Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Turk J Med Sci. 2022 Dec;52(6):1889-1899. doi: 10.55730/1300-0144.5536. Epub 2022 Dec 21.
The objectives were to define the distribution of rheumatic diseases in patients with erythrocyte sedimentation rate (ESR) ≥ 100 mm/h and to find variables that can differentiate main study groups from others.
Charts of patients admitted with ESR ≥ 100 mm/h between 2015 and 2020 were reviewed. Patients were divided into four diagnostic groups based on etiology: infection (without a rheumatic diagnosis), oncologic (without a rheumatic diagnosis), rheumatic, and no definitive diagnosis. Patients with the rheumatic diagnosis were divided into three main study groups: those who had been recently diagnosed with a rheumatic disease, those who had a flare-up of the rheumatic disease, and those who had an infection in the course of the rheumatic disease. Appropriate statistical tests and decision-tree analysis by R and ROC curve were applied. p < 0.05 was considered statistically significant.
A total of 2442 patients (311 (12.7%) with rheumatic disorders) were identified. Eightysix (27.7%) patients had newly diagnosed rheumatic disease (41; 47.7% with vasculitis); 111 (35.7%) had rheumatic disease flare-up (92; 82.9% with inflammatory arthritis); and 114 (36.6%) had coexisting infection (61; 53.5% inflammatory arthritis). Irrespective of the study group, the most commonly encountered diseases were rheumatoid arthritis and spondyloarthritis. Serum albumin levels (2.78 mg/dL) and platelet count (290/mm6 ) were valuable to discriminate disease flare-up and coexisting infection; moreover, high ferritin levels were accounted for adult-onset Still disease among patients with newly diagnosed rheumatic diseases.
Extremely high ESR is still a valuable clinical parameter, and rheumatic causes are significant besides malignancy and infections. Albumin, thrombocyte count, and ferritin are other tests that clinicians should consider when caring for a patient with ESR ≥ 100 mm/h who has rheumatic disease.
本研究旨在明确红细胞沉降率（ESR）≥100mm/h 患者中各类风湿性疾病的分布，并寻找可将主要研究组与其他组区分开的变量。
回顾了 2015 年至 2020 年间 ESR≥100mm/h 入院患者的病历。根据病因将患者分为四大诊断组：感染（无风湿性诊断）、肿瘤（无风湿性诊断）、风湿性疾病和未明确诊断。将诊断为风湿性疾病的患者分为三个主要研究组：近期确诊风湿性疾病、风湿性疾病发作和风湿性疾病过程中的感染。采用 R 语言的适当统计检验和决策树分析及 ROC 曲线。p＜0.05 认为具有统计学意义。
共纳入 2442 例患者（311 例（12.7%）患有风湿性疾病）。86 例（27.7%）患者为新发风湿性疾病（41 例；47.7%为血管炎）；111 例（35.7%）为风湿性疾病发作（92 例；82.9%为炎性关节炎）；114 例（36.6%）为合并感染（61 例；53.5%为炎性关节炎）。无论在哪个研究组中，最常见的疾病都是类风湿关节炎和脊柱关节炎。血清白蛋白水平（2.78mg/dL）和血小板计数（290/mm6）有助于鉴别疾病发作和合并感染；此外，铁蛋白水平升高与新发风湿性疾病患者中的成人Still 病有关。
极高的 ESR 仍然是一个有价值的临床参数，除恶性肿瘤和感染外，风湿性病因也很重要。白蛋白、血小板计数和铁蛋白是临床医生在治疗 ESR≥100mm/h 且患有风湿性疾病的患者时应考虑的其他检查。
