PT  - JOURNAL ARTICLE
AU  - McKenzie, Shannan F.
AU  - Beydoun, Hind
AU  - Ganjoo, Rohini
AU  - Dobrydneva, Yuliya
TI  - Concordance or Discordance Between ESR and hs-CRP: Are Both Tests Necessary for Patient Diagnosis?
AID  - 10.29074/ascls.2021003168
DP  - 2024 Sep 06
TA  - American Society for Clinical Laboratory Science
4099  - http://hwmaint.clsjournal.ascls.org/content/early/2024/09/12/ascls.2021003168.short
4100  - http://hwmaint.clsjournal.ascls.org/content/early/2024/09/12/ascls.2021003168.full
AB  - INTRODUCTION: Erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP) are screening tests for inflammation and are often ordered simultaneously. Our study investigated concordance between ESR and hs-CRP to optimize patient diagnosis.METHODS: A retrospective review was conducted on ESR and hs-CRP tests performed simultaneously in the same clinical encounter during a 10-month period at Alaska Regional Hospital. Kappa statistics and correlation coefficients were calculated to evaluate the level of concordance between ESR and hs-CRP tests. Logistic regression models and receiver operator characteristic (ROC) curves were constructed to evaluate the ability of each screening test to predict the other screening test.RESULTS: ESR and hs-CRP were elevated in 54% and 76% of the patient population (N = 860) respectively. Among patients with abnormal ESR, 93% also had abnormal hs-CRP, whereas among patients with abnormal hs-CRP, 66% also had abnormal ESR. ESR and hs-CRP tests agreed in 70% of cases. Kappa statistics indicated a fair to moderate level of agreement between dichotomous ESR and hs-CRP tests, with significant differences among patients with and without noninfectious organ diseases, but no other demographic or clinical characteristics. The correlation coefficient between continuous ESR and hs-CRP was nearly 0.40, with no statistically significant correlation among patients with connective tissue/musculoskeletal/autoimmune diseases or diabetes. Finally, hs-CRP and ESR were predictive of each other based on logistic regression and ROC analyses.CONCLUSION: hs-CRP identified the majority of inflammatory conditions and should be included in the first line of testing when the clinical indication clearly suggests an inflammatory process.