Latar Belakang: Sirosis hati dengan dekompensasi akut merupakan masalah
kesehatan dengan beban biaya yang besar dan berpengaruh negatif terhadap
produktivitas dan kualitas hidup. Belum diketahui sepenuhnya prediktor mortalitas
dalam perawatan pasien sirosis hati dekompensasi akut di Indonesia.
Tujuan: Mengetahui proporsi dan prediktor mortalitas dalam perawatan pasien
sirosis hati dekompensasi akut di Rumah Sakit Cipto Mangunkusumo (RSCM).
Metode: Studi kohort retrospektif berbasis data rekam medis pasien sirosis hati
dekompensasi akut di RSCM (2016-2019). Analisis bivariat dan multivariat regresi
logistik dilakukan untuk mengidentifikasi prediktor mortalitas dalam perawatan.
Dua sistem skor dikembangkan berdasarkan identifikasi faktor-faktor tersebut.
Hasil: 241 pasien dianalisis, sebagian besar adalah laki-laki (74,3%), menderita
hepatitis B (38,6%) dan Child-Pugh B dan C (40% dan 38%). Perdarahan saluran
cerna ditemukan pada 171 pasien (70,95%) dan 29 pasien (12,03%) meninggal
dalam perawatan. Prediktor independen mortalitas dalam perawatan adalah usia
(adjusted OR:1,09 [1,03–1,14]; p=0,001), infeksi bakterial (adjusted OR: 6,25
[2,31–16,92]; p<0,001), kadar bilirubin total (adjusted OR: 3,01 [1,85– 4,89];
p<0,001) dan kadar kreatinin (adjusted OR: 2,70 [1,20–6,05]; p=0,016). Skor
logistik dan aditif untuk prediksi mortalitas dalam perawatan memiliki nilai
AUROC masing-masing 0,89 dan 0,86.
Simpulan: Proporsi mortalitas dalam perawatan pasien sirosis hati dekompensasi
akut di RSCM adalah 12,03%. Prediktor independen dari mortalitas dalam
perawatan antara lain usia, adanya infeksi bakterial, kadar bilirubin dan kreatinin.
Telah dikembangkan sistem skor prediksi mortalitas dalam perawatan pasien sirosis
hati dekompensasi akut.
Background: Acutely decompensated liver cirrhosis is associated with a highmedical cost and negatively affects productivity and quality of life. Data on thepredictors of in-hospital mortality in acutely decompensated liver cirrhosis patientsin Indonesia is still limited.Objective: To determine the proportion and predictors of in-hospital mortality inacutely decompensated liver cirrhosis patients at Cipto Mangunkusumo Hospital.Methods: Retrospective cohort study using the hospital database of acutelydecompensated liver cirrhosis at Cipto Mangunkusumo Hospital (2016-2019).Bivariate and multivariate logistic regression analyses were performed to identifypredictors of in-hospital mortality. Two scoring systems were developed based onthe identified factors.Results: 241 patients were analyzed, mostly male (74,3%), suffering from hepatitisB (38.6%) and Child-Pugh B and C (40% and 38%). Gastrointestinal bleeding wasfound in 171 patients (70,95%) and 29 patients (12,03%) died duringhospitalization. The independent predictors of in-hospital mortality were age(adjusted OR: 1,09 [1,03-1,14]; p = 0,001), bacterial infection (adjusted OR: 6,25[2,31-16,92]; p <0,001), total bilirubin levels (adjusted OR: 3,01 [1,85-4,89]; p<0,001) and creatinine levels (adjusted OR: 2,70 [1,20-6,05]; p = 0,016). Thelogistic and additive scoring system for predicting in-hospital mortality hadAUROC values of 0,89 and 0,86, respectively.Conclusion: The proportion of in-hospital mortality in acutely decompensated livercirrhosis at Cipto Mangunkusumo Hospital was 12,03%. The independentpredictors of in-hospital mortality were age, bacterial infection, bilirubin, andcreatinine levels. The in-hospital mortality prediction scoring systems have beendeveloped for acutely decompensated liver cirrhosis.