Erythrocyte sedimentation rate (ESR)
ESR is how far red cells settle in a tube of blood in an hour, a nonspecific sign of inflammation. A National Library of Medicine page gives upper limits of 15 to 30 mm/hr by age and sex. Values run higher in women, with age and in pregnancy. A Dutch cohort linked 20 or above to more deaths. Methods differ.
- Status
- Ordered by a clinician and also sold direct to consumers by some US laboratories. FDA classifies erythrocyte sedimentation rate tests and automated sedimentation rate devices as class I devices exempt from premarket notification [1][2].
- Measures
- How far red blood cells settle in a column of blood in one hour, in millimeters. FDA describes an increased rate as indicating tissue damage or inflammation [1].
- Also called
- ESR, sed rate, sedimentation rate, erythrocyte sedimentation rate, Westergren sedimentation rate, Westergren ESR, sed rate by modified Westergren
- Tested for
- inflammation, unexplained fever, joint pain, arthritis, polymyalgia rheumatica, giant cell arteritis, autoimmune disease monitoring, infection monitoring
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Linked in research4
- LimitedLimited evidence: one Dutch cohort of 5,226 older adults linked an ESR of 20 to 50 to 23% more deaths, and above 50 to 89% more.
- LimitedLimited evidence: one Norwegian cohort of 2,014 men linked a higher ESR to more deaths from coronary heart disease over 23 years.
- LimitedLimited evidence: in UK primary care, a raised inflammatory marker went with a 3.5% chance of a cancer diagnosis within a year, against 1.5% when normal.
- LimitedLimited evidence: among 4,807 clinic patients with an ESR of 100 or above, infection was found in 40%, autoimmune disease in 38% and malignancy in 36%.
Reported risks0
No risks sourced yet.
Reference ranges
Each range is the one its source published, in mm/hr. Where sources differ, each is shown.
US National Library of Medicine, MedlinePlus Medical Encyclopedia, men under 50
Men under 50, by the Westergren method · [3], [4], [5]
| Range | What the source calls it |
|---|---|
| below 15 mm/hr | "normal results" |
| 15 or above mm/hr | No name given |
From the US National Library of Medicine's encyclopedia for the public, which cites two textbooks and gives no account of how the limits were derived. It states that ranges may vary slightly among laboratories. It prints the age groups as under 50 and over 50 without saying where a person of exactly 50 falls. It gives no lower limit, so this block does not classify low results [3]. Other age and sex adjustments are in print. Miller and colleagues proposed in the BMJ in 1983, from 26,836 men and 1,076 women, that the upper limit be taken as age in years divided by 2 for men, and age plus 10, divided by 2, for women, as reported by a 2017 letter that tested the rule [4]. Wetteland and colleagues in 1996 estimated upper reference levels at ages 20, 55 and 90 of 12, 14 and 19 mm/hr for men, in 3,910 Norwegian adults [5]. Because those limits change with each year of age, they are described here and not placed as bands.
US National Library of Medicine, MedlinePlus Medical Encyclopedia, men over 50
Men over 50, by the Westergren method · [3], [4]
| Range | What the source calls it |
|---|---|
| below 20 mm/hr | "normal results" |
| 20 or above mm/hr | No name given |
From the same page, with no account of how the limit was derived [3]. The 1983 rule of age divided by 2 gives a limit of 25 mm/hr at age 50 and 40 at age 80, as that rule is reported by a later letter [4].
US National Library of Medicine, MedlinePlus Medical Encyclopedia, women under 50
Women under 50, by the Westergren method · [3], [5]
| Range | What the source calls it |
|---|---|
| below 20 mm/hr | "normal results" |
| 20 or above mm/hr | No name given |
From the same page, with no account of how the limit was derived. The page lists pregnancy and anemia among states with an increased rate [3]. Wetteland and colleagues estimated upper reference levels for women of 18, 21 and 23 mm/hr at ages 20, 55 and 90 [5].
US National Library of Medicine, MedlinePlus Medical Encyclopedia, women over 50
Women over 50, by the Westergren method · [3], [4]
| Range | What the source calls it |
|---|---|
| below 30 mm/hr | "normal results" |
| 30 or above mm/hr | No name given |
From the same page, with no account of how the limit was derived [3]. The 1983 rule of age plus 10, divided by 2, gives a limit of 30 mm/hr at age 50 and 45 at age 80, as that rule is reported by a later letter [4].
US National Library of Medicine, MedlinePlus Medical Encyclopedia, children from the newborn period to puberty
Children from after the newborn period to puberty, by the Westergren method · [3]
| Range | What the source calls it |
|---|---|
| below 3 mm/hr | No name given |
| 3 to 13 mm/hr | "normal results" |
| above 13 mm/hr | No name given |
From the same page, printed as 3 to 13 mm/hr for newborn to puberty, with no ages in years and no account of how the range was derived [3].
US National Library of Medicine, MedlinePlus Medical Encyclopedia, newborns
Newborns, by the Westergren method · [3]
| Range | What the source calls it |
|---|---|
| 0 to 2 mm/hr | "normal results" |
| above 2 mm/hr | No name given |
From the same page, printed as 0 to 2 mm/hr, with no age in days and no account of how the range was derived [3].
Lorubbio and colleagues, Italian reference interval study, 2025, women
Women older than 18, by the Westergren method · [6]
| Range | What the source calls it |
|---|---|
| below 1 mm/hr | No name given |
| 1 to 22 mm/hr | "reference interval" |
| above 22 mm/hr | No name given |
The 1st to 99th percentiles in 468 women among 989 outpatients and blood donors in Arezzo presumed to be free of illness, a wider span than the usual 2.5th to 97.5th percentiles. By age, the study's upper limits for women were 21 mm/hr at 18 to 49, 21 at 50 to 69 and 22 at 70 and older, and the authors propose one interval for all adult women. The study was funded by the maker of the two automated analyzers it compared with the Westergren method [6].
Lorubbio and colleagues, Italian reference interval study, 2025, men aged 18 to 69
Men aged 18 to 69, by the Westergren method · [6]
| Range | What the source calls it |
|---|---|
| below 1 mm/hr | No name given |
| 1 to 14 mm/hr | "reference interval" |
| above 14 mm/hr | No name given |
The 1st to 99th percentiles in 397 men from the same sample. By age, the upper limits were 13 mm/hr at 18 to 49 and 16 at 50 to 69. The study was funded by an analyzer manufacturer [6].
Lorubbio and colleagues, Italian reference interval study, 2025, men aged 70 and older
Men aged 70 and older, by the Westergren method · [6]
| Range | What the source calls it |
|---|---|
| below 1 mm/hr | No name given |
| 1 to 22 mm/hr | "reference interval" |
| above 22 mm/hr | No name given |
The 1st to 99th percentiles in 124 men aged 70 and older from the same sample. The upper limit is 8 mm/hr above the one for younger men in the same study. The study was funded by an analyzer manufacturer [6].
Fest and colleagues, Rotterdam Study, 2019
Adults in a Dutch population cohort, mean age 70 · [7]
| Range | What the source calls it |
|---|---|
| below 20 mm/hr | No name given |
| 20 to 50 mm/hr | "moderately elevated" |
| above 50 mm/hr | "markedly elevated" One to see a doctor about |
Categories the authors chose to study deaths, not reference limits, and the same for men and women at every age. Both raised categories were associated with more deaths over a median of 14.9 years. The abstract does not name the measuring method [7].
van den Broek and Letsky, London antenatal study, 2001, first half of pregnancy without anemia
Pregnant women in the first half of pregnancy who are not anemic · [8]
| Range | What the source calls it |
|---|---|
| below 18 mm/hr | No name given |
| 18 to 48 mm/hr | "reference range" |
| above 48 mm/hr | No name given |
The 95% reference range in healthy women attending routine antenatal visits at one London hospital, measured by the Westergren method. Across all 1,019 women the values ran from 4 to 112 mm/hr, and both gestational age and hemoglobin influenced the result. The abstract does not give the week that divides the two halves of pregnancy or the hemoglobin level used to define anemia [8].
van den Broek and Letsky, London antenatal study, 2001, second half of pregnancy without anemia
Pregnant women in the second half of pregnancy who are not anemic · [8]
| Range | What the source calls it |
|---|---|
| below 30 mm/hr | No name given |
| 30 to 70 mm/hr | "reference range" |
| above 70 mm/hr | No name given |
From the same study. The whole range sits above the limit of 20 mm/hr that the National Library of Medicine page gives for women under 50 [8][3].
van den Broek and Letsky, London antenatal study, 2001, first half of pregnancy with anemia
Pregnant women in the first half of pregnancy who are anemic · [8]
| Range | What the source calls it |
|---|---|
| below 21 mm/hr | No name given |
| 21 to 62 mm/hr | "reference range" |
| above 62 mm/hr | No name given |
From the same study. The abstract does not give the hemoglobin level used to define anemia [8].
van den Broek and Letsky, London antenatal study, 2001, second half of pregnancy with anemia
Pregnant women in the second half of pregnancy who are anemic · [8]
| Range | What the source calls it |
|---|---|
| below 40 mm/hr | No name given |
| 40 to 95 mm/hr | "reference range" |
| above 95 mm/hr | No name given |
From the same study. The abstract does not give the hemoglobin level used to define anemia [8].
American College of Rheumatology and EULAR classification criteria for giant cell arteritis, 2022
People aged 50 or older being classified for giant cell arteritis · [9]
| Range | What the source calls it |
|---|---|
| below 50 mm/hr | No name given |
| 50 or above mm/hr | No name given |
One weighted item in a points score, worth 3 points and met by an ESR of 50 mm/hr or above or a C-reactive protein of 10 mg/L or above. Classification needs 6 points or more from several items, among them a positive artery biopsy or ultrasound sign, so a result of 50 or above is not a diagnosis. The authors state that the criteria are validated for use in clinical research [9].
Daniels and colleagues, Mayo Clinic study of extreme elevation, 2017
Adults, as the level one large US clinic study defined as extreme · [10]
| Range | What the source calls it |
|---|---|
| below 100 mm/hr | No name given |
| 100 or above mm/hr | "extreme elevation" A doctor, immediately |
A definition used to select patients for a study, not a reference limit. Among 4,807 patients with an ESR of 100 mm/hr or above, the leading associated diagnoses were infection in 40%, autoimmune disease in 38% and malignancy in 36%, and the authors report that almost all patients had an identifiable cause. The shares overlap. The study says nothing about results under 100 [10].
What has been shown to move it
Shown to lower it3
Rheumatoid arthritis
Shown to improve joint swelling, stiffness and grip in adults with rheumatoid arthritis, matching or beating standard drugs, in trials mostly from China.
Against DMARDs, grip strength, morning stiffness, CRP and tender joint count differed (P < 0.05), and ESR and swollen joint count did not.
The numbers and sources
- Effect
- Across 14 RCTs, TwHF extracts improved grip strength, swollen joint count and morning stiffness against placebo (P < 0.001). Against DMARDs, grip strength, morning stiffness, CRP and tender joint count differed (P < 0.05), and ESR and swollen joint count did not [1]. Across 40 RCTs (3,092 patients), tripterygium glycosides added to DMARDs lowered morning stiffness, tender and swollen joint counts, pain scores, CRP, ESR and rheumatoid factor against DMARDs alone (all p < .001) [2]. A network meta-analysis of 21 trials (5,039 participants) ranked TwHF with methotrexate first and TwHF alone second for ACR20 response among the conventional DMARDs compared [3]. In 207 patients, ACR50 response at 24 weeks was 46.4% on methotrexate, 55.1% on TwHF (p 0.014) and 76.8% on both (p < 0.001) [4]. In 121 US patients, 65.0% on TwHF extract and 32.8% on sulfasalazine met ACR20 at 24 weeks (P 0.001) [5].
- Population
- Adults with active rheumatoid arthritis, mostly in China [1][2][3][4]. 121 patients at US centers [5].
- Sources
- [1], [2], [3], [4], [5]
- Caveats
- The methotrexate trial was open label, with blinded assessors [4]. In the sulfasalazine trial only 62 patients had outcome data at 24 weeks, and 62% and 41% stayed on treatment [5]. Most pooled trials were small and Chinese.
Rheumatoid arthritis
Shown to lower disease activity, joint counts and inflammation markers in adults with rheumatoid arthritis, in few small trials with very low certainty.
The numbers and sources
- Effect
- Across 6 publications (539 patients), curcumin lowered DAS28 (MD -1.20, 95% CI -1.85 to -0.55), ESR (MD -29.47), swollen joint count (MD -5.33) and tender joint count (MD -6.33) against controls [19]. Across 7 RCTs, DAS28 fell by 1.47 (95% CI -1.68 to -1.26), with lower rheumatoid factor, ESR and CRP [20]. Across 6 placebo-controlled trials (244 participants), ACR20 response, DAS28, ESR, CRP, pain and joint counts all improved, with very low certainty for most outcomes [21].
- Population
- Adults with rheumatoid arthritis [19][20][21].
- Sources
- [19], [20], [21]
- Caveats
- The trials were few and small, heterogeneity was substantial [20], and the certainty of evidence was very low [21].
Joint pain and arthritis
Small trials found boron supplements eased knee discomfort over 2 weeks and lowered inflammation markers in arthritis. Several were short, and one was run by the maker.
In 60 adults with knee osteoarthritis, 15 days of calcium fructoborate improved C-reactive protein, fibrinogen and sedimentation rate against placebo, with no serious adverse events.
The numbers and sources
- Effect
- In 60 adults with self-reported knee discomfort, calcium fructoborate 110 mg twice a day lowered McGill Pain Questionnaire scores by 8.9 points and WOMAC scores by 13.73 points more than placebo at day 14 (both p < 0.0001), with no change on placebo [10]. In 60 adults with knee osteoarthritis, 15 days of calcium fructoborate improved C-reactive protein, fibrinogen and sedimentation rate against placebo, with no serious adverse events [11]. In 72 people with rheumatoid arthritis on etanercept, calcium fructoborate or borax (6 mg of boron a day) for 60 days improved disease activity scores and lowered ESR, hsCRP, IL-1α, IL-6 and TNF-α against placebo [12]. A 1994 review reported a 20-person trial in osteoarthritis in which 50% improved on 6 mg of boron a day against 10% on placebo [13].
- Population
- 60 adults aged 35 to 65 with knee discomfort in Mexico [10]. 60 middle-aged adults with knee osteoarthritis [11]. 72 adults with rheumatoid arthritis in Iraq [12]. 20 adults with osteoarthritis [13].
- Sources
- [10], [11], [12], [13]
- Caveats
- Trials ran 2 weeks to 2 months. The knee discomfort trial was designed by FutureCeuticals, which supplied the calcium fructoborate and employed most authors [10]. The 20-person trial is known only from its author's review [13]. No meta-analysis was located.
Studies disagree1
Rheumatoid arthritis disease activity
Shown to lower disease activity modestly in adults with rheumatoid arthritis. Reviews disagree on CRP, ESR and pain.
The numbers and sources
- Effect
- Across 6 studies (438 patients), vitamin D lowered DAS28 (WMD -0.41, 95% CI -0.59 to -0.23), ESR (WMD -3.40) and tender joint count (WMD -1.44) against control [6]. Across 11 RCTs, it lowered pain scores (WMD -1.30) and DAS28-CRP (WMD -0.58, 95% CI -0.86 to -0.31), while CRP, ESR and HAQ did not change [7]. A third meta-analysis of 11 studies found lower DAS28 (WMD -0.83, 95% CI -1.38 to -0.28), CRP and ESR, with no change in HAQ or pain scores [8].
- Population
- Adults with rheumatoid arthritis in RCTs [6][7][8].
- Sources
- [6], [7], [8]
- Caveats
- The reviews disagree on CRP, ESR and pain, and heterogeneity was high [7].
Tested, and not shown to change it4
C-reactive protein and other inflammation markers
Shown to lower CRP and some other inflammation markers in adults with inflammatory conditions or diabetes. These are blood markers, not clinical outcomes.
In 21 knee osteoarthritis studies (1,705 patients), CRP (SMD -0.906, 95% CI -1.543 to -0.269) and TNF-alpha were lower than placebo, while ESR, IL-1beta, IL-6 and PGE-2 did not differ.
The numbers and sources
- Effect
- In 9 studies, curcumin lowered CRP by 3.67 mg/L (95% CI -6.96 to -0.38). In 23 studies hs-CRP was lower than placebo, with stronger effects below 2,000 mg a day [14]. In 28 RCTs in prediabetes and type 2 diabetes, curcumin or turmeric lowered CRP (SMD -0.50), TNF-alpha (SMD -1.70) and IL-6 (SMD -2.97) [15]. In 6 RCTs (472 adults with type 2 diabetes), hs-CRP was 1.06 mg/L lower (95% CI -1.97 to -0.16, I² 17.3%) [16]. In 21 knee osteoarthritis studies (1,705 patients), CRP (SMD -0.906, 95% CI -1.543 to -0.269) and TNF-alpha were lower than placebo, while ESR, IL-1beta, IL-6 and PGE-2 did not differ [17]. With piperine added, 18 RCTs showed lower IL-6, while CRP and TNF-alpha did not change significantly [18].
- Population
- People with proinflammatory or autoinflammatory conditions [14]; adults with prediabetes or type 2 diabetes [15][16]; adults with knee osteoarthritis [17]; adults in curcumin with piperine trials [18].
- Sources
- [14], [15], [16], [17], [18]
- Caveats
- Blood markers, not clinical outcomes. Certainty was low for every marker in the 28-trial review, which also found publication bias for CRP [15]. The curcumin with piperine review found no significant CRP change [18].
Rheumatoid arthritis
Mixed results: one review found better disease activity markers in rheumatoid arthritis, while others found small or no effects on pain and swollen joints.
Across 18 RCTs (1,018 patients), tender joint count fell (SMD -0.59, 95% CI -0.79 to -0.39), while ESR, CRP and DAS28 did not change significantly.
The numbers and sources
- Effect
- Across 20 RCTs (1,252 patients), omega-3 improved eight disease activity markers. Of five inflammatory markers, only leukotriene B4 fell (SMD -0.440, 95% CI -0.676 to -0.205) [11]. Across 23 placebo-controlled trials, pooled effects on pain (SMD -0.16, 95% CI -0.40 to 0.09), tender joints (SMD -0.20, 95% CI -0.46 to 0.05) and swollen joints (SMD -0.10, 95% CI -0.28 to 0.07) were small, with intervals that include no effect [12]. Across 18 RCTs (1,018 patients), tender joint count fell (SMD -0.59, 95% CI -0.79 to -0.39), while ESR, CRP and DAS28 did not change significantly [13].
- Population
- Adults with rheumatoid arthritis in RCTs [11][12][13].
- Sources
- [11], [12], [13]
- Caveats
- The certainty of the evidence was mostly very low or low [12]. The authors of [12] note that earlier findings of lower NSAID use may reflect inadequate blinding.
Rheumatoid arthritis
Mixed results: reviews agree probiotics lower CRP or IL-6 in rheumatoid arthritis, but disagree on disease activity.
Across 4 RCTs (153 participants), DAS fell (SMD -0.58, 95% CI -0.97 to -0.19), CRP fell borderline (SMD -0.32, 95% CI -0.65 to 0.00), and ESR and cytokines did not change.
The numbers and sources
- Effect
- Across 9 studies (361 patients), probiotics lowered IL-6 (SMD -0.708) and did not change disease activity scores (MD 0.023, 95% CI -0.584 to 0.631) [8]. Across 4 RCTs (153 participants), DAS fell (SMD -0.58, 95% CI -0.97 to -0.19), CRP fell borderline (SMD -0.32, 95% CI -0.65 to 0.00), and ESR and cytokines did not change [9]. A review of 8 RA trials (344 patients) found CRP 3.04 mg/L lower (95% CI -4.47 to -1.62). With high risk-of-bias trials excluded, DAS28 did not differ from placebo (SMD -0.54, 95% CI -1.94 to 0.85) [10].
- Population
- Adults with rheumatoid arthritis, mostly women, over 8 weeks to 1 year [8][9][10].
- Sources
- [8], [9], [10]
- Caveats
- The reviews agree on lower CRP or IL-6 and disagree on disease activity. Strains, doses and durations varied [10].
Inflammation markers (CRP)
Small trials found no change in CRP in knee osteoarthritis, and lower airway inflammation markers in asthma.
The numbers and sources
- Effect
- In 100 adults with knee osteoarthritis, CRP and ESR did not differ between powder and placebo after 12 weeks [3]. In the asthma crossover trial, airway markers including cysteinyl leukotrienes and 8-isoprostane in exhaled breath fell on PCSO-524 against placebo [6].
- Population
- 100 adults with knee osteoarthritis [3] and 20 adults with asthma [6].
- Sources
- [3], [6]
- Caveats
- Two small trials measuring different markers. No meta-analysis of inflammation markers was located.
How it compares with the reference method
Matched the reference method1
The age-based rule for the upper limit
One study of 249 Japanese outpatients over 65 found most measured ESR values fell under the limit the 1983 age rule predicts.
The numbers and sources
- Compared with
- ESR measured in clinically stable older outpatients with a normal C-reactive protein
- Effect
- The rule, published by Miller and colleagues in 1983, takes the upper limit as age divided by 2 in men and age plus 10, divided by 2, in women. In 249 outpatients aged 65 to 91, median ESR was 6 mm/hr in men (range 1 to 31) and 12 in women (range 2 to 45), and the median gap between the predicted limit and the measured value was 30 mm/hr. Most measured values were lower than the predicted limit, and the authors conclude that the rule can be applied to older and Asian patients [4].
- Population
- 85 men and 164 women, mean age 75, at one Japanese university hospital, selected for stable health and a C-reactive protein of 0.03 or below in the letter's units [4].
- Sources
- [4]
- Caveats
- A short letter with no comparison group, in people chosen for having no sign of inflammation, so it does not show how often the rule misses disease. The rule is described here as the letter reports it, not from the 1983 paper itself [4].
Mixed results1
Detecting giant cell arteritis
Shown in a meta-analysis of 68 studies: an ESR above 100 raised the likelihood of giant cell arteritis about 3 times, and 40 or below lowered it.
The numbers and sources
- Compared with
- Temporal artery biopsy, imaging or clinical diagnosis
- Effect
- In patients suspected of giant cell arteritis, an ESR above 100 mm/hr had a positive likelihood ratio of 3.11 (95% CI 1.43 to 6.78). The absence of an ESR above 40 mm/hr had a negative likelihood ratio of 0.18 (0.08 to 0.44). The authors conclude that no single feature was strong enough to confirm or refute the diagnosis taken alone [15]. The 2022 classification criteria give 3 points for an ESR of 50 mm/hr or above or a raised C-reactive protein, out of 6 needed [9].
- Population
- 14,037 patients with suspected giant cell arteritis in 68 studies [15].
- Sources
- [15], [9]
- Caveats
- The studies used different reference standards, and the patients were already suspected of the disease, so the figures do not apply to an ESR found on a routine test [15].
Did not match the reference method2
Measuring method
Shown to differ by method: an international standards group found newer methods gave results up to 142% different from the Westergren method.
The numbers and sources
- Compared with
- The Westergren method
- Effect
- A working group of the International Council for Standardization in Haematology reviewed the literature and external quality surveys from more than 6,000 laboratories on four continents. Only 28% of laboratories used the unmodified Westergren method. Results from newer instruments differed from Westergren results by up to 142%, and non-Westergren methods differed from one another by up to 42% [13]. In an Italian study of 989 people, mean results on two automated analyzers were 1 mm/hr lower and 1 mm/hr higher than the Westergren mean of 7 mm/hr, and the upper reference limits differed by analyzer [6].
- Population
- External quality surveys from over 6,000 laboratories [13]. 989 outpatients and blood donors in Italy [6].
- Sources
- [13], [6]
- Caveats
- A laboratory report does not always say which method was used. The Italian study was funded by the maker of the two analyzers it tested [6].
Age and sex
Shown to run higher in women and to rise with age in three population studies, about 2 times higher in women and in people over 65.
The numbers and sources
- Compared with
- ESR in men and in the youngest adults of the same studies
- Effect
- In 3,910 Norwegian adults aged 20 to 90, mean ESR was about 3 mm/hr at age 20, 6 at 55 and 10 at 90 in men, and 6, 9 and 11 in women. The upper reference levels at those ages were 12, 14 and 19 mm/hr for men and 18, 21 and 23 for women, and about 76% of all results were below 9 mm/hr [5]. In 1,472 adults drawn at random from a Spanish town, median ESR in women was 2 times that in men, and in people over 65 it was 2 times that in people aged 18 to 35. Body mass index, metabolic syndrome and smoking went with higher values, and 9.6% of people were above the laboratory's limits of 20 mm/hr for men and 30 for women [14]. In 989 Italian adults, median Westergren values rose with age from 3 to 9 mm/hr in men and from 8 to 11 in women [6]. That study describes the intervals proposed by Böttiger and Svedberg in 1967 as 0 to 15 mm/hr at ages 20 to 49 and 0 to 22 at ages 50 to 69 for the first group it lists, and 0 to 24 at ages 15 to 49 and 0 to 32 at ages 50 to 69 for women [6].
- Population
- 2,145 men and 1,765 women in the Oslo area, 93% blood donors [5]. 1,472 adults aged 18 to 91 in a Spanish municipality [14]. 989 adults in Arezzo [6].
- Sources
- [5], [14], [6]
- Caveats
- The Spanish study used an automated photometric method, not the Westergren tube. The 1967 intervals are quoted from the Italian study, not from the original paper, and that study does not name the sex of the first group [14][6].
What studies tie it to
Linked in research4
Death from any cause
Limited evidence: one Dutch cohort of 5,226 older adults linked an ESR of 20 to 50 to 23% more deaths, and above 50 to 89% more.
The numbers and sources
- Effect
- Against an ESR below 20 mm/hr, the adjusted hazard ratio for death from any cause was 1.23 (95% CI 1.12 to 1.35) at 20 to 50 mm/hr and 1.89 (1.38 to 2.60) above 50 mm/hr. In people older than 75 with no other illness recorded, an ESR above 20 mm/hr still had a hazard ratio of 1.29 (1.01 to 1.64) [7].
- Population
- 5,226 participants in the Rotterdam Study, mean age 70.3, with 3,749 deaths over a median of 14.9 years [7].
- Sources
- [7]
- Caveats
- One observational cohort of older adults. ESR is a nonspecific sign of illness, and the source did not test whether lowering it changes the risk of death [7].
Death from coronary heart disease
Limited evidence: one Norwegian cohort of 2,014 men linked a higher ESR to more deaths from coronary heart disease over 23 years.
The numbers and sources
- Effect
- After adjustment for age, hemoglobin, smoking, cholesterol and systolic blood pressure, ESR was a strong short-term and long-term predictor of death from coronary heart disease, most of all in men who had developed angina or had a positive exercise test at a second survey 7 years later. More deaths from other causes and more nonfatal heart attacks were seen only in the upper range of ESR [11].
- Population
- 2,014 apparently healthy men aged 40 to 60 examined in 1972 to 1975 and followed for 23 years [11].
- Sources
- [11]
- Caveats
- One observational cohort of men. The abstract gives no hazard ratios and no ESR levels [11].
Cancer diagnosed within a year
Limited evidence: in UK primary care, a raised inflammatory marker went with a 3.5% chance of a cancer diagnosis within a year, against 1.5% when normal.
The numbers and sources
- Effect
- One-year cancer incidence was 3.53% (95% CI 3.37 to 3.70) in patients with a raised inflammatory marker, 1.50% (1.43 to 1.58) in patients whose markers were normal and 0.97% (0.87 to 1.07) in untested controls. Risk was greater with higher marker levels, older age and in men. The sensitivity of ESR for cancer was 43.6%, so more than half of the people with cancer had an ESR that was not raised [12].
- Population
- 160,000 UK primary care patients with an inflammatory marker test in 2014 and 40,000 untested matched controls, linked to the cancer registry [12].
- Sources
- [12]
- Caveats
- Observational. The incidence figures pool three markers, C-reactive protein, ESR and plasma viscosity, and the test was ordered for a reason in each patient. The authors state that inflammatory markers are not useful for ruling cancer out [12].
Diagnoses found at 100 mm/hr or above
Limited evidence: among 4,807 clinic patients with an ESR of 100 or above, infection was found in 40%, autoimmune disease in 38% and malignancy in 36%.
The numbers and sources
- Effect
- The leading diagnosis associated with an ESR of 100 mm/hr or above was infection (1,932 patients, 40%), followed by autoimmune disease (1,839, 38%) and malignancy (1,736, 36%). The authors report that almost all patients had an identifiable cause. Values were slightly higher in men than in women, and did not correlate with age, race or C-reactive protein [10].
- Population
- 4,807 patients with an ESR of 100 mm/hr or above examined at Mayo Clinic in Rochester, Minnesota, from 2002 to 2011 [10].
- Sources
- [10]
- Caveats
- Retrospective, at one referral center, with no comparison group below 100 mm/hr. The diagnosis groups overlap [10].
Sources
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