Hot topic in geriatric medicine Markedly elevated erythrocyte sedimentation rate in older adults. How significant clinically? O.K. Cengiz, S.E. Esmen, M. Varli, A. Yalcin *, S. Aras, V. Atmis, T. Atli Department of Geriatric Medicine, Ankara University School of Medicine, Cebeci, Ankara 06110, Turkey 1. Introduction Erythrocyte sedimentation rate (ESR) is a simple and cheap laboratory test generally used for evaluating acute phase response [1]. ESR defined as the precipitation rate of erythrocytes in one hour when blood was put in an anti-coagulated tube placed in a vertical position [2]. Erythrocyte sedimentation rate values markedly increase in various diseases especially malignancies, infections, collagen tissue diseases (CTD) [3]. Therefore, many clinicians feel forced to perform many diagnostic tests when elevated ESR was found. Although ESR is a simple and cheap laboratory test, sensitivity and specificity of ESR are low [4]. Therefore, ESR cannot be used as a screening test for asymptomatic individuals. Generally, ESR is used for detecting where a disease exists or not in clinically suspicious situations, for assessing response to treatment or for follow-up [5]. Erythrocyte sedimentation rate also increases in situations like obesity, pregnancy and also increases by aging [1–3]. Elevation of ESR by age was shown in many studies. Erythrocyte sedimentation rate increases 0.85 mm/h in every 5 years after puberty. Although the cause of ESR elevation by aging is not known certainly, elevation can be associated with increased levels of fibrinogen [2,6,7]. Westergren method is the most used method to measure ESR in clinical practice [7]. History and physical examination are very useful to find the cause of ESR elevation. But generally clinicians need more advanced and invasive diagnostic tests to find the reason lying under ESR elevation. In this study, we aimed to evaluate clinical significance and the reasons of markedly elevated ESR in geriatric population. 2. Methods and patients Among 1682 outpatients admitted consecutively to Ankara University School of Medicine Geriatrics clinics during one-year period, 110 individuals with ESR greater or equal to 80 mm/h were rolled into the study. Demographic data were obtained and detailed physical examination was performed as a part of multidimensional geriatric assessment. Cognitive functions and functionality of participants were also assessed. After clinical evaluation, in order to find the causes of ESR elevation, whole blood count, biochemical parameters, C-reactive protein (CRP), serum protein electrophoresis, urine examination, chest radiogram were performed. Blood smear, serum iron levels, total iron binding capacity, transferrin saturation, ferritin levels, serum vitamin B12 levels, and folic acid levels were all assessed in patients with anemia. Blood, urine, throat, sputum, feces, wound cultures were European Geriatric Medicine 4 (2013) 28–31 A R T I C L E I N F O Article history: Received 26 July 2012 Accepted 1 October 2012 Available online 10 November 2012 Keywords: Older adults Erythrocyte sedimentation rate Infectious diseases Malignancy Collagen tissue diseases A B S T R A C T Objective: Erythrocyte sedimentation rate (ESR) despite being a fast and cheap test to evaluate acute phase response, has low sensitivity and specificity. Atypical courses and lack of specific signs and symptoms of the diseases in elderly restrict the use of ESR for diagnosis. We aimed to determine clinical importance and possible etiologies of markedly elevated ESR in older adults. Patients and methods: One thousand six hundred and eighty-two patients consecutively admitted to Ankara University School of Medicine Geriatric clinics were evaluated. A hundred and ten patients with ESR more than 80 mm/h were included into study and evaluated for the possible causes of ESR elevation. Results: Etiology of elevated ESR was due to infectious diseases in 53 (48.2%), malignancy in 19 (17.3%), and collagen tissue diseases in 17 (15.5%) patients. Some of the etiologies coexisted in 10 (9.1%) patients. No specific etiology was detected in 31 (28.2%) patients. Among infectious diseases, pneumonia (n = 20/ 53, 37.7%) was the leading cause followed by urinary tract infections (UTI) (n = 17/53, 32.1%). Multiple myeloma (n = 7/19, 36.8%) was the leading cause among malignancies. Rheumatoid arthritis (n = 10/17, 58.8%) was the leading cause among collagen tissue diseases. Leukocyte count and C-reactive protein levels are useful to determine infectious diseases as a cause of markedly elevated ESR. ß 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. * Corresponding author. Ug ˘ur Mumcu Street, 69/9 Gazi Osman Pas ¸ a, Ankara, Turkey. Tel.: +90 312 5957234. E-mail address: ahmetemreyalcin@hotmail.com (A. Yalcin). Available online at www.sciencedirect.com 1878-7649/$ – see front matter ß 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. http://dx.doi.org/10.1016/j.eurger.2012.10.002