Choosing Wisely:

Don’t order an erythrocyte sedimentation rate to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein to detect acute phase inflammation.

Rationale and Comments: C-reactive protein is a more sensitive and specific reflection of the acute phase of inflammation than is the erythrocyte sedimentation rate. In the first 24 hours of a disease process, the C-reactive protein will be elevated, whereas the erythrocyte sedimentation rate may be normal. If the source of inflammation is removed, the C-reactive protein will return to normal within a day or so, whereas the erythrocyte sedimentation rate will remain elevated for several days until excess fibrinogen is removed from the serum.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Hematologic
  • Rheumatologic
  • References: • Crowson CS, Rahman MU, Matteson EL. Which measure of inflammation to use? A comparison of erythrocyte sedimentation rate and C-reactive protein measurements from randomized clinical trials of golimumab in rheumatoid arthritis. J Rheumatol. 2009;36(8):1606-10.
    • Wu AH, Lewandrowski K, Gronowski AM, Grenache DG, Sokoll LJ, Magnani B. Antiquated tests within the clinical pathology laboratory. Am J Manag Care. 2010;16(9):e220-7.
    • Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem. 2004:279(47):48487-90.
    • Henriquez-Camacho C, Losa J. Biomarkers for sepsis. Biomed Res Int. 2014;2014:547818.
    • Lelubre C, Anselin S, Zouaoui Boudjeltia K, Biston P, Piagnerelli M. Interpretation of C-reactive protein concentrations in critically ill patients. Biomed Res Int. 2013;2013:124021.

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