Higher Erythrocyte Sedimentation Rate is Associated with Accelerated White Matter Lesion Progression.

BACKGROUND: The erythrocyte sedimentation rate (ESR) is a non-specific marker of systemic inflammation. White matter lesions (WMLs), appeared as hyperintensities on T2-weighted and FLAIR MRI, reflect chronic microvascular ischemia of cerebral white matter. Inflammation has been implicated in the pathogenesis and progression of WML. We hypothesized that higher ESR levels are associated with greater WML progression. METHODS: We retrospectively screened 2356 patients aged ≥40 years or older who underwent serial MRI brain at least one year apart between 2011 and 2015 at the Mayo Clinic 1,377 patients with an available baseline ESR measurement were included in the analysis. ESR was annual rate of of WMH progression stratified into quartiles; high ESR was defined as values >23 mm/hr (Q4), whereas low ESR was defined as values ranging from 0 to 23 mm/hr (Q1-Q3). . The primary outcome was the annualized change in WML volume (cc/year). Univariate and multivariable linear regression analyses assessed the association between ESR and WML progression. RESULTS: Of the 1377 patients meeting the inclusion criteria, 54.2% were female, and the median age was 69 (IQR 60-76) years. The annual rate of WMH progression was faster in high-ESR group than in the low-ESR group (median 0.93 cc/year vs. 0.76 cc/year, p = 0.010). In univariate regression analysis, high ESR was significantly associated with greater WML progression (β = 0.42, p = 0.013). After multivariable adjustment, including baseline WML volume, upper-quartile ESR remained independently associated with greater annualized WML progression (β = 1.23; 95% CI 0.17-2.28; p = 0.023). CONCLUSION: Elevated ESR independently predicts WML progression, suggesting that systemic inflammation may contribute to the progression of cerebral small vessel disease.