Journal of ovarian research · 2026
Revisiting ESR in PCOS: an easily obtainable link to immune and metabolic dysregulation.
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Jin Congcong, Xu Yue, Xu Licong, Zhang Namin, Zhou Congcong, Shen Yun, Pan Jiexue
Аннотация
BACKGROUND: Polycystic ovary syndrome (PCOS) is closely associated with systemic low-grade inflammation, yet evidence regarding erythrocyte sedimentation rate (ESR), a cost-effective and stable inflammatory marker, in reproductive-aged women without comorbidities remains limited, particularly its relationships with metabolic-endocrine parameters. This study aimed to characterize ESR dynamics in reproductive-aged women with PCOS who have no systemic comorbidities versus normo-ovulatory controls, and to evaluate its associations with endocrine and metabolic disturbances while controlling for systemic confounders.
METHODS: In this retrospective analysis, we enrolled a total of 2,006 women diagnosed with PCOS and 10,038 normo-ovulatory women as controls. ESR was measured using an automated ESR analyzer, and metabolic-endocrine parameters (lipid profile, hepatic/renal function, and reproductive hormones) were quantified using automated immunoassays. The alterations in ESR levels and their associations with endocrine and metabolic conditions were assessed.
RESULTS: PCOS women exhibited significantly elevated ESR levels across all age/BMI strata, with a higher hyper-ESR (ESR > 20 mm/h) prevalence. ESR was positively correlated with atherogenic lipids and renal/hepatic function. LH/FSH ratio, TT, and atherogenic lipids contributd to hyper-ESR in both PCOS and control groups, indicating neuroendocrine/metabolism-inflammation crosstalk. Despite associations, ESR demonstrated low discriminative performance for incident PCOS and suboptimal predictive value for dyslipidemia/hyperandrogenemia across distinct populations.
CONCLUSIONS: This large-scale study suggests ESR may serve as an accessible biomarker of chronic inflammation associated with PCOS, which is linked to metabolic-endocrine dysregulation. The findings offer new insights into the pathophysiology of PCOS and may support the clinical utility of ESR in monitoring disease severity and guiding anti-inflammatory interventions in PCOS women.
METHODS: In this retrospective analysis, we enrolled a total of 2,006 women diagnosed with PCOS and 10,038 normo-ovulatory women as controls. ESR was measured using an automated ESR analyzer, and metabolic-endocrine parameters (lipid profile, hepatic/renal function, and reproductive hormones) were quantified using automated immunoassays. The alterations in ESR levels and their associations with endocrine and metabolic conditions were assessed.
RESULTS: PCOS women exhibited significantly elevated ESR levels across all age/BMI strata, with a higher hyper-ESR (ESR > 20 mm/h) prevalence. ESR was positively correlated with atherogenic lipids and renal/hepatic function. LH/FSH ratio, TT, and atherogenic lipids contributd to hyper-ESR in both PCOS and control groups, indicating neuroendocrine/metabolism-inflammation crosstalk. Despite associations, ESR demonstrated low discriminative performance for incident PCOS and suboptimal predictive value for dyslipidemia/hyperandrogenemia across distinct populations.
CONCLUSIONS: This large-scale study suggests ESR may serve as an accessible biomarker of chronic inflammation associated with PCOS, which is linked to metabolic-endocrine dysregulation. The findings offer new insights into the pathophysiology of PCOS and may support the clinical utility of ESR in monitoring disease severity and guiding anti-inflammatory interventions in PCOS women.