Abstract
<title>Abstract</title> <p>Background Metabolic syndrome (MetS) is now a major public health challenge driven by chronic low-grade inflammation. Erythrocyte sedimentation rate (ESR) and derived indices may inexpensively identify MetS. This study evaluated the discriminating performance and association of ESR and selected inflammatory indices with MetS among adults in eastern Uganda. Methods A hospital based matched sequential case-control study was conducted among 228 adults (114 MetS,114non MetS) in April 2026 in eastern Uganda. MetS was defined by the harmonized Joint Interim Statement (JIS) definition. Derived inflammatory indices including ESR-to-monocyte ratio (EMR) and ESR/WBC ratio were calculated based on the hospital laboratory normal ranges. Receiver operation curve (ROC) analysis and Logistic regression analysis were performed in STATA 14. Statistical significance was considered at p < 0.05. Results ESR had a moderately high AUC for MetS (Males; AUC = 0.64: cutoff=15mm/hr, Females; AUC = 0.77: cutoff=25mm/hr). Elevated ESR was strongly associated with MetS (Males; cOR 5.01, 95% CI: 1.06–26.12; p = 0.013, females; cOR 13.82 95%CI:4.6-41.12; p < 0.001). After multivariate adjustment, elevated ESR remained independently associated with MetS (Males; aOR 5.4, 95% CI: 1.24–34.63; p = 0.004, Females: aOR 14.1, 95% CI: 1.57–126; p = 0.018). Elevated EMR and ESR/WBC ratio (aOR 3.6, p = 0.046) and (aOR 4.6, p = 0.019) were also independently associated with MetS. Conclusion ESR can moderately discriminate Mets individuals from non-MetS individuals in eastern Uganda. Derived ESR based indices are strongly associated with Metabolic syndrome in this population. Further validation of their clinical utility in MetS is recommended.</p>