Normal Range for Erythrocyte Sedimentation Rate (ESR) and Age Adjustment
The normal ESR values increase with age and are generally higher in women than in men, with values typically considered elevated when they exceed 20 mm/h in men and 30 mm/h in women. 1
Normal ESR Values by Age and Sex
For Women:
- Ages 20-24: approximately 7.2 mm/h 2
- Ages 25-45: minimal change from baseline 2
- Ages 50-54: approximately 8.9 mm/h 2
- Ages 70-74: approximately 11.6 mm/h 2
- Ages 80-84: approximately 15.4 mm/h 2
For Men:
- Ages 20-24: approximately 4.1 mm/h 2
- Ages 50-54: approximately 6.1 mm/h 2
- Ages 70-74: approximately 8.8 mm/h 2
- Ages 80-84: approximately 10.9 mm/h 2
Clinical Interpretation of ESR Values
- ESR values are typically considered elevated when they exceed 20 mm/h in men and 30 mm/h in women 1
- Moderate elevation (50-100 mm/h) suggests significant underlying disease 1
- High elevation (>100 mm/h) has high specificity (92.2%) for conditions like giant cell arteritis 1, 3
- The American Heart Association considers ESR ≥30 mm/h elevated in moderate and high-risk populations for rheumatic fever, and ESR ≥60 mm/h elevated in low-risk populations 1
Age-Adjusted ESR Formulas
Several formulas have been developed to account for age-related changes in ESR:
- For men: Upper limit of normal = (age in years) ÷ 2 1
- For women: Upper limit of normal = (age in years + 10) ÷ 2 1
Factors Affecting ESR Values
- Sex: Women typically have higher baseline ESR values than men 1, 2
- Age: ESR increases with age in both sexes 2
- Anemia: Can artificially elevate ESR values 1
- Azotemia: Can artificially elevate ESR values 1
- Body mass index: Significantly associated with ESR in women with osteoarthritis 4
Clinical Applications and Limitations
- ESR is particularly useful in monitoring conditions such as giant cell arteritis, polymyalgia rheumatica, and Kawasaki disease 1, 3
- In elderly patients, ESR may be as high as 35-40 mm/h in healthy individuals 5
- Approximately 25% of elderly patients with confirmed disease (malignant or non-malignant) may have ESR values below the upper limit of normal 5
- ESR values at 30 minutes strongly correlate with 60-minute readings (r=0.926), allowing for potential time-saving in urgent clinical settings 6
Clinical Pitfalls
- Normal ESR does not rule out disease, especially in elderly patients 5
- ESR may be normal in approximately 6% of patients with polymyalgia rheumatica at diagnosis 7
- C-reactive protein (CRP) may be a more sensitive indicator of current disease activity in some inflammatory conditions 7
ESR remains a valuable but imperfect tool in clinical practice. Understanding its age and sex-related variations is essential for proper interpretation and clinical decision-making.