The erythrocyte sedimentation rate

Olshaker, Jonathan S.; Jerrard, David A.

doi:10.1016/s0736-4679(97)00197-2

Cited by 59 publications

(47 citation statements)

References 49 publications

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“…Furthermore, the role of the ESR may be limited because of its lack of specificity for septic arthritis. 7,8,13,14,31,32 In our patient sample, there was a large proportion (36%) of patients with septic arthritis who had jWBC less than 50,000 cells/mm 3 . The range of jWBC was quite broad, with a substantial number of patients (6 of 61 [10%]) who had counts less than 10,000 cells/ mm 3 ; the lowest jWBC was 168 cells/mm 3 .…”

Section: Discussionmentioning

confidence: 76%

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Henderson

Dickman

et al. 2004

Acad Emergency Med

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It is difficult to differentiate septic arthritis from other causes of monoarticular arthritis solely with a history and physical examination. The clinician must rely on ancillary tests to make a diagnosis, such as the white blood cell count of peripheral blood (WBC), the erythrocyte sedimentation rate (ESR), and the white blood cell count of the joint fluid ( jWBC) obtained from arthrocentesis. Although it is known that septic arthritis is associated with abnormalities in these tests, the majority of the data are based on studies in the pediatric population. In addition, although several emergency medicine texts indicate that a jWBC greater than 50,000 cells/mm 3 is ''positive,'' it is known that septic arthritis can occur in patients with low jWBCs. Objectives: To determine whether specific ancillary tests have sufficiently high sensitivities to rule out septic arthritis in adults.Methods: This was a retrospective consecutive case series of patients from an urban emergency department (ED). Patients at least 18 years old who had septic arthritis confirmed by positive arthrocentesis culture or operative findings were included in the study. WBC greater than 11,000 cells/mm 3 , ESR greater than 30 mm/hr, and jWBC greater than 50,000 cells/mm 3 were considered elevated. Results: Seventy-three patients met the inclusion criteria. The sensitivities of an elevated WBC, ESR, or jWBC in adults who had septic arthritis were 48%, 96%, and 64%, respectively. There were broad ranges of WBC, ESR, or jWBC among the patients. More than one third of adult patients with septic arthritis had jWBCs less than 50,000 cells/mm 3 . All patients had an abnormality in at least one of these tests. Conclusions: The WBC, ESR, and jWBC are extremely variable in adults with septic arthritis. Laboratory tests do not rule out septic arthritis with accuracy.

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Section: Discussionmentioning

confidence: 76%

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Henderson

Dickman

et al. 2004

Acad Emergency Med

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“…Any cause or focus of inflammation increases ESR. The ESR increases in pregnancy or rheumatoid arthritis, and decreases in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure 15,22,27) . The clinical usefulness of ESR is limited to monitoring.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Chung

Won

Kwon

et al. 2011

J Korean Neurosurg Soc

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in a single institution. Exclusion criteria were as follows : preceding the spine surgery in the previous 2 weeks, preexisting or postoperative infection, being less than 18 years of age, and being discharged less than 5 days after the spinal surgery. Clinical data relevant to the study included age, sex, body mass index (BMI), BT, site and type of surgery, and surgery duration.All patients received a preoperative antibiotic prophylaxis with a first generation cephalosporin, cefazolin, and also postoperative antibiotics were injected through their fourth postoperative day. All patients were operated under general anesthesia and received daily clinical examinations until discharge. INTRODUCTIONDespite advances in prophylaxis, the incidence of deep infection after instrumented spinal surgery remains between 0.4% and 4.3% 14,16,19) and may be higher in patients undergoing fusion after spinal trauma 26) . Although infection can be a disabling complication of any surgical procedure, spinal infection can be particularly devastating due to the close proximity of the neurological structures. Early detection of an infection may prevent substantial problem later.It is often difficult to diagnose postoperative spinal infection before clinical symptoms become apparent. Magnetic resonance imaging can help to diagnose the soft-tissue change but is expensive to use as a screening tool and may not be available. Although inflammatory markers, such as C-reactive protein (CRP), white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and body temperature (BT), easily are measured, their specificities are not high.In a recent meta-analysis, procalcitonin (PCT) was superior to Objective : Classical markers of infection cannot differentiate reliably between inflammation and infection after neurosurgery. This study investigated the dynamics of serum procalcitonin (PCT) in patients who had elective spine surgeries without complications. Methods : Participants were 103 patients (47 women, 56 men) who underwent elective spinal surgery. Clinical variables relevant to the study included age, sex, medical history, body mass index (BMI), site and type of surgery, and surgery duration. Clinical and laboratory data were body temperature, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and PCT, all measured preoperatively and postoperatively on days 1, 3, and 5. Results : PCT concentrations remained at <0.25 ng/mL during the postoperative course except in 2 patients. PCT concentrations did not correlate with age, sex, DM, hypertension, BMI, operation time, operation site, or use of instrumentation. In contrast, CRP concentrations were significantly higher with older age, male, DM, hypertension, longer operation time, cervical operation, and use of instrumentation. Conclusion : PCT may be useful in the diagnosing neurosurgical patients with postoperative fever of unknown origin.

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“…However, regardless of the diagnostic criteria, measurement of ESR and CRP has been deemed an important part of the workup of patients suspected of PJI [42]. These valuable markers can be performed rapidly, inexpensively, [12,25,32,36,37,41]. Therefore, it seems to be impossible to convert these quantitative tests into absolute binary systems (ie, infected versus noninfected).…”

Section: Discussionmentioning

confidence: 99%

“…Medical records were reviewed to retrieve demographic details and associated comorbidities. We excluded 180 patients for the following reasons: (1) comorbid conditions with confounding effects on ESR and CRP (eg, inflammatory autoimmune disorders, malignancies, organ failure [kidney, liver, heart], or preexisting infectious diseases [12,25]) and (2) revision surgeries indicated for periprosthetic or component fractures. Our aseptic cohort consisted of 1095 patients in the hip group and 594 patients in the knee group.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

120

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Background Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. Questions/purposes Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. Methods We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. Results ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. Conclusions The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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The erythrocyte sedimentation rate

Cited by 59 publications

References 49 publications

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

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