Extremely elevated erythrocyte sedimentation rate: patient diagnoses at a tertiary Indian hospital

Introduction and Aim: Extremely elevated Erythrocyte Sedimentation Rate (EEESR) is the term commonly used for elevation of ESR more than or equal to 100mm in the first hour. To the best of our knowledge, this is the first study in Indian population. Aim was to study the common etiologies of EEESR in Indian patients at a tertiary hospital. Materials and Methods: A retrospective, cross- sectional and descriptive study was carried out and included all patients 18 years of age and above, and who had a raised ESR of 100 mm and above at the end of 1st hour at least one time between January 2018 to December 2018 and tested at our institute. The patient’s demographic details, ESR values and diagnoses were retrieved from electronic records and were divided into 7 categories like infections, malignancy, renal diseases, autoimmune diseases, mixed diagnoses, miscellaneous and unknown. Results: During the study period, 607 patients had EEESR. There were 335 males and 272 females. The mean age was 55 years. Within the broad categories of diseases, infection was the most common cause (52%) followed in descending order by renal diseases (12.4%), malignancy (9.6%), miscellaneous (8.4%), mixed diagnoses (7.6%), autoimmune diseases (7%) and unknown (3%). In the infection category, pneumonia was the commonest. Conclusion: This study on frequency of common etiologies of EEESR is the first study in Indian population. Our study reaffirms findings that most patients have an underlying cause for EEESR. The commonest etiology in Indian patients is infection with pneumonia being the frequent cause.

Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications

Introduction: Complications of malaria can develop suddenly and unexpectedly. Although various parameters have been associated with severity of malaria, they have not been studied as predictors of these events. Many of the malarial complications are inflammatory in nature, and C-reactive protein (CRP) and elevated erythrocyte sedimentation rate (ESR) could be early markers of these complications and might precede and predict the development of complications. Methodology: A total of 122 inpatients with uncomplicated newly diagnosed malaria were studied. CRP, ESR, hemoglobin, and platelets were measured before initiating treatment. Patients were monitored closely for the subsequent development of complications based on the World Health Organization’s definition of severe malaria. Results: Seven patients (5.7%) had worsening of symptoms compared to the day of admission and had higher pretreatment CRP and increased ESR compared to those patients who did not develop complications. Area under receiver operator characteristic curve was 0.761(p=0.02) for CRP and 0.739 (p = 0.035) for ESR. CRP>124 mg/L and increased ESR (>34.5 mm in the first hour) had a sensitivity of 71.4% and specificity of 79.1%, respectively, for predicting complications of malaria. Other parameters did not reach statistical significance for predicting complications. Elevated CRP and elevated ESR had a negative predictive value of 97.8%. Conclusions: Elevated CRP>124mg/L and increased ESR>34.5 mm in the first hour at the time of diagnosis in patients with uncomplicated malaria identifies patients who might subsequently develop complications of malaria.