% had resolving inflammatory disorders, 28% disclosed a variable interfering with the ESR measure (false-positive ESR), 32% had unexplained discrepancies, and 8% had an active inflammatory disease (false-negative CRP).
CONCLUSION:
In hospital practice, joint measurement of ESR and CRP is unwarranted. Because of slow variation and frequent confounding, ESR is frequently misleading in unselected patients. When an inflammatory disorder is suspected, priority should be given to CRP.
Affiliation
Hospital Informatics and Public Health, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France; Medical School, Université Paris Descartes, Faculté de médecine, France.
Journal Details
This article was published in the following journal.
Name: The American journal of medicine
ISSN: 1555-7162
Pages: 863.e7-863.e13
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20800157
- DOI: http://dx.doi.org/10.1016/j.amjmed.2010.04.021
Medical and Biotech [MESH] Definitions
Erythrocyte Aggregation
The formation of clumps of RED BLOOD CELLS under low or non-flow conditions, resulting from the attraction forces between the red blood cells. The cells adhere to each other in rouleaux aggregates. Slight mechanical force, such as occurs in the circulation, is enough to disperse these aggregates. Stronger or weaker than normal aggregation may result from a variety of effects in the ERYTHROCYTE MEMBRANE or in BLOOD PLASMA. The degree of aggregation is affected by ERYTHROCYTE DEFORMABILITY, erythrocyte membrane sialylation, masking of negative surface charge by plasma proteins, etc. BLOOD VISCOSITY and the ERYTHROCYTE SEDIMENTATION RATE are affected by the amount of erythrocyte aggregation and are parameters used to measure the aggregation.
Schnitzler Syndrome
An extremely rare condition manifested as monoclonal IMMUNOGLOBULIN M dysproteinemia without features of lymphoproliferative disease, but with chronic urticaria, fever of unknown origin, disabling bone pain, hyperostosis, and increased erythrocyte sedimentation rate.
Necrobiotic Xanthogranuloma
A cutaneous necrobiotic disorder characterized by firm, yellow plaques or nodules, often in a periorbital distribution. It is often accompanied by an elevated ERYTHROCYTE SEDIMENTATION RATE; LEUKOPENIA; and MONOCLONAL GAMMOPATHY (IgG-kappa type) and systemic involvement.
Hospital-physician Joint Ventures
A formal financial agreement made between one or more physicians and a hospital to provide ambulatory alternative services to those patients who do not require hospitalization.
Polymyalgia Rheumatica
A syndrome in the elderly characterized by proximal joint and muscle pain, high erythrocyte sedimentation rate, and a self-limiting course. Pain is usually accompanied by evidence of an inflammatory reaction. Women are affected twice as commonly as men and Caucasians more frequently than other groups. The condition is frequently associated with GIANT CELL ARTERITIS and some theories pose the possibility that the two diseases arise from a single etiology or even that they are the same entity.
PubMed Articles
Renal dysfunction and inflammatory markers in hypertensive patients seen in a university hospital.
BACKGROUND: Today, chronic kidney diseases represent a great challenge to public health as regards the acquisition of knowledge to support interventions that can slow the progression of renal function...
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) : Solo or duet?
The value of C-reactive protein in symptomatic versus asymptomatic carotid artery stenosis.
ABSTRACT Inflammatory markers may help establish the diagnosis of carotid atherosclerotic disease and predict the progression and outcomes. We evaluated inflammatory markers in symptomatic and asympto...
BACKGROUND: Previous studies in post-operative orthopedic and pediatric patients suggest that erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) testing may be helpful in ruling out sep...
Clinical Trials
The purpose of this study is to: 1. To investigate the wrist joint synovial blood flow intensity and model by quantitative three-dimensional (3D) power Doppler ultrasonography (PDU...
The values of laboratory examinations which are useful for the diagnoses of appendicitis are white blood cell count (WBC), C-reactive protein (CRP) and erythrocyte blood sedimentation rate...
Pharmacokinetics Study of Colchicine in Familial Mediterranean Fever (FMF) Patients
Colchicine is widely recognized as safe and effective treatment of Familial Mediterranean Fever (FMF) in children and adults. Colchicine is currently used to treat FMF in younger patients...
C-Reactive Protein as a Predictor of Stem Cell Transplant Complications
The purpose of this study is to determine if C-Reactive Protein levels are predictive for complications post transplant.
Positron Emission Tomography in Rheumatoid Arthritis With Adalimumab (PETRA)
Biologics are routinely used for the treatment of rheumatoid arthritis (RA). Adalimumab is a human monoclonal antibody that inhibit the Tumor Necrosis Factor alpha (TNF-alpha). Identificat...
