Predictive utility of monocyte chemoattractant Protein-1 (MCP-1) and D-dimer in risk stratification of sepsis: a prospective cohort study

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Abstract

Background. Sepsis is a severe and life-threatening clinical syndrome characterized by a dysregulated host immune response to infection. This maladaptive response promotes widespread endothelial injury and abnormalities in coagulation, often progressing to multi-organ dysfunction and death. Mortality rates remain high, highlighting the urgent need for reliable biomarkers to enable early identification of patients at high risk. Such tools are particularly valuable in low- and middle-income countries (LMICs), where access to advanced diagnostic and therapeutic resources is limited. Monocyte Chemoattractant Protein-1 (MCP-1) is a chemokine that reflects hyperactivation of the innate immune system, while D-dimer indicates activation of coagulation and fibrinolysis. Although both pathways are central to the pathophysiology of sepsis, data evaluating their combined prognostic value in LMIC settings remain scarce. This study aimed to assess the prognostic significance of MCP-1 and D-dimer, both individually and in combination, for predicting 28-day mortality in patients with sepsis. Materials and methods. We conducted a prospective cohort study involving 83 adult patients with newly diagnosed sepsis at Dr. Saiful Anwar General Hospital, Malang, Indonesia. Serum MCP-1 levels were measured using enzyme-linked immunosorbent assay (ELISA), and plasma D-dimer levels were determined by immunoturbidimetry at the time of diagnosis. Patients were followed for 28 days, and survival outcomes were evaluated using Kaplan–Meier survival analysis and Cox proportional hazards regression models. Results. Among the 83 participants, 58 patients (70%) died within 28 days. Non-survivors demonstrated significantly higher MCP-1 and D-dimer levels compared with survivors. An MCP-1 concentration ≥ 123.03 pg/mL was strongly associated with increased mortality (HR 2.664, p = 0.005). Elevated D-dimer (≥ 43.5 mg/L FEU) showed a weaker individual association, but when combined with MCP-1, predictive accuracy for mortality was significantly enhanced (HR 3.986, p = 0.037). Conclusion. The concurrent elevation of MCP-1 and D-dimer identifies patients with sepsis who are at markedly increased risk of death. These findings support the potential utility of integrating inflammatory and coagulation biomarkers for early risk stratification. Moreover, they highlight the central role of the inflammation–coagulation axis in sepsis pathophysiology, with particular relevance for clinical practice in resource-limited settings.

About the authors

Agustin Iskandar

Universitas Brawijaya; Dr. Saiful Anwar General Hospital

Author for correspondence.
Email: agustin_almi@ub.ac.id

PhD, Clinical Pathologist, Associate Profesor, Department of Clinical Pathology, Faculty of Medicine

Indonesia, Malang; Malang

S. Fathonah

Universitas Brawijaya; Dr. Saiful Anwar General Hospital

Email: agustin_almi@ub.ac.id

Clinical Pathologist, Lecturer, Department of Clinical Pathology

Indonesia, Malang; Malang

M. Soraya

Universitas Brawijaya; Dr. Saiful Anwar General Hospital; Ulin General Hospital

Email: agustin_almi@ub.ac.id

Clinical Pathologist, Department of Clinical Pathology, Faculty of Medicine, Clinical Pathologist, Department of Clinical Pathology

Indonesia, Malang; Malang; Banjarmasin

N. N. Lova

Indonesian Doctor Association

Email: agustin_almi@ub.ac.id

General Practitioner, Member of Indonesian Doctor Association

Indonesia, Malang

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