Any process that elevates fibrinogen levels (e.g., pregnancy, infection, diabetes mellitus, end-stage renal disease, heart disease, malignancy) may also elevate the ESR. An extremely high ESR value (>100 mm/hr) may indicate the presence of infection, multiple myeloma, lymphoplasmacytic lymphoma (Waldenström macroglobulinemia), giant cell (temporal) arteritis, polymyalgia rheumatica, or hypersensitivity vasculitis. One study reported that the average ESR was over 90 mm per hour in patients with temporal arteritis, with values over 30 mm per hour in 99% of the patients.[41] The extremely high elevation of the ESR (>100 mm per hour) is associated with a low false-positive rate for a significant underlying illness.[42] Infection is likely the cause of an extreme elevation, followed by collagen vascular disease and metastatic tumors.[43] In oncology, a high ESR tends to correlate with a poor prognosis for various types of cancers.[44][45]
Leave a reply