# Detailed Comparison of Westergren ESR and Automated 18°C ESR Using the YHLO VISION ESR Analyzer: A Comprehensive Assessment in an Indian Cohort

## TL;DR

This study compares two ESR testing methods in an Indian cohort, finding strong agreement and reliability in an automated alternative to the traditional Westergren method.

## Contribution

The study provides a detailed, large-scale comparison of automated ESR analysis with the Westergren method in a real-world Indian clinical setting.

## Key findings

- 94.65% of ESR measurements were within acceptable limits between the two methods.
- A strong positive linear correlation (r = 0.9809) was observed between automated and manual ESR results.
- Both methods effectively identified patients with elevated ESR levels (p < 0.001).

## Abstract

Background

Erythrocyte sedimentation rate (ESR) is a widely used, simple, and cost-effective test for diagnosing and monitoring conditions. Although the Westergren method is the gold standard, it has limitations like long processing times, infection risks, and a requirement for citrated blood samples. Automated ESR methods have been developed to overcome these issues.

Materials and methods

Blood samples were obtained from 4,000 patients who visited the central laboratory for ESR testing after providing informed consent. Each sample was first tested for ESR using the YHLO VISION ESR V4.0 Analyzer (Shenzhen YHLO Biotech Co., Ltd., Shenzhen, China) and subsequently analyzed with the manual Westergren method. The analysis included calculations of mean and standard deviation, Bland-Altman agreement assessment, linear regression, and Mann-Whitney U tests to evaluate the relationship between the two methods.

Result

Using data from 4,000 patient specimens, results demonstrated good agreement between methods with 94.65% of measurements within acceptable limits, a strong positive linear correlation (r = 0.9809, R² = 0.9621), and a systematic bias of 4.95 mm/h. Both methods effectively distinguished between patients with and without clinical evidence of elevated ESR (p < 0.001).

Conclusions

The 18°C measurement method provides a viable alternative with high clinical reliability and potential for cost-effectiveness.