Hubungan High Senitivity C-Reactive Protein / Albumin Ratio Dengan Derajat Keparahan Pada Ulkus Kaki Diabetikum

Abstract

Objective: To determine the association between the high-sensitivity C-reactive protein (Hs-CRP)/albumin ratio (CAR) and severity of diabetic foot ulcer (DFU).

Methods: This study is a cross-sectional analytical study examining the relationship between CAR and the severity of DFU in patients admitted to Adam Malik Hospital from May to July 2025. CAR is calculated by dividing the hs-CRP level by albumin levels. Hs-CRP and albumin were measured using the Cobas c 503 device, with hs-CRP measured using an immunoturbidimetric assay and albumin measured using a colorimetric assay. The grade of DFU was determined using the Megitt Wagner classification. A Kruskal-Wallis test was analyzed to compare parameters with the severity of DFU, a Spearman correlation test was used to analyze the relationship between CAR and the severity of DFU and this was followed by ordinal logistic regression analysis. Data were statistically analyzed using SPSS, and results were considered significant if p < 0.05.

Results: From the research sample of 32 DFU patients, the median age was 57.5 (46–81) years, with an equal number of male and female patients (50%). According to the Megitt Wagner classification, Grade IV was found in 31.3% of patients, Grade V in 25%, Grade II in 21.9%, Grade III in 18.8%, and Grade I in 3.1%. The majority of patients used insulin therapy (50%) with a median duration of DM of 5 years. The median hs-CRP value was 10.5 mg/dL (1.8–49.4), the median albumin value was 2.51 g/dL (1.77–4.17), and the median CAR value was 4.9 (0.65–19.68). There was a significant difference in hs-CRP (p=0.045) and CAR (p=0.024) levels between grades I-V, but no significant difference in albumin levels (p=0.122). Based on the analysis results, there was a significant moderate positive correlation (r = 0.580, p = 0.001) between CAR values and the severity of DFU. The odds ratio (OR) was 1.374 (95% CI: 1.11–1.69), indicating that a 1-unit increase in CAR value would increase the likelihood of patients being categorised in a more severe Megitt Wagner grade by 1.374 times.

Conclusion: There is a significant positive moderate correlation between CAR value and severity of DFU using Megitt Wagner classification.