Research Article

Hubungan konsentrasi serum C-Reactive Protein dan D-dimer dengan derajat keparahan dan mortalitas pasien COVID-19

Kadek Surya Atmaja , Anak Agung Gede Oka Suta Wicaksana, I Wayan Angga Suarmerta Putra, Wayan Wahyu Semara Putra

Kadek Surya Atmaja
Intern of Pulmonology and Respiratory Medicine Department, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia. Email: suratmaja89@gmail.com

Anak Agung Gede Oka Suta Wicaksana
Intern of Internal Medicine Department. Wangaya Regional General Hospital, Denpasar, Bali, Indonesia

I Wayan Angga Suarmerta Putra
Resident of Pulmonology and Respiratory Medicine Department, Sanglah General Hospital, Denpasar, Bali, Indonesia

Wayan Wahyu Semara Putra
Pulmonologist of Pulmonology and Respiratory Medicine Department, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia.
Online First: August 31, 2021 | Cite this Article
Atmaja, K., Wicaksana, A., Putra, I., Putra, W. 2021. Hubungan konsentrasi serum C-Reactive Protein dan D-dimer dengan derajat keparahan dan mortalitas pasien COVID-19. Intisari Sains Medis 12(2): 680-685. DOI:10.15562/ism.v12i2.971


Background: Clinical features of COVID-19 are variably from asymptomatic, to severe symptoms including acute respiratory distress syndrome (ARDS), multiple organ failure, and death. A specific biomarker is needed to predict the possibility of COVID-19 patients fall into severe complications and disease severity. D-dimer and C-Reactive Protein (CRP) are biomarkers that are elevated in COVID-19 patients.

Method: This is an observational analytic study. The purpose of this research is to explore the correlation between D-dimer serum concentration and CRP with disease severity and mortality in hospitalized COVID-19 patients. This research used secondary data from a medical record with inclusion criteria patient more than 18 years old, confirmed COVID-19 by real-time Polymerase chain reaction (rt-PCR), that hospitalized in Wangaya General Hospital during July 2020 until December 2020.

Result: Statistical analysis show that there is significant mean difference between D-dimer and CRP concentration based on COVID-19 disease severity (p <0.001 dan p <0.001). AUC value on ROC curve for CRP and D-dimer concentration in predict the mortality of COVID-19 patient are 0.88 (p <0.001, 95% CI: 0.829 – 0.48) and 0.88 (p < 0.001, 95% CI = 0.821 – 0.950) respectively. In this research, serum D-dimer with concentration more than 4,181 ng/mL statistically significant affect the mortality of COVID-19 patient (OR = 11.713; CI = 1.620 - 84.682; p = 0.015). CRP concentration statistically is not significant affect the mortality of COVID-19 patient.

Conclusion: There is a statistically mean difference in both D-dimer and CRP concentration based on COVID-19 disease severity. D-dimer concentration of more than 4,181 ng/mL significantly affects the COVID-19 mortality. CRP concentration is not correlated with COVID-19 mortality

 

Latar Belakang: Fitur klinis pasien dengan COVID-19 bervariasi dari tanpa gejala maupun dengan gejala ringan hingga terjadinya acute respiratory distress syndrome (ARDS), gagal multi organ, dan kematian. Dibutuhkan suatu biomarker yang dapat digunakan dalam memprediksi kemungkinan pasien yang akan jatuh kedalam derajat penyakit maupun komplikasi yang berat. D-dimer dan C-Reactive Protein (CRP) merupakan biomarker yang diketahui meningkat pada pasien COVID-19.

Metode: Penelitian ini merupakan penelitian analitik observasional, yang bertujuan untuk mengetahui hubungan konsentrasi D-dimer serum dan CRP dengan derajat keparahan dan mortalitas pasien COVID-19 yang dirawat inap. Penelitian ini menggunakan data sekunder yang bersumber dari rekam medis dengan kriteria inklusi pasien usia diatas 18 tahun dengan diagnosis terkonfirmasi COVID-19 dengan real-time Polymerase chain reaction (rt-PCR), yang dirawat inap di RSUD Wangaya Denpasar periode Juli 2020 hingga Desember 2020.

Hasil: Hasil uji statistik menunjukan terdapat perbedaan rerata konsentrasi D-dimer dan CRP berdasarkan derajat keparahan pasien COVID-19 yang bermakna secara statistik (p <0,001 dan p <0,001). Nilai AUC kurva ROC konsentrasi CRP dan D-dimer dalam memprediksi mortalitas pasien secara berturut-turut didapatkan  sebesar  0.88 (p <0,001,  95% IK: 0,829 – 0,48 ) dan 0.88 (p <0,001,  95% IK: 0,821 – 0,950). D-dimer serum dengan konsentrasi diatas 4.181 ng/mL pada penelitian ini terbukti  secara statistik bermakna  mempengaruhi mortalitas pasien COVID-19 (OR OR 11,713; IK:1,620-84,682; p=0,015). Konsentrasi CRP serum tidak terbukti secara statistik bermakna dalam mempengaruhi mortalitas pasien COVID-19.

Simpulan:  Terdapat perbedaan rerata yang bermakna secara statistik konsentrasi serum D-dimer dan CRP berdasarkan derajat keparahan penyakit COVID-19. Konsentrasi serum D-dimer diatas 4.181 ng/mL terbukti mempengaruhi mortalitas pasien dengan COVID-19 secara bermakna. Konsentrasi CRP tidak berhubungan terhadap mortalitas pada pasien COVID-19.

References

Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020;87(4):281-286. doi:10.1007/s12098-020-03263-6.

Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci. 2020;57(6):389-399. doi:10.1080/10408363.2020.1770685.

Zhang L, Guo H. Biomarkers of COVID-19 and technologies to combat SARS-CoV-2. Adv Biomark Sci Technol. 2020;2:1-23. doi:10.1016/j.abst.2020.08.001.

Willim, H.A., Hardigaloeh, A.T., Supit, A.I., Handriyani. 2020. Koagulopati pada Coronavirus Disease-2019 (COVID-19): Tinjauan pustaka. Intisari Sains Medis 11(3): 749-756. DOI: 10.15562/ism.v11i3.766.

World Health Organization. Therapeutics and COVID-19: living guideline. WHO. int. 2021 [cited 7 February 2021]. Available from: https://www.who.int/publications/i/item/therapeutics-and-covid-19-living-guideline.

Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754. Published 2018 Apr 13. doi:10.3389/fimmu.2018.00754.

Tan C, Huang Y, Shi F, et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol. 2020;92(7):856-862. doi:10.1002/jmv.25871.

Johnson E, Schell J, Rodgers G. The D?dimer assay. American Journal of Hematology. 2019;94:833-839. doi: 10.1002/ajh.25482.

Ozen M, Yilmaz A, Cakmak V, et al. D-Dimer as a potential biomarker for disease severity in COVID-19. Am J Emerg Med. 2021;40:55-59. doi:10.1016/j.ajem.2020.12.023.

Yao, Y., Cao, J., Wang, Q. et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. j intensive care 8, 49 (2020). https://doi.org/10.1186/s40560-020-00466-z.

Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. doi:10.1016/j.jinf.2020.04.021

Soni M, Gopalakrishnan R, Vaishya R, Prabu P. D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases. Diabetes Metab Syndr. 2020;14(6):2245-2249. doi:10.1016/j.dsx.2020.11.007.

Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020;14:1753466620937175. doi:10.1177/1753466620937175.

Tjahyadi R, Astuti T, Listyoko A. COVID-19 :Correlation Between CRP and LDH to Disease Severity and Mortality In Hospitalized COVID-19 Patients. Medica Hospitalia : Journal of Clinical Medicine. 2020;7(1A):144-149. doi: 10.36408/mhjcm.v7i1A.467.


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