CLINICAL USE OF THE ERYTHROCYTE SEDIMENTATION-RATE IN THE EVALUATION OF FEBRILE INTRAVENOUS-DRUG-USERS

Study objective: To investigate the use of the erythrocyte sedimentati on rate in the evaluation of febrile IV drug users. Design: Prospectiv e observational cohort study. Setting: Municipal hospital emergency de partment. Type of participants: One hundred six IV drug users aged 18 years or older, with rectal temperatures of 37.8 C or more. Interventi ons: Clinical and laboratory variables were obtained by trained resear ch assistants, using a standardized data collection instrument. Result s: The erythrocyte sedimentation rate was the only variable consistent ly associated with illness severity in both the univariate and multiva riable analyses (P<.0001). At an erythrocyte sedimentation rate of 100 mm/hr or more, the test had a specificity of 96% (95% confidence inte rval, 81% to 100%). In contrast, the erythrocyte sedimentation rate di splayed a relatively poor sensitivity at low values (88% [95% confiden ce interval, 77% to 95%] at an erythrocyte sedimentation rate less tha n 20). Conclusion: An erythrocyte sedimentation rate of 100 or more sh ould be regarded as a marker for serious illness in IV drug users with fever, but a ''normal'' erythrocyte sedimentation rate of less than 2 0 does not reliably exclude the presence of serious disease in this pa tient population.