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Erythrocyte Sedimentation Rate: Its Determinants and Relationship with Risk Factors Involved in Ischemic Stroke

  • Kaur, Kirandeep (Department of Human Genetics, Guru Nanak Dev University) ;
  • Kaur, Amandeep (Department of Viral Research and Diagnostic Laboratory) ;
  • Kaur, Anupam (Department of Human Genetics, Guru Nanak Dev University)
  • Received : 2022.02.03
  • Accepted : 2022.03.15
  • Published : 2022.03.31

Abstract

Erythrocyte sedimentation rate (ESR) evaluation is a useful tool for monitoring disease activity in various inflammatory and non-inflammatory conditions. ESR is known to be influenced by a multitude of confounding factors. The present study aimed to assess the possible determinants of the ESR and its relationship with various risk factors involved in ischemic stroke. ESR and other hematological and biochemical parameters were investigated in 163 ischemic stroke patients (107 males and 56 females) selected based on imaging techniques including magnetic resonance imaging (MRI) or computed tomography (CT) scans. Statistical analysis was performed using the SPSS 16.0 software. Linear regression analysis showed a significant inverse relationship of hemoglobin (Hb) and hematocrit or packed cell volume (PCV) (P<0.001 for females; P<0.01 for males) with the ESR. It was observed that the red blood cell (RBC) count was not strongly correlated with the ESR (P<0.05 for both males and females). It was also observed that sex significantly affected the variables determining the ESR levels, whereas age had no effect. Gender differences were also observed with respect to Hb, RBC, PCV, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ESR. The possible determinants of higher ESR levels in ischemic stroke may be sex, Hb, hematocrit, and RBC count, but the role of other clinical and laboratory parameters cannot be underestimated.

Keywords

Acknowledgement

We are very thankful to UPE for financial support to KK, Dr. Ashok Uppal for providing samples and all the participants for their timely support to carry out this study.

References

  1. Ernst E, Matrai A, Marshall M. Blood rheology in patients with transient ischemic attacks. Stroke. 1988;19:634-636. https://doi.org/10.1161/01.str.19.5.634
  2. Ami RB, Barshtein G, Zeltser D, Goldberg Y, Shapira I, Roth A, et al. Parameters of red blood cell aggregation as correlates of the inflammatory state. Am J Physiol Heart Circ Physiol. 2001;280: H1982-1988. https://doi.org/10.1152/ajpheart.2001.280.5.H1982
  3. Yedgar S, Kaul DK, Barshtein G. RBC adhesion to vascular endothelial cells more potent than RBC aggregation in inducing circulatory disorders. Microcirculation. 2008;15:581-583. https://doi.org/10.1080/10739680802105482
  4. Anuk T, Assayag EB, Rotstein R, Fusman R, Zeltser D, Berliner S, et al. Prognostic implications of admission inflammatory profile in acute ischemic neurological events. Acta Neurol Scand. 2002;106:196-199. https://doi.org/10.1034/j.1600-0404.2002.01224.x
  5. Chamorro A, Vila N, Ascaso C. Saiz A, Montalvo J, Alonso P, et al. Early prediction of stroke severity. Role of the erythrocyte sedimentation rate. Stroke. 1995;26:573-576. https://doi.org/10.1161/01.str.26.4.573
  6. Jurado RL. Why shouldn't we determine the erythrocyte sedimentation rate?. Clin Infect Dis. 2001;33:548-549. https://doi.org/10.1086/322605
  7. No authors listed. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41:105-114. https://doi.org/10.1016/0895-4356(88)90084-4
  8. Westergren, A. Studies of the suspension stability of the blood in pulmonary tuberculosis. Acta Medica Scandinavica. 1921;54: 247-282. https://doi.org/10.1111/j.0954-6820.1921.tb15179.x
  9. Singh AS, Atam V, Yathish BE, Das L, Koonwar S. Role of erythrocyte sedimentation rate in ischemic stroke as an inflammatory marker of carotid atherosclerosis. J Neurosci Rural Pract. 2014;5:40-45. https://doi.org/10.4103/0976-3147.127870
  10. Steinvil A, Shapira I, Arbel Y, Justo D, Berliner S, Rogowski O. Determinants of the erythrocyte sedimentation rate in the era of microinflammation: excluding subjects with elevated C-reactive protein levels. Am J Clin Pathol. 2008;129:486-491. https://doi.org/ 10.1309/U04E2YFJRR6JQQTK
  11. Erikssen G, Liestol K, Bjornholt JV, Stormorken H, Thaulow E, Erikssen J. Erythrocyte sedimentation rate: a possible marker of atherosclerosis and a strong predictor of coronary heart disease mortality. Eur Heart J. 2000;21:1614-1620. https://doi.org/10.1053/euhj.2000.2148
  12. Zaremba J, Skrobanski P, Losy J. Acute ischaemic stroke increases the erythrocyte sedimentation rate, which correlates with early brain damage. Folia Morphol (Warsz). 2004;63:373-376.
  13. Kellert L, Martin E, Sykora M, Bauer H, Gussmann P, Diedler J, et al. Cerebral oxygen transport failure?: Decreasing haemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: Stroke: Relevant impact of haemoglobin, hematocrit and transfusion (STRAIGHT)- an observational study. Stroke. 2011;42:2832-2837. https://doi.org/10.1161/STROKEAHA.110.606665
  14. Bohler T, Kynast-Wolf G, Coulibaly B, Sie A, Kapaun A. Gender-specific distribution of hematological parameters in adults living in Nouna, Burkina Faso. Open Hematol J. 2008;2:1-4. https://doi.org/10.2174/1874276900802010001
  15. Mcllhagger R, Gow AJ, Brett CE, Corley J, Taylor M, Deary IJ, et al. Differences in the haematological profile of healthy 70 year old men and women: normal ranges with confirmatory factor analysis. BMC Blood Disorders. 2010;10:4. https://doi.org/10.1186/1471-2326-10-4
  16. Sharif S, Ghaffar S, Saqib M, Naz S. Analysis of hematological parameters in patients with ischemic stroke. Endocrinol Metab Int J. 2020;8:17-20. https://doi.org/10.15406/emij.2020.08.00271
  17. Kanfer EJ, Nicol BA. Haemoglobin concentration and erythrocyte sedimentation rate in primary care patients. J R Soc Med. 1997;90:16-18. https://doi.org/10.1177/014107689709000106
  18. Kimberly WT, Wu O, Arsava EM, Garg P, Ji R, Vangel M, et al. Lower hemoglobin correlates with larger stroke volumes in acute ischemic stroke. Cerebrovasc Dis Extra. 2011;1:44-53. https://doi.org/10.1159/000328219
  19. Qasim SA. The influence of packed cell volume (PCV) and temperature on erythrocytes sedimentation rate (ESR). Baghdad Science J. 2011;8:118-121. https://doi.org/10.21123/bsj.8.1.118-122
  20. Bottiger LE, Svedberg CA. Normal erythrocyte sedimentation rate and age. Br Med J. 1967;2:85-87. https://doi.org/10.1136/bmj.2.5544.85
  21. Wetteland P, Roger M, Solberg HE, Iversen OH. Population-based erythrocyte sedimentation rate in 3910 subjectively healthy Norwegian adults: a statistical study based on men and women from the Oslo area. J Intern Med 1996;240:125-131. https://doi.org/10.1046/j.1365-2796.1996.30295851000.x
  22. Bochen K, Krasowska A, Milaniuk S, Kulczynska M, Prystupa A, Dzida G. Erythrocyte sedimentation rate-an old marker with new applications. J Pre Clin Clin Res. 2011;5:50-55.
  23. Yousufuddin M, Young N. Aging and ischemic stroke. Aging (Albany NY). 2019;11:2542-2544. https://doi.org/10.18632/aging.101931.
  24. Feher G, Koltai K, Kesmarky G, Szapary L, Juricskay I, Toth K. Hemorheological parameters and ageing. Clin Hemorheol Microcirc. 2006;35:89-98.
  25. Comoglu SS, Cilliler AE, Guven H. Erythrocyte sedimentation rate: Can be a prognostic marker in acute ischemic stroke. Turkish J Cerebro Dis. 2013;19:18-22. https://doi.org/10.5505/tbdhd.2013.32042
  26. Lowe GD. Circulating inflammatory markers and risks of cardiovascular and non-cardiovascular disease. J Thromb Haemost. 2005;3:1618-1627. https://doi.org/10.1111/j.1538-7836.2005.01416.x
  27. Gopi S, Sharif SM. Inflammatory markers in acute ischaemic stroke in relation to clinical severity and early outcome. J Evidence Based Med Healthcare. 2018;5:248-254. https://doi.org/10.18410/jebmh/2018/51
  28. Taskin E, Celik S, Yavuz DM, Kara F. Investigation of relationship between erythrocyte sedimentation rate and erythrocyte indices. J Med Sci. 2019;9:87-89 https://doi.org/10.5505/kjms.2019.67934
  29. Singh AS, Atam V, Yathish BE, Das L, Koonwar S. Role of erythrocyte sedimentation rate in ischemic stroke as an inflammatory marker of carotid atherosclerosis. JNRP. 2014;5:40-45. https://doi.org/10.4103/0976-3147.127870
  30. Bottiger LE. Erythrocyte sedimentation rate and plasma lipids. Acta Med Scand. 1973;193:53-57. https://doi.org/10.1111/j.0954-6820.1973.tb10538.x