The Diagnostic Value of Extremely Elevated Erythrocyte Sedimentation Rate in A Tertiary Pediatric Hospital

Öz

Objective: The aim of this study was to evaluate the frequency, demographic and clinical characteristics of pediatric patients with extremely elevated erythrocyte sedimentation rate (ESR) in a reference children's hospital, and to improve clinicians' ability to use extremely elevated ESR in the differential diagnosis.

Material and Methods:  A retrospective cohort study was conducted to examine the clinical data of pediatric patients with extremely elevated ESR ( ≥100 mm/h). The patients were divided into 6 main groups according to their diagnosis as infectious, non-infectious inflammatory disease (NIID), malignancy, nephrologic, miscellaneus and unknown. Then, the specific sub-diagnoses of the patients were determined and evaluated. Clinical and laboratory data of the patients were recorded.

Results: We analyzed the results of a total of 3166 patients with high ESR (≥20 mm/h) and 189 (5.96%) patients with extremely elevated ESR were included in the final analysis. The most common etiology of extremely elevated ESR was NIID (35.9%), followed by infections (33.3%), malignancies (19.0%) nephrologic (2.6%), miscellaneus (4.7%) and unknown (4.2%). The most common specific diagnosis was acute rheumatic fever, Kawasaki disease, lymphadenitis and leukemia. The high ESR was only negatively correlated with hemoglobin and albumin levels.

Conclusion: Identifying the most common diseases that cause extreme ESR elevation in children can help clinicians in the differential diagnosis of diseases but it cannot be used as a screening tool for diseases.

Anahtar Kelimeler

• Acute phase reactants
• erythrocyte sedimentation rate
• children
• differential diagnosis

Üçüncü Basamak Bir Çocuk Hastanesinde Belirgin Yüksek Eritrosit Sedimantasyon Hızının Tanısal Değeri

Öz

Amaç: Bu çalışmanın amacı, referans bir çocuk hastanesinde belirgin olarak artmış eritrosit sedimantasyon hızı (ESR) olan pediatrik hastaların sıklığını, demografik ve klinik özelliklerini değerlendirmek ve klinisyenlerin aşırı yüksek ESR'yi ayırıcı tanıda kullanma becerilerini geliştirmektir.

Gereç ve Yöntem: Retrospektif, kesitsel olarak planlanmış olan bu çalışmada ESR değeri ≥100 mm/saat olan pediyatrik hastalar değerlendirilmiştir. Hastalar tanılarına göre enfeksiyöz, enfeksiyöz olmayan inflamatuar hastalıklar (NIID), malignite, nefrolojik, diğer ve bilinmeyen olarak 6 ana gruba ayrıldı. Daha sonra hastaların spesifik alt tanıları belirlenerek, klinik ve laboratuvar verileri değerlendirildi.

Bulgular: Yüksek ESR'si (≥20 mm/saat) olan toplam 3166 hasta içerisinde belirgin yüksek ESR'si olan 189 (%5.96) hasta çalışmaya dahil edildi. Belirgin yüksek ESR'nin en yaygın nedeni NIID (%35.9) iken, bunu enfeksiyonlar (%33.3), maligniteler (%19.0), nefrolojik (%2.6), diğer (%4.7) ve bilinmeyen (%4.2) olarak bulundu. En sık görülen spesifik alt tanı akut romatizmal ateş, Kawasaki hastalığı, lenfadenit ve lösemi idi. Yüksek ESR, yalnızca hemoglobin ve albümin seviyeleri ile negatif korelasyon gösterdi.

Sonuç: Çalışmamız 3. Basamak, referans bir çocuk hastanesinde yapılmış literatürdeki en geniş seridir. Çocuklarda belirgin ESR yükselmesine neden olan en yaygın hastalıkların bilinmesi, klinisyenlere ayırıcı tanıda yardımcı olacaktır.

Anahtar Kelimeler

• akut faz reaktanlar
• eritrosit sedimentasyon hızı
• çocuklar
• ayırıcı tanı

Kaynakça

1. Kratz A, Plebani M, Peng M, Lee YK, McCafferty R, Machin SJ. International Council for Standardization in Haematology (ICSH) (2017). ICSH recommendations for modified and alternate methods measuring the erythrocyte sedimentation rate. Int J Lab Hematol 2017;39:448-57.
2. Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. Erythrocyte Sedimentation Rate and C-reactive Protein Measurements and Their Relevance in Clinical Medicine. WMJ 2016;115:317-21.
3. Ramsay ES, Lerman MA. How to use the erythrocyte sedimentation rate in paediatrics. Arch Dis Child Educ Pract Ed 2015;100:30-6.
4. Lapić I, Padoan A, Bozzato D, Plebani M. Erythrocyte Sedimentation Rate and C-Reactive Protein in Acute Inflammation. Am J Clin Pathol 2020;153:14-29.
5. Schäfer VS, Weiß K, Krause A, Schmidt WA. Does erythrocyte sedimentation rate reflect and discriminate flare from infection in systemic lupus erythematosus? Correlation with clinical and laboratory parameters of disease activity. Clin Rheumatol 2018;37:1835-44.
6. Mahmood D Al-Mendalawi. Extremely elevated erythrocyte sedimentation rate. Etiology at a tertiary care center in Saudi Arabia. Saudi Med J 2011;32:536; author reply 536.
7. Xu W, Zhao W, Qian R, Xiao-Li L, Wang Y, Dai D, Zhu Y. Clinical observation of extremely elevated erythrocyte sedimentation rate. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2021;33:613-7.
8. Lluberas-Acosta G, Schumacher HR Jr. Markedly elevated erythrocyte sedimentation rates: consideration of clinical implications in a hospital population. Br J Clin Pract Apr-May 1996;50:138-42.

9. Manchon ND, Poutrain JR, Senant J, Cottin B, Bercoff E, Bourreille J. Valeur diagnostique d’une augmentation franche de la vitesse de sédimentation. Diagnostic value of a distinct rise in sedimentation rate. Presse medicale 1988;17:905–7.
10. Irving Kushner. Acute phase reactants. Paul L Romain. Oct 2021. https://www.uptodate.com/contents/acute-phase-reactants?
11. Schimmelpfennig RW, Jr, Chusid MJ. Illnesses associated with extreme elevation of the erythrocyte sedimentation rate in children. Clin Pediatr (Phila) 1980;19:175-8.
12. Abbag FI, Al Qahtani JM. Extreme elevation of the erythrocyte sedimentation rate in children. Ann Saudi Med May-Jun 2007;27:175-8.
13. Aydoğan Ü, Sarı O, Akbulut H, Sarıcı SÜ, Sağlam K, Özcan O. Evaluation of the diseases with an erythrocyte sedimentation rate over 100 mm/hour in children. Gülhane Tıp Derg 2010;52:257-60.
14. Özkan HÇ, Çam H, Kasapçopur Ö, Taştan Y. Çocuklarda belirgin eritrosit sedimentasyon hızı yüksekliği ile ilişkili hastalıklar Orijinal Araştırma. Türk Ped Arş 2003; 38: 25-31.
15. Daniels LM, Tosh PK, Fiala JA, Schleck CD, Mandrekar JN, Beckman TJ. Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients’ Diagnoses, Demographic Characteristics, and Comorbidities. Mayo Clin Proc 2017; 92:1636–43.
16. Ohta R, Kaneko M, Hattori S. Diseases With Extremely Elevated Erythrocyte Sedimentation Rates in a Secondary Healthcare Facility: Retrospective Cohort Study. Shimane J Med Sci 2017;34:7-33.
17. Acute rheumatic fever: Clinical manifestations and diagnosis. https://www.uptodate.com/contents/acute-rheumatic-fever-clinical-manifestations-and-diagnosis, Andrew Steer, Elizabeth TePas, Oct 2021.
18. Buda P, Friedman-Gruszczyńska J, Książyk J. Anti-inflammatory Treatment of Kawasaki Disease: Comparison of Current Guidelines and Perspectives. Front Med (Lausanne) 2021;8:738850.
19. Otero-Castro V, Bonella B, Cristaldo N, Fiorentini F, Giunta D, Ferreyro BL. Extremely elevated erythrosedimentation in an adult population in the City of Buenos Aires. Rev Chilena Infectol 2017;34:314-8.
20. Belinskaia DA, Voronina PA, Shmurak, VI, Jenkins RO, Goncharov NV. Serum Albumin in Health and Disease: Esterase, Antioxidant, Transporting and Signaling Properties. Int J Mol Sci 2021;22:10318