Hubungan CRP, LED, dan Rasio Neutrofil Limfosit terhadap Keparahan Ulkus Diabetikum di RSUP Haji Adam Malik Medan

Abstract

Introduction. Diabetes mellitus (DM) is a chronic disease with increasing prevalence and frequent complications in the form of diabetic ulcers, which contribute to high amputation and mortality rates. Diabetic ulcers occur due to vascular and neuropathy disorders in DM patients. Assessing ulcer severity using inflammatory biomarkers such as CRP, ESR, and NLR is considered important clinically, but evidence in local populations is still limited. Therefore, this study evaluated the association between CRP, ESR, and NLR with diabetic ulcer severity in DM patients. Methods. This study was an observational analytical study with a cross-sectional design involving patients with type 2 diabetes mellitus with diabetic ulcers at Haji Adam Malik General Hospital, Medan. Samples were obtained through consecutive sampling technique with a minimum of 80 subjects who met the inclusion criteria and were not included in the exclusion criteria. Clinical and laboratory data were analyzed using parametric and nonparametric statistical tests according to the data distribution, with a significance level of p<0.05. The relationship between inflammatory biomarkers and ulcer severity was evaluated using correlation and regression analysis to determine the most influential variables. Results. The majority of the study sample was 56.5 years old, male, and had an overweight BMI. CRP, NLR, and ESR values were found to be significantly associated with ulcer severity (p<0.05). Multivariate analysis found a significant correlation between CRP and NLR with the severity of diabetic ulcers (p<0.001). There was a non-significant association between ESR values and diabetic ulcer severity (p=0.309). Discussion. CRP, ESR, and NLR were evaluated as inflammatory biomarkers with clinical relevance in assessing the severity of diabetic foot ulcers due to their elevation in diabetesrelated inflammation. CRP and NLR demonstrated greater accuracy in predicting ulcer severity and the risk of complications, while ESR was used as a supporting indicator, particularly in cases of suspected infection or osteomyelitis. Conclusion. CRP, NLR, and ESR can be used as markers of diabetic ulcer severity and have a significant correlation with diabetic ulcer severity, although the correlation with ESR is weak. Keywords: Diabetic Ulcer, CRP, NLR, ESR, and Wagner Criteria