Perbedaan Kadar C-Reactive Protein pada Demam Akut karena Infeksi Dengue dan Demam Tifoid
Authors: Idhayu Adeputri Tanesha , Chen Lie Khie , Suhendro Suhendro , Abdullah Murdani 
Published: March 2018

Pendahuluan. Infeksi dengue dan demam tifoid merupakan penyakit endemik di Indonesia. Namun pada awal awitan demam terdapat kesulitan dalam membedakan keduanya. Oleh karena itu dibutuhkan modalitas pemeriksaan penunjang yang sederhana untuk membantu diagnosis infeksi dengue dan demam tifoid. C-Reactive Protein (CRP) merupakan alat bantu diagnostik yang terjangkau, cepat dan murah untuk diagnosis penyebab demam akut. Penelitian ini bertujuan mengetahui perbedaan kadar CRP pada demam akut karena infeksi dengue dengan demam tifoid.Metode. Penelitian ini merupakan studi potong lintang pada pasien demam akut dengan diagnosis demam dengue/ demam berdarah dengue atau demam tifoid yang dirawat di IGD atau ruang rawat RSCM, RS Pluit dan RS Metropolitan Medical Center Jakarta dalam kurun waktu Januari 2010 sampai dengan Desember 2013. Kadar CRP yg diteliti adalah CRP yang diperiksa 2-5 hari setelah awitan demam. Data penyerta yang dikumpulkan adalah data demografis, data klinis, pemberian antibiotik selama perawatan, leukosit, trombosit, neutrofil, LED dan lama perawatan.Hasil. Sebanyak 188 subjek diikutsertakan pada penelitian ini, terdiri dari 102 pasien dengue dan 86 pasien demam tifoid. Median (RIK) CRP pada infeksi dengue 11,65 (16) mg/L dan pada demam tifoid 53 (75) mg/L. Terdapat perbedaan median CRP yang bermakna antara infeksi dengue dan demam tifoid (p <0,001). Pada titik potong persentil 99%, didapatkan hasil kadar CRP infeksi dengue sebesar 45,91 mg/L dan kadar CRP demam tifoid pada level persentil 1% sebesar 8 mg/L.Simpulan. Terdapat perbedaan kadar CRP pada demam akut karena infeksi dengue dengan demam tifoid. Pada titik potong persentil 99%, kadar CRP >45,91 mg/L merupakan diagnostik CRP untuk demam tifoid, kadar CRP <8 mg/L merupakan diagnostik CRP untuk infeksi dengue. kadar CRP 8-45,91 mg/L merupakan area abu-abu dalam membedakan diagnosis keduanya.Kata Kunci: dengue, demam tifoid, protein C-reaktif The Difference of C-Reactive Protein Levels in Acute Fever caused by Dengue and Typhoid InfectionsIntroduction. Dengue infection and typhoid fever are endemic disease in Indonesia. But in the early days of onset sometimes it is difficult to distinguish them. A simple modality test is needed to support the diagnosis. C-Reactive Protein (CRP) is an affordable, fast and relatively less expensive diagnostic tool to diagnose the causes of acute fever. This study was aimed to determine the differences of CRP level in the acute febrile caused by dengue infection or typhoid fever. Methods. A cross sectional study has been conducted among acute febrile patients with diagnosis of dengue fever/ dengue hemorrhagic fever or typhoid fever who admitted to the emergency room or hospitalized in Cipto Mangunkusumo Hospital, Pluit Hospital, and Metropolitan Medical Center Hospital Jakarta between January 2010 and December 2013. Data obtained from medical records. CRP used in this study was examined at 2-5 days after onset of fever. The other collected data were demographic data, clinical data, use of antibiotics, leukocytes, platelets, neutrophils, ESR, and length of stay in hospital. Results. 188 subjects met the inclusion criteria; 102 patients with dengue and 86 patients with typhoid fever. Median CRP levels in dengue infection was 11.65 (16) mg/L and in typhoid fever was 53 (75) mg/L. There were significant differences in median CRP levels between dengue infection and typhoid fever (p < 0.001). At the 99% percentile cut-off point, CRP levels for dengue infection was 45.91 mg/L and CRP levels for typhoid fever at 1% percentile was 8 mg / L. Conclusions. There was significantly different levels of CRP in acute fever due to dengue infection and typhoid fever. At the 99% percentile cut-off point, CRP level >45.91 mg/L was diagnostic for typhoid fever, CRP level <8 mg/L was diagnostic for dengue infection. CRP level between 8 to 45.91 mg/L was a gray area for determining diagnosis of dengue infection and typhoid fever. Keywords: C-reactive protein, dengue, typhoid fever