Erythrocyte sedimentation rate as an independent prognostic marker for mortality: a prospective population-based cohort study

Abstract

Background: A very high erythrocyte sedimentation rate (ESR) is usually an indication of underlying pathology. Additionally, a moderately elevated ESR may also be attributable to biological ageing. Whether the ESR is a prognostic factor for mortality, regardless of age, has been scarcely investigated. Therefore, the objective was to analyse the association between elevated ESR levels and the risk of mortality in a prospective cohort of the general population. Methods: We studied data from the Rotterdam Study (1990–2014). ESR levels were measured at baseline and individuals were followed until death or end of study. Associations between moderately (20–50 mm h−1) and markedly (>50 mm h−1) elevated ESR levels and all-cause mortality were assessed using multivariate Cox proportional hazard models. Results: In total, 5226 participants were included, and the mean age was 70.3 years. During a median follow-up time of 14.9 years, 3749 participants died (71.7%). After adjustment, both a moderately elevated ESR and a markedly elevated ESR were associated with a significantly higher risk of overall mortality [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.12–1.35 and HR 1.89, 95% CI 1.38–2.60, respectively]. Although the ESR becomes higher with age, in a group aged above 75 years, without any comorbidities, an ESR > 20 mm h−1 remained associated with a significantly increased risk of mortality (HR 1.29, 95%CI 1.01–1.64). Conclusion: An elevated ESR is an independent prognostic factor for mortality. Despite the fact that ESR increases with age, it remains associated with an increased risk of mortality and warrants close follow-up.