Extremely elevated erythrocyte sedimentation rates: Associations with patients' diagnoses and clinical characteristics

Abstract

INTRODUCTION: The aim of the study was to assess the etiological distribution of patients with an erythrocyte sedimentation rate (ESR) over 100 mm/hour and to evaluate differences in demographic, comorbidity, laboratory characteristics, and clinical outcomes. METHODS: This retrospective observational clinical study included patients aged 18 years and older who were admitted to the internal medicine inpatient clinic between May 1, 2015 and June 1, 2021 and had ESR values above 100 mm/h. Demographic data, comorbidities, laboratory parameters, imaging studies, histopathological findings, microbiological and serological data, along with in-hospital and post-discharge mortality, were collected from the hospital's electronic database. Two independent clinicians evaluated the data to identify diagnoses associated with elevated ESR. Patients were divided into six categories based on the most likely diagnosis. RESULTS: The study included 441 patients, 52.6% of whom were female, and the mean age was 72.6 years. The etiological distribution was as follows: infectious diseases (34%), malignancies (31.5%), undiagnosed cases (15.9%), renal diseases (9.8%), other causes (5%), and rheumatologic diseases (3.8%). Etiological distributions did not differ by gender, age, or ESR ranges. The in-hospital mortality rate was 3.6%, and the overall mortality rate from hospitalization to the data collection date was 64.4%. Mortality was higher in patients with malignancies (81.3%) compared to other etiologies (p<0.001). Patients who died had higher mean age, ferritin levels, having diabetes mellitus, heart failure, or malignancy, and lower hemoglobin and lymphocyte levels compared to survivors (p<0.05 for all). CONCLUSION: Most patients with an ESR over 100 mm/hour had significant underlying medical conditions, with infectious diseases and malignancies comprising two-thirds of the cases.; INTRODUCERE: Scopul studiului a fost de a evalua distribu?ia etiologic? a pacien?ilor cu o vitez? de sedimentare eritrocitar? (VSH) peste 100 mm/or? ?i de a evalua diferen?ele demografice, de comorbiditate, caracteristicile de laborator ?i aspectele clinice. METODE: Acest studiu clinic observa?ional retrospectiv a inclus pacien?i cu vârsta peste 18 ani care au fost interna?i în clinica de medicin? intern? între 1 mai 2015 ?i 1 iunie 2021 ?i au avut valori VSH peste 100 mm/h. Datele demografice, comorbidit??ile, parametrii de laborator, studiile imagistice, constat?rile histopatologice, datele microbiologice ?i serologice, împreun? cu mortalitatea în spital ?i dup? externare, au fost colectate din baza de date electronic? a spitalului. Doi clinicieni independen?i au evaluat datele pentru a identifica diagnosticele asociate cu VSH crescut. Pacien?ii au fost împ?r?i?i în ?ase categorii pe baza diagnosticului cel mai probabil. REZULTATE: Studiul a inclus 441 de pacien?i, dintre care 52,6% erau femei, iar vârsta medie a fost de 72,6 ani. Distribu?ia etiologic? a fost urm?toarea: boli infec?ioase (34%), afec?iuni maligne (31,5%), cazuri nediagnosticate (15,9%), boli renale (9,8%), alte cauze (5%) ?i boli reumatologice (3,8%). Distribu?iile etiologice nu au fost diferite în func?ie de sex, vârst? sau intervale de VSH. Rata mortalit??ii în spital a fost de 3,6%, iar rata global? a mortalit??ii de la spitalizare pân? la data colect?rii datelor a fost de 64,4%. Mortalitatea a fost mai mare la pacien?ii cu tumori maligne (81,3%) comparativ cu alte etiologii (p<0,001). Pacien?ii care au decedat au avut o vârst? medie mai mare, niveluri de feritin?, diabet zaharat, insuficien?? cardiac? sau malignitate ?i niveluri mai sc?zute de hemoglobin? ?i limfocite în compara?ie cu supravie?uitorii (p<0,05 pentru to?i). CONCLUZIE: Majoritatea pacien?ilor cu o VSH peste 100 mm/or? au avut afec?iuni medicale subiacente semnificative, bolile infec?ioase ?i malignit??ile cuprinzând dou? treimi din cazuri. This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine