Erythrocyte Sedimentation Rate (ESR) as a Predictor of White Matter Lesion (WML) Progression
Hans Mautong1, Bhrugun Anisetti2, Manjurul Shourav2, Michelle Lin2
1Universidad de Especialidades Espiritu Santo, 2Mayo Clinic Florida
Objective:
To evaluate the role of erythrocyte sedimentation rate (ESR) as a surrogate of inflammation in predicting white matter lesion (WML) progression.
Background:
ESR is a non-specific test that measures increased inflammatory activity within the body. WMLs are microvascular injuries within the white matter of the brain. It has been suggested that inflammation may play a role in the genesis and progression of WML. We hypothesized that high levels of ESR may predict WML progression.
Design/Methods:
We retrospectively evaluated the records of 2356 patients with chronic microvascular ischemia identified by a natural language processing algorithm seen at a healthcare network from 2011 to 2015 with 2 serial MRIs of the brain at least 1 year apart. High ESR was defined as >23 mm/hr (Q4). WML volume was quantified using an automated deep-learning algorithm applied to axial T2 FLAIR images with the primary outcome measured as an annual change in WML volume (cc/year). Univariate linear regression analysis was used to determine if ESR was a predictor of WML progression, and a subsequent multivariate model was used to adjust for potential confounders.
Results:
Of the 1377 patients who met our final inclusion criteria, 54.2% were female and the median age was 69 (60-76) years. About 24.7% of patients had a high ESR and the median WML progression was 0.79 (0.15-1.96) cc/year. The univariate linear regression model showed that a high ESR significantly predicted WML progression (β = 0.42, p < 0.013). After adjusting for age, sex, comorbidities, medications, and metabolic biomarkers in the multivariate model, a high ESR remained an independent predictor of WML progression (β = 1.24, p < 0.021).
Conclusions:
ESR is an independent predictor of WML progression, suggesting that inflammation may play a role in the progression of cerebral small vessel disease.