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. 2019 Apr 10:3:14.
doi: 10.1186/s41927-019-0061-z. eCollection 2019.

The utility of ESR, CRP and platelets in the diagnosis of GCA

Fiona Li Ying Chan  1 , Susan Lester  1 , Samuel Lawrence Whittle  1 , Catherine Louise Hill  1
Affiliations

The utility of ESR, CRP and platelets in the diagnosis of GCA

Fiona Li Ying Chan et al. BMC Rheumatol. .

Abstract

Background: To compare the utility of ESR, CRP and platelets for the diagnosis of GCA.

Method: A clinical diagnosis of GCA was determined by case-note review of 270 individuals (68% female, mean age 72 years) referred to a central pathology service for a temporal artery biopsy between 2011 and 2014. The highest levels of ESR, CRP and platelets (within 2 weeks of diagnosis) were documented. Evaluation of ESR, CRP and platelets for the diagnosis of GCA were compared using Receiver Operating Characteristic Area Under the Curve (ROC-AUC), and sensitivity/specificity at optimum cut-off values.

Results: GCA was clinically diagnosed in 139 (67%) patients, with 81 TAB positive. The AUC estimates for ESR, CRP and platelets were comparable (0.65 vs 0.72 vs 0.72, p = 0.08). The estimated optimal cut-off levels were confirmed at 50 mm/hour for ESR, and determined as 20 mg/L for CRP and 300 × 109/L for platelets. Sensitivity estimates for these three tests were comparable (p = 0.45) and ranged between 66% for ESR and 71% for platelets. Specificity estimates were also comparable (p = 0.11) and ranged between 57% for ESR and 68% for CRP. There was only moderate agreement between the three positive tests (agreement 67%, kappa: 0.34), and when considered collectively, CRP and platelet positive tests were independent predictors of GCA (p < 0.001), but the ESR was not (p = 0.76).

Conclusion: ESR, CRP and platelets are moderate, equivalent diagnostic tests for GCA, but may yield disparate results in individual patients. A combination of CRP and platelet tests may provide the best diagnostic utility for GCA.

Keywords: Diagnosis; Giant cell arteritis; Inflammatory markers; Vasculitis.

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Conflict of interest statement

This study has obtained appropriate ethics approval for data collection, storage and publication via Southern Adelaide Clinical Human Research Ethics Committee (South Australia, Australia) with the approval number of 354.09. The need for informed consent was waived by the aforementioned ethics committee.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study Flowchart
Fig. 2
Fig. 2
Receiver operating curves (ROC) analysis to compare the diagnostic utility of ESR, CRP and platelet counts for the diagnosis of GCA. The three ROC curves are not significantly different (p = 0.08)
Fig. 3
Fig. 3
Sensitivity and Specificity curves for different cut-off values of a ESR, b CRP and c Platelet counts for the diagnosis of GCA
See this image and copyright information in PMC

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