Clinical significance of erythrocyte sedimentation rate-based stratification in a large retrospective SLE cohort

Objectives Erythrocyte sedimentation rate (ESR) is one of the most commonly used markers of inflammation in clinical practice. However, its value in predicting disease behavior in patients with systemic lupus erythematosus (SLE) remains controversial. The aim of this study was to determine the clinical significance of ESR in a large cohort of Chinese patients with SLE. Methods Data of 1,217 patients with documented ESR values were extracted from a lupus database collected by Jiangsu Lupus Collaborative Group. The associations of ESR with diverse manifestations, disease activity, damage accruement, and concurrent infection status were evaluated using logistic regression, and receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoffs for ESR and the C-reactive protein (CRP)/ESR ratio. The prognosis of patients with normal and high ESR was assessed using Kaplan–Meier analysis. Results Of the patients in this cohort, 81.0% had increased ESR values. ESR elevation was independently associated with fever (OR = 1.664, 95%CI = 1.072–2.583), serositis (OR = 2.005, 95%CI = 1.105–3.64), interstitial pneumonia (OR = 3.394, 95%CI = 1.176–9.796), hypoalbuminemia (OR = 1.536, 95%CI = 1.076–2.193), and anemia (OR = 3.102, 95%CI = 2.213–4.348). Compared with the damage accrual score [the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)], there was a stronger correlation between the ESR value and the SLE Disease Activity Index (SLEDAI) score, and a value not less than 25 mm/h helped to define disease activity with high sensitivity. The increase of ESR was much slower than that of CRP at the time of infection, and a CRP/ESR ratio ≥0.5 had high specificity to depict the presence of infection. The 5- and 10-year survival rates of patients with elevated ESR values were worse than those with normal values. Conclusions This study suggests that ESR is not only related to disease activity and prognosis but also to the patient’s autoimmune status. The CRP/ESR ratio helps distinguish the presence of infection in patients with SLE.