Study points to ESR as a useful marker in canine ICU care: full analysis

A new prospective study is putting an old laboratory marker back into the canine ICU conversation. Researchers at the University of Pisa reported that erythrocyte sedimentation rate, or ESR, measured at ICU admission was associated with mortality in hospitalized dogs and may also function as a marker for sepsis, according to their paper in the Journal of Veterinary Emergency and Critical Care. The work adds to a small but growing body of veterinary literature suggesting ESR may have more clinical value in dogs than its limited current use would imply. (pmc.ncbi.nlm.nih.gov)

That matters in part because ESR has long occupied an uneasy place in veterinary medicine. In human medicine, it remains a familiar, if nonspecific, inflammation marker. In dogs, however, acute-phase proteins such as CRP have generally taken center stage. Even so, recent veterinary studies and reviews have argued that ESR deserves a second look, particularly now that point-of-care and semiautomated methods make testing more feasible in clinical settings. Earlier work from Pisa also helped validate a point-of-care ESR device for dogs, while broader reviews have highlighted ESR’s low cost and potential usefulness in inflammatory disease monitoring. (pmc.ncbi.nlm.nih.gov)

In the ICU study, investigators prospectively evaluated residual blood samples from dogs hospitalized at the University of Pisa Veterinary Teaching Hospital between September 2021 and February 2024. According to the abstract, the team set out to determine whether ESR at admission was related to mortality, whether ESR trends over the first 48 to 72 hours of hospitalization tracked with outcomes, and whether ESR could serve as a marker of sepsis. The study’s headline takeaway was straightforward: admission ESR predicted mortality, and the marker showed promise in identifying sepsis in canine ICU patients. (pmc.ncbi.nlm.nih.gov)

The broader literature gives that conclusion some context. A 2025 study in Animals found ESR had the strongest prognostic value among several single inflammatory biomarkers in dogs with systemic inflammatory disease, including in a SIRS subgroup, where an ESR cutoff of 18 mm/h was associated with mortality prediction and relatively high specificity. That study also found ESR compared favorably with CRP, white blood cell count, neutrophil-to-lymphocyte ratio, and albumin-globulin ratio in prognostic modeling. While that was not an ICU-only population, it supports the Pisa group’s suggestion that ESR may capture cumulative inflammatory burden in ways that are clinically useful when patients are critically ill. (mdpi.com)

Industry or expert reaction specific to this ICU paper was limited in publicly accessible sources, but the surrounding research community has been moving in the same direction. A focused 2025 review on ESR in dogs and cats concluded that the available evidence is now strong enough to underscore ESR’s potential in companion animal medicine, and other canine studies have tied ESR to inflammatory disease burden in both referral and routine-practice settings. Taken together, the reaction is less about sudden disruption and more about cautious rehabilitation of a familiar test that may have been underused. (mdpi.com)

Why it matters: For veterinary professionals, especially those in emergency and critical care, the appeal is practical. If ESR can help with early risk stratification, serial monitoring, or sepsis suspicion in ICU dogs, it could offer a low-cost adjunct to more established markers rather than compete with them outright. That may be especially relevant in settings where rapid, repeatable, point-of-care tools are valuable, or where teams are balancing prognostic insight with cost discussions for pet parents. At the same time, ESR’s known limitations still apply: it is nonspecific, can be influenced by hematologic variables, and should not be interpreted in isolation. (pmc.ncbi.nlm.nih.gov)

What to watch: The next step will be validation. Clinicians should watch for full-text discussion of the ICU cohort’s cutoff values, serial trend data over 48 to 72 hours, and sepsis-specific performance, as well as any multicenter follow-up studies that compare ESR head-to-head with CRP, lactate, APPLE scoring, or sepsis frameworks already used in critical care. If those data hold up, ESR could move from an overlooked lab number to a more routine part of canine ICU monitoring. (pmc.ncbi.nlm.nih.gov)