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Eritrosit Sedimantasyon Hızı ve C-Reaktif Protein: Hâlâ Değerli mi?

ERYTHROCYTE SEDIMENTATION RATE AND C-REACTIVE PROTEIN: ARE THEY STILL WORTHWHILE?

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Abstract (2. Language): 
Objective: It is important to use simple, cheap, rapid and reliable laboratory tests in primary care. Erythrocyte sedi¬mentation rate (ESR), one of the most frequently used tests, has lost its popularity after the introduction of modern laboratory test in clinical practice. The aim of this study is to determine the sensitivity and specificity of ESR and C—reac-tive protein (CRP). Method: Five hundred patients selected from Adana Numune Hospital Internal Medicine Outpatient Clinic were grouped as healthy, malignancy, rheumatological diseases, infections and other diseases using medical history, physical and laboratory examination. Results: Of 500 patients, 36.6% (n=183) had infectious dis¬eases, 34.2% (n=171) other diseases, 4.2% (n=21) malig¬nancy, 6.2% (n=31) rheumatological diseases and 18.8% (n=94) were healthy. ESR increased by age in both genders. The highest ESR values were in malignant and rheumatolog-ical diseases. High ESR values were found in 100% of malig¬nancy cases, 97% of rheumatological, 65% of infectious, 36% of other diseases and 22% of healthy individuals. Overall sensitivity of ESR was 72.3% and specificity was 77.7%; they were 53.2% and 83% for CRP, respectively. When compared with CRP, the sensitivity of ESR was 81.6% and specificity was 59.6%. Conclusion: ESR for sensitivity and CRP for specificity seemed to be superior. Using two tests together might pro¬vide both high sensitivity and high specificity in diagnosis.
Abstract (Original Language): 
Amaç: Birinci basamakta basit, ucuz, hızlı ve doğru laboratu-var testlerinin kullanımı önemlidir. En sık kullanılan testlerden eritrosit sedimentasyon hızı (ESH), modern laboratuvar yöntemlerinin klinik kullanıma girmesiyle popülaritesini kaybetmiştir. Bu çalışmadaki amacımız, ESH ve C—reaktif proteinin (CRP) tanısal duyarlılığını ve özgüllüğünü saptamaktır. Yöntem: Adana Numune Eğitim ve Araştırma Hastanesi Dahiliye Polikliniği'nden seçilen 500 olguyu; öykü, fizik muaye¬ne ve laboratuvar tetkiklerine dayanarak sağlıklı, romatizmal hastalıklar, enfeksiyonlar, habis hastalıklar ve diğerleri olmak üzere beş gruba ayırdık. Bulgular: Olguların %36.6'sında (n=183) enfeksiyon hastalıkları, %34.2'sinde (n=171) diğer hastalıklar, %4.2'sinde (n=21) habis hastalıklar, %6.2'sinde (n=31) romatizmal hastalıklar saptandı, %18.8'i (n=94) sağlıklıydı. Her iki cinste de ESH değeri yaşla artmaktaydı. En yüksek ESH değerleri habis ve romatizmal hastalıklardaydı. Sedimantasyon, habis has¬talıkların %100'ünde, romatizmal hastalıkların %97'sinde, enfeksiyon hastalıklarının %65'inde, diğer hastalıkların %36'sında, sağlıklı bireylerin ise %22'sinde yüksekti. ESH'nin duyarlılığı %72.3, özgüllüğü %77.7; CRP'nin du¬yarlılığı %53.2, özgüllüğü %83 idi. CRP'ye göre ise ESH'nın duyarlılığı %81.6, özgüllüğü ise %59.6 idi. Sonuç: Duyarlılık açısından ESH, özgüllük açısından ise CRP daha üstün görünmektedir. Bu iki testin birlikte kullanımı ile tanıda yüksek duyarlılık ve özgüllüğe ulaşılabilir.
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REFERENCES

References: 

1. Choi JW, Pai SH. Influences of hypercholesterolemia on red cell indices and erythrocyte sedimentation rate in elderly persons. Clin Chim Acta 2004; 341: 117-21.
2. Miao G. Reference values of erythrocyte sedimentation rate of adult healthy subjects. Arch Med Res 2002; 33: 506-9.
3. Bholasingh R, Cornel JH, Kamp O ve ark. The prognostic value of markers of inflammation in patients with troponin T-negative chest pain before discharge from the emergency department. Am J Med 2003; 115: 521-8.
4. Husain TM, Kim DH. C-reactive protein and erythrocyte sedimentation rate in orthopaedics. The University of Pennsylvania Orthopaedic Journal 2002;
15: 13-6.
5. Reinhart WH. Erythrocyte sedimentation rate-just an old fashion? Ther
Umsch2006; 63: 108-12.
6. Cantini F, Salvarani C, Olivieri I ve ark. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: A prospective follow-up study. Semin Arthritis
Rheum 2000; 30: 17-24.
7. Hazleman B. Laboratory investigations useful in the evaluation of polymyal-gia rheumatica (PMR) and giant cell arteritis (GCA). Clin Exp Rheumatol
2000; 18: 29-31.
8. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. NEngl J Med 2002; 347: 1557-65.
9. Stein CM, Xavier R. Extreme elevation of the erythrocyte sedimentation rate in patients admitted to a general medical ward in Harare, Zimbabwe. J Trop
Med Hyg1989; 92: 259-62.
10. Hoerbelt R, Keunecke L, Grimm H, Schwemmle K, Padberg W. The value of a noninvasive diagnostic approach to mediastinal masses. Ann Thorac Surg
2003; 75: 1086-90.
11. Baicus C, Ionescu R, Tanasescu C. Does this patient has cancer? The assess¬ment of age, anemia, and erythrocyte sedimentation rate in cancer as a cause of weight loss. A retrospective study based on a secondary care university hospital in Romania. Eur J Intern Med 2006; 17: 28-31.
12. Ingelsson E, Arnlov J, Sundstrom J, Lind L. Inflamation, as measured by the erythrocyte sedimentation rate, is an independent predictor for the develop¬ment of heart failure. J Am Coll Cardiol 2005; 45: 1802-6.
13. Brigden M. The erythrocyte sedimentation rate. Still a helpful test when used
judiciously. Postgrad Med1998; 103: 257-62.
14. Sox HC Jr, Ligand MH. The erythrocyte sedimentation rate. Guidelines for
rational use. Ann Intern Med1986; 104: 515-23.
15. Ridker PM, Koenig W, Fuster V. C-reactive protein and coronary heart dis¬ease. NEngl J Med 2004; 351: 295-8.
16. Lazzarini L, Conti E, Tositti G, de Lalla F. Erysipelas and cellulitis: Clinical and microbiological spectrum in an Italian tertiary care hospital. J Infect
2005; 51: 383-9.
17.
Akpına
r E, Saatçı E, Bozdemir N, Ergün G. Klinikte problem çözme ve aile hekimliğinde hastaya yaklaşım. Arfliv2002; 11: 345-87.
18. Arnlöv J, Sundström J, Lind L. Inflammation, as measured by the erythrocyte sedimentation rate, is an independent predictor for the development of heart failure. J Am Coll Cardiol 2005; 45: 1802-6.
19. Fincher RM, Page MI. Clinical significance of extreme elevation of the ery-throcyte sedimentation rate. Arch Intern Med 1986; 146: 1581-3.
20. Tinetti ME, Schmidt A, Baum J. Use of the erythrocyte sedimentation rate in chronically ill, elderly patients with a decline in health status. Am J Med
1986; 80: 844-8.
21. Monig H, Marquardt D, Arendt T, Kloehn S. Limited value of elevated ery-throcyte sedimentation rate as an indicator of malignancy. Fam Pract 2002;
19: 436-8.
22. Meyer B, Schaller K, Rohde V, Hassler W. The C-reactive protein for detec¬tion of early infections after lumbar microdiscectomy. Acta Neurochir 1995;
136: 145-50.
23. Katz PR, Karuza J, Gutman SI, Bartholomew W, Richman G. A comparison between erythrocyte sedimentation rate (ESR) and selected acute-phase pro¬teins in the elderly. Am J Clin Pathol 1990; 94: 637-40.
24. Arvidson NG, Larsson A, Larsen A. Disease activity in rheumatoid arthritis: Fibrinogen is superior to the erythrocyte sedimentation rate. Scand J Clin Lab
Invest2002; 62 (4): 315-9.
25. Brigden ML. Clinical utility of the erythrocyte sedimentation rate. Am Fam
Physician1999; 60 (5): 1443-50.
26. Mustard RA Jr, Bohnen JM, Haseeb S, Kasina R. C-reactive protein levels predict postoperative septic complications. Arch Surg 1987; 122: 69-73.
27. Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severi¬ty of acute pelvic inflammatory disease. Am J Obstet Gynecol 1993; 169:
1143-9.
28. Ruuskanen O, Meurman O, Sarkkinen H. Adenoviral diseases in children: A study of 105 hospital cases. Pediatrics 1985; 76: 79-83.

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