Relationship between C-Reactive Protein Levels and D-Dimer in Patients with Sepsis in the ICU of RSUD (Regional General Hospital) Prof. Dr. H. Aloei Saboe
Main Article Content
Introduction. Sepsis remains a major global health problem with high incidence and mortality, including in Indonesia. One of the key factors contributing to sepsis-related mortality is the uncontrolled activation of inflammatory and coagulation pathways. C-reactive protein (CRP) serves as a marker of inflammation, while D-dimer reflects coagulation activation. Both biomarkers are commonly elevated in sepsis and are thought to be closely associated. This study aimed to evaluate the relationship between CRP and D-dimer levels in sepsis patients treated in the Intensive Care Unit (ICU) of RSUD Prof. Dr. H. Aloei Saboe. Methods. This analytic observational study employed a cross-sectional design and was conducted in the ICU of RSUD Prof. Dr. H. Aloei Saboe from July to November 2025. A total of 48 sepsis patients were included using total sampling based on medical record data from January to December 2024. The relationship between CRP and D-dimer levels was analyzed using the Pearson correlation test. Results. All patients showed elevated CRP levels (100%), and most had increased D-dimer levels (97.9%). Bivariate analysis demonstrated a statistically significant positive correlation between CRP and D-dimer levels, with a correlation coefficient of +0.333, indicating a weak to moderate association. Conclusion. There is a significant positive correlation between CRP and D-dimer levels in sepsis patients in the ICU of RSUD Prof. Dr. H. Aloei Saboe. Higher CRP levels tend to be accompanied by increased D-dimer levels, reflecting the interplay between inflammation and coagulation activation in sepsis.
2. Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Am J Respir Crit Care Med. 2016;193(3):259–272.
3. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia Tahun 2018. Jakarta: Kemenkes RI; 2019.
4. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810.
5. Seymour CW, Kennedy JN, Wang S, Chang CH, Elliott CF, Xu Z, et al. Derivation, validation, and potential treatment implications of novel clinical phenotypes for sepsis. JAMA. 2019;321(20):2003–2017.
6. Iba T, Levy JH. Inflammation and thrombosis: roles of neutrophils, platelets, and endothelial cells in disseminated intravascular coagulation. J Thromb Haemost. 2018;16(2):231–241.
7. Iba T, Levy JH. Pathogenesis of sepsis-induced coagulopathy and disseminated intravascular coagulation. Semin Thromb Hemost. 2020;46(1):89–95.
8. Levi M, van der Poll T. Coagulation and sepsis. Thromb Res. 2017;149:38–44.
9. Insani Haq N, Susianto O. Kadar protein C-reaktif pasien sepsis dan non-sepsis di ruang rawat intensif RSUD Ulin Banjarmasin. Homeostasis. 2020;3(3):425–434.
10. Nuswantoro A, Perdede LH, Aulia AS, Aditia A. Hubungan kadar C-reactive protein dengan derajat keparahan pasien COVID-19 yang dirawat inap di rumah sakit. Jurnal Media Penelitian Dan Pengembangan Kesehatan. 2022;32(4):45–52.
11. Pradhan S, Ghimire A, Bhattarai B, Khanal B, Pokharel K, Lamsal M, et al. The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary intensive care unit of a tertiary care center in Nepal. Indian J Crit Care Med. 2016;20(7):417–420.
12. Valerio L, Ghiotto S, Riva N, Cattaneo M, Dalla Valle F, Falanga A. Course of D-dimer and C-reactive protein in survivors and nonsurvivors of sepsis: a retrospective analysis of 577 patients. Thromb Haemost. 2021;121(1):98–101.
13. Lu J, Zhou X, Sun Q, Chen X, Wang Y. Association between D-dimer-to-albumin ratio and 28-day mortality in patients with sepsis. Sci Rep. 2024;14:1532.
14. Li T, Hu WQ, Li X, Zhang JP, Tan LZ, Yu LX, et al. Prognostic value of PaO₂/FiO₂, SOFA, and D-dimer in elderly patients with sepsis. J Int Med Res. 2022;50(6):3000605221100755.
15. Atmaja KS, Wicaksana AAGOS, Putra IWAS, Putra WWS. Hubungan konsentrasi serum C-reactive protein dan D-dimer dengan derajat keparahan dan mortalitas pasien COVID-19. Intisari Sains Medis. 2021;12(2):680–685.
16. Pradnyasari SANP, Hidayat M, Fathana PB. Hubungan kadar D-dimer dan C-reactive protein terhadap berat gejala pada pasien COVID-19. Unram Medical Journal. 2022;11(4):1192–1197.
17. Ngwa DN, Pathak A, Agrawal A. IL-6 regulates C-reactive protein gene expression via STAT3 activation. Mol Immunol. 2022;146:50–56.
18. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805–1812.
19. Franceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Inflammaging: a new immune–metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018;14(10):576–590.
20. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131–2135.
21. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M, et al. Markers of inflammation and cardiovascular disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499–511.
22. Lippi G, Mullier F, Favaloro EJ. D-dimer: old dogmas, new (COVID-19) tricks. Clin Chem Lab Med. 2022;61(5):841–850.
23. Adam SS, Key NS, Greenberg CS. D-dimer antigen: current concepts and future prospects. Blood. 2009;113(13):2878–2887.
24. Kabrhel C, Mark Courtney D, Camargo CA Jr, Plewa MC, Nordenholz KE, Moore CL, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med. 2010;17(6):589–597.
25. Schuetz P, Chiappa V, Briel M, Greenwald JL. Procalcitonin algorithms for antibiotic therapy decisions. Arch Intern Med. 2011;171(15):1322–1331.
