Abstract Details

Title Diagnostic Accuracy of ESR, CRP, and Platelet Count (and Their Combinations) for Giant Cell Arteritis: A Meta-analysis of 14,000 Patients

Topic Autoimmune Neurology

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 2-005

Objective

To determine the pooled diagnostic accuracy of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet count—individually and in combination—for the diagnosis of giant cell arteritis (GCA), using biopsy or validated clinical diagnosis as reference standards.

Background Acute phase reactants such as ESR and CRP are routinely used to evaluate suspected GCA, but their comparative diagnostic value and optimal combinations remain uncertain. Platelet count, often elevated in systemic inflammation, may add specificity. A quantitative synthesis of these markers can refine clinical triage before temporal artery biopsy or vascular imaging

Design/Methods

A PRISMA-DTA–based meta-analysis evaluated ESR, CRP, and platelet accuracy in suspected GCA using bivariate models, examined “both normal” and “triple elevation” combinations, and applied QUADAS-2.0 for quality assessment.

Results Fourteen studies comprising 14,037 patients (4,277 biopsy-confirmed GCA) were included. Pooled estimates showed: ESR ≥50 mm/hr sensitivity 84% (81–87) and specificity 41% (36–47); CRP ≥20 mg/L sensitivity 89% (86–91) and specificity 43% (39–47); platelets ≥400 × 10?/L sensitivity 58% (53–63) and specificity 80% (75–84). The “both ESR and CRP normal” profile was rare (3–5% of GCA) with high rule-out value (specificity 97%, negative LR ≈ 0.15), whereas “triple elevation” (ESR + CRP + platelets) yielded specificity 84% and positive LR ≈ 2.6. CRP and platelets had the highest AUCs (0.72–0.76). Heterogeneity was moderate, largely from steroid pretreatment and threshold variation; results remained robust after excluding high-risk studies per QUADAS-2.0

Conclusions

CRP is the most sensitive and platelets the most specific marker for GCA, with normal ESR + CRP effectively ruling out disease and triple elevation markedly increasing diagnostic likelihood.

Authors/Disclosures
Shradha P. Kakde, MBBS PRESENTER	Dr. Kakde has nothing to disclose.
Sharath Chandra Anne, MBBS	Mr. Anne has nothing to disclose.
Meghnath Kakde	Mr. Kakde has nothing to disclose.
Anas Mansour, MD	Dr. Mansour has nothing to disclose.
Ahmed R. Harb	Mr. Harb has nothing to disclose.
Meghana Chennupati, MBBS	Miss Chennupati has nothing to disclose.
Harshawardhan D. Ramteke, Sr., MBBS	Dr. Ramteke has nothing to disclose.
Rakhshanda Khan, MBBS	Dr. Khan has nothing to disclose.

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