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Petry

Perbedaan kesintasan 30-hari pasien usia lanjut dengan pneumonia komunitas pada berbagai derajat ketergantungan di awal perawatan = The difference of 30 days survival in elderly patients with community acquired pneumonia in various degree of dependency during admission

"[ABSTRAK

Latar Belakang : Pasien usia lanjut seringkali memerlukan rawat inap karena infeksi pneumonia yang disertai dengan penurunan status fungsional. Hubungan antara penurunan status fungsional pada pasien usia lanjut dengan pneumonia komunitas yang dirawat inap dengan kesintasan belum banyak diteliti.

Tujuan : Mendapatkan informasi mengenai perbedaan kesintasan 30-hari pasien pneumonia komunitas berusia lanjut dengan berbagai derajat ketergantungan. Metodologi : Penelitian kohort retrospektif berbasis analisis kesintasan terhadap pasien usia lanjut dengan pneumonia komunitas di ruang rawat akut geriatri RSCM periode Januari 2010-Desember 2013. Dilakukan ekstraksi data dari rekam medik mengenai status fungsional, kondisi klinis dan faktor perancu, kemudian dicari data mortalitasnya dalam 30 hari. Status fungsional awal perawatan dinilai dengan indeks ADL Barthel, kemudian dikelompokkan menjadi tiga kelompok, yaitu mandiri-ketergantungan ringan, ketergantungan sedang-berat dan ketergantungan total. Perbedaan kesintasan antara ketiga kelompok ditampilkan dalam kurva Kaplan Meier. Perbedaan kesintasan antara ketiga kelompok diuji dengan Log-rank test, dengan batas kemaknaan <0,05. Analisis multivariat dengan Cox?s proportional hazard regression untuk menghitung adjusted hazard ratio (dan interval kepercayaan 95%-nya) dengan koreksi terhadap variabel perancu.

Hasil : Dari 392 subjek, sebanyak 79 subjek (20,2%) meninggal dunia dalam waktu 30 hari. Rerata kesintasan seluruh subjek 25 hari (IK95% 24,66-26,49), kelompok mandiri-ketergantungan ringan 28 hari (IK95% 27,38-29,46), ketergantungan sedang-berat 25 hari (IK95% 23,71-27,25), ketergantungan total 23 hari (IK95% 21,46-24,86). Kesintasan 30-hari pada kelompok mandiri- ketergantungan ringan 92,1% (SE 0,029), ketergantungan sedang-berat 80,2% (SE 0,046), ketergantungan total 68,0% (SE 0,041). Crude HR pada ketergantungan sedang-berat 2,68 (p=0,008; IK95% 1,29-5,57), ketergantungan total 4,32 (p<0,001; IK95% 2,24-8,31) dibandingkan dengan mandiri-ketergantungan ringan. Setelah dilakukan adjustment terhadap variabel perancu didapatkan fully adjusted HR pada kelompok ketergantungan total 3,82 (IK95% 1,95-7,51), ketergantungan sedang-berat 2,36 (IK 95% 1,13-4,93).

Simpulan : Terdapat perbedaan kesintasan 30-hari pasien pneumonia komunitas berusia lanjut pada berbagai derajat ketergantungan; semakin berat derajat ketergantungan, semakin buruk kesintasan 30-harinya.

ABSTRACT

Background : Elderly patients often require hospitalization because of pneumonia accompanied by decreased functional status. The relationship between the declines in functional status in elderly patients with community acquired pneumonia who are hospitalized with survival rate has not been widely studied. Objective : To determine the difference of 30-days survival in elderly patients with community-acquired pneumonia in various degree of dependency during admission.

Method : A retrospective cohort study based on survival analysis of the elderly patients with community-acquired pneumonia in acute geriatric ward RSCM from January 2010 to December 2013. Extraction of data from medical records regarding functional status, clinical conditions and confounding factors, then followed up the 30-day mortality. Functional status at the start of hospitalization was assessed by the ADL Barthel index, then grouped into three, which are independent-mild dependence, moderate-severe dependence and total dependence. The difference of survival rate among the three groups is shown in the Kaplan- Meier curves. The difference in survival rate among the three groups were tested with the log-rank test, with a significance limit of <0.05. Multivariate analysis with Cox's proportional hazards regression to calculate adjusted hazard ratio (and its 95% confidence interval) with correction for confounding variables.

Results : Of the 392 subjects, a total of 79 subjects (20.2%) died within 30 days. The mean survival rate of all subjects was 25 days (95%CI 24.66-26.49), independent-mild dependence group was 28 days (95%CI 27.38-29.46), moderate-severe dependence group was 25 days (95%CI 23,71-27.25), the total dependence group was of 23 days (95%CI 21.46-24.86). The 30-day survival of independent-mild dependence group was 92.1% (SE 0.029), moderate-severe dependence group was 80.2% (SE 0.046), total dependence group was 68.0% (SE 0.041). Crude HR of moderate-severe dependence group was 2.68 (p=0.008; 95%CI 1.29-5.57), the total dependence group was 4.32 (p<0.001; 95%CI 2.24- 8.31) compared with independent-mild dependence group. After adjustment for confounding variables, obtained the fully adjusted HR was 3,82 (95%CI 1,95- 7,51) in total dependence group, and 2,36 (95%CI 1,13-4,93) in moderate-severe dependence group.

Conclusion : There are differences in 30-day survival rate of elderly patients with community-acquired pneumonia in various degrees of dependence; the more severe the degree of dependence, the worse its 30-day survival rate.;Background : Elderly patients often require hospitalization because of pneumonia accompanied by decreased functional status. The relationship between the declines in functional status in elderly patients with community acquired pneumonia who are hospitalized with survival rate has not been widely studied. Objective : To determine the difference of 30-days survival in elderly patients with community-acquired pneumonia in various degree of dependency during admission.

Conclusion : There are differences in 30-day survival rate of elderly patients with community-acquired pneumonia in various degrees of dependence; the more severe the degree of dependence, the worse its 30-day survival rate., Background : Elderly patients often require hospitalization because of pneumonia accompanied by decreased functional status. The relationship between the declines in functional status in elderly patients with community acquired pneumonia who are hospitalized with survival rate has not been widely studied. Objective : To determine the difference of 30-days survival in elderly patients with community-acquired pneumonia in various degree of dependency during admission.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

T58723

UI - Tesis Membership Universitas Indonesia Library

Popy Yusnidar

Pengaruh status frailty terhadap komplikasi 30 hari pascabedah elektif pada pasien usia lanjut = The impact of frailty on 30-day complications after elective surgery in the elderly patients

"Latar Belakang. Komplikasi pascabedah elektif meningkat sejalan dengan peningkatan usia. Status frailty pada pasien usia lanjut dikaitkan dengan peningkatan kejadian komplikasi pascabedah. Pengaruh status frailty terhadap komplikasi 30 hari pascabedah perlu diteliti lebih lanjut pada pasien usia lanjut di Indonesia.

Tujuan. Mengetahui pengaruh status frailty terhadap komplikasi 30 hari pascabedah elektif pada pasien usia lanjut.

Metode. Studi dengan desain kohort prospektif untuk meneliti pengaruh status frailty terhadap kejadian komplikasi 30 hari pascabedah elektif pada pasien usia lanjut, dengan menggunakan pengambilan data pada pasien yang menjalani pembedahan elektif di RS Cipto Mangunkusumo pada tanggal 20 April sampai dengan 13 Juli 2018. Penilaian frailty dengan menggunakan FI 40 items. Analisis bivariat dan multivariat dengan logistik regresi dilakukan untuk menghitung crude risk ratio (RR) dan adjusted RR terjadinya komplikasi 30 hari pascabedah elektif antara kelompok frail terhadap kelompok fit, dan antara kelompok pre-frail terhadap kelompok fit dengan menggunakan SPSS.

Hasil. Sebanyak 21,1% dari total 180 subjek pasien usia lanjut yang menjalani pembedahan elektif mengalami komplikasi 30 hari pascabedah. Proporsi kejadian komplikasi 30 hari pada kelompok frail lebih tinggi dibandingkan dengan kelompok pre-frail dan fit (41,7% vs 15% vs 9,4%). Pada analisis multivariat, didapatkan adjusted RR pada kelompok frail sebesar 4,579 (IK 95% 1,799-8,118), setelah memperhitungkan faktor perancu, yakni jenis pembedahan. Pada kelompok pre-frail, tidak ditemukan komplikasi yang berbeda bermakna walaupun terdapat kecenderungan komplikasi lebih tinggi dibandingkan kelompok fit.

Kesimpulan. Kondisi frail meningkatkan risiko komplikasi 30 hari pascabedah elektif pada pasien usia lanjut. Sedangkan pre-frail dibandingkan fit walaupun tidak menunjukkan perbedaan yang signifikan, namun terdapat kecenderungan peningkatan komplikasi.

Background. Postoperative complication is increased in the elderly patients. Frailty in the elderly is associated with postoperative complication. The impact of frailty on 30- day complications after elevtive surgery needs to be evaluated in the elderly patients in Indonesia.
Objectives. To identify the impact of frailty on 30-day complications after elective surgery in the elderly patients.
Methods. A prospective cohort study was conducted to determine the impact of frailty on 30-day complications after elective surgery in the elderly patient in Cipto Mangunkusumo hospital from 20 April to 13 Juli 2018. Frailty was asessed using Frailty Index 40 items. Analysis was done using SPSS statistic for univariate, bivariate and multivariate logistic regression to obtain crude risk ratio and adjusted risk ratio of probability of 30-day complications after elective surgery in the elderly patients.
Result. Out of the total 180 eldery patients who underwent elective surgery, 21,1% of those had 30-day complications. Postoperative complications were higher in those with frail than pre-frail and fit subjects(41,7% vs 15% vs 9,4%). Multivariate analysis using logistic regression analysis with type of surgery as counfounder, revelead that adjusted RR in frail group was 4.579 (95% CI 1.799-8.118). Although pre-frail subjects showed higher postoperative complications than fit subjects, but there were no differences significantly.
Conclusion. Elderly patients with frail condition had higher 30-day complications after elective surgery. There were no significant differences between pre-frail compared to fit subject on 30-day complications after elective surgery, although pre-frail subject tends to showed higher complication."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Nanda Noor Muhammad

Uji Kesahihan dan Keandalan Kuesioner World Health Organization Quality of Life-HIV BREF dalam Bahasa Indonesia untuk Mengukur Kualitas Hidup Pasien HIV/AIDS = Validity and Reability Test of Indonesian Version World Health Organization Quality of Life HIV BREF Questionnaire to Measure The Quality of Life Patients with HIV/AIDS.

"ABSTRAK

Latar belakang: Menurut data tahun 2015 dari WHO dan UNAIDS, ada sekitar 36,7 juta orang di dunia hidup dengan HIV/AIDS. Di Indonesia, berdasarkan data dari Kementerian Kesehatan Republik Indonesia, prevalensi HIV mencapai 0,4 dimana terdapat 232.323 penderita HIV dan 86.780 penderita AIDS yang dilaporkan pada tahun 2016. Kualitas hidup terkait kesehatan pada pasien HIV dapat digunakan sebagai salah satu indikator keberhasilan terapi. Penelitian ini bertujuan untuk mengetahui kesahihan dan keandalan kuesioner WHOQOL-HIV BREF dalam bahasa Indonesia sebagai alat untuk mengukur kualitas hidup pada pasien HIV/AIDS.

Metode: Penelitian potong lintang ini dilakukan di Poliklinik khusus HIV RSCM pada bulan November 2016 dengan cara consecutive sampling. Penelitian dilakukan dalam 2 tahap yaitu tahap awal yang merupakan proses adaptasi bahasa dan budaya dan tahap akhir yaitu uji kesahihan dan keandalan dari kuesioner.

Hasil : Dari 56 responden yang mengisi kuesioner diketahui bahwa 69,6% laki-laki. Melalui pendekatan multi-trait scaling analysis didapatkan nilai koefisien korelasi yang tinggi terhadap skor total domainnya sehingga dapat dapat dikatakan memiliki validasi yang baik. Korelasi antar domain kuesioner WHOQOL-HIV BREF dan domain kuesioner SF-36 didapatkan 6 domain yang signifikan bermakna (p <0,005) dengan nilai koefisien korelasi kuat (r=0,60-0,79). Keandalan kuesioner dinilai dengan intra class correlation coefficient masing-masing domain 0,401-0,484 dan nilai Alpha Cronbach 0,513-0,798.

Kesimpulan: Kuesioner WHOQOL-HIV BREF dalam bahasa Indonesia sahih dan andal. Diharapkan kualitas hidup dapat dipertimbangkan sebagai salah satu acuan respon pengobatan.

ABSTRACT

Background According to data from WHO and UNAIDS in 2015, approximately 36.7 million people worldwide living with HIV AIDS. In Indonesia, according to the data from the Ministry of Health Republik Indonesia, the HIV prevalence reached 0.4 where 232.323 people living with HIV and 86.780 people already in AIDS stage at 2016. Health status, which contributes to the quality of life in HIV patients, can be used as one indicators of the success of therapy. This study aims to determine the validity and reliability of the questionnaire WHOQOL HIV BREF in Indonesian as a tool for measuring the quality of life of HIV patients.

Methods: A cross sectional study was conducted in HIV Integrated Service Unit Cipto Mangunkusumo General Hospital RSCM in November 2016 with consecutive sampling method. The study was conducted in two phases first, the language and cultural adaptation process and second phase was to test the validity and reliability of the questionnaire.

Result: Total 56 respondents who filled the questionnaire, 69.6 % of them were men. Through a multi-trait scaling analysis, correlation coefficient value has a high correlation to the total score domain, and thus can be concluded that it has a good validation. Correlation between questionnaire domain WHOQOL-HIV BREF and SF-36 questionnaire domain obtained 6 significant domain (p <0.005) with a strong correlation coefficient (r=0.60 to 0.79). Reliability of the questionnaire was assessed by intra class correlation coefficient, each domain from 0.401 to 0.484 and 0.513 to 0.798 for Cronbach Alpha.

Conclusion: The questionnaire WHOQOL-HIV BREF in the Indonesian language is valid and reliable. As such the quality of life can be considered as one criteria of a successful response of HIV treatment."

2017

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Lusiana Kurniawati

Hubungan antara Saat Trakeostomi dengan Mortalitas Pasien Kritis Terventilasi Mekanik di Unit Perawatan Intensif = Association between Tracheostomy Timing on ICU Mortality in Mechanically Ventilated Patients

"Latar Belakang

Trakeostomi merupakan tindakan yang umum dilakukan di unit perawatan intensif. Tindakan trakeostomi dapat menurunkan hambatan udara jalan napas, memiliki potensi untuk menurunkan obat sedasi dan pneumonia terkait ventilator sehingga diharapkan dapat menurunkan mortalitas dan morbiditas pasien di unit perawatan intensif. Namun batasan waktu untuk melakukan trakeostomi pada pasien kritis yang diprediksikan akan memerlukan bantuan ventilasi jangka panjang hingga saat ini masih dalam perdebatan karena berbagai penelitian terdahulu menunjukkan hasil yang berbeda-beda.

Tujuan

Mengetahui hubungan antara saat trakeostomi dengan mortalitas perawatan unit intensif. Mengetahui insiden mortalitas antara trakeostomi dini dan lanjut pada pasien perawatan unit intensif dengan ventilasi mekanik.

Metodologi

Penelitian dengan desain kohort retrospektif, dilakukan terhadap 162 pasien kritis dengan ventilasi mekanik yang menerima tindakan trakeostomi selama perawatan intensif di RSUPN Dr. Cipto Mangunkusumo pada kurun waktu Januari 2008-Desember 2012. Data saat untuk melakukan trakeostomi, klinis, laboratorium, dan radiologis dikumpulkan. Pasien diamati untuk melihat kejadian mortalitas selama perawatan intensif. Analisis hubungan antara saat trakeostomi dengan mortalitas perawatan intensif menggunakan tes X2. Analisis multivariat dengan regresi logistik digunakan untuk menghitung adjusted odds ratio (dan interval kepercayaan 95%) antara kelompok trakeostomi dini dan lanjut untuk terjadinya mortalitas perawatan intensif dengan memasukkan variabel-variabel perancu sebagai kovariat.

Hasil

Terdapat hubungan yang tidak bermakna antara trakeostomi dini dan lanjut dengan mortalitas unit perawatan intensif pada uji X2 (p=0,07) dengan RR 0,67 (IK95% 0,51-1,05). Insiden mortalitas pada trakeostomi dini dan lanjut sebesar 28,4% dan 42%.

Kesimpulan

Kelompok trakeostomi dini cenderung untuk memiliki insiden mortalitas yang lebih rendah dibandingkan dengan trakeostomi lanjut. Namun saat trakeostomi tidak berhubungan dengan mortalitas unit perawatan intensif secara statistik.

Background
Tracheostomy is a common procedure in the intensive care unit . Tracheostomy can reduce airway resistance, the usage of sedation and ventilator-associated pneumonia. Based on these advantages, tracheostomy can potentially reduce ICU mortality and morbidity . But the timing to perform a tracheostomy in critically ill patients who are predicted to require long-term ventilatory support is still under debate, because previous studies showed different results.
Objective
Investigating the association between tracheostomy timing with intensive care unit mortality. Knowing the incidence of ICU mortality between early and late tracheostomy in patients with mechanical ventilation in intensive care unit.
Methods
Retrospective cohort study design was conducted on 162 critically ill patients in mechanical ventilation. These patients also underwent tracheostomy procedure during intensive care treatment in Cipto Mangunkusumo during period from January 2008-December 2012. The timing to tracheostomy, clinical, laboratory, and radiological data were collected . Patients were observed for the incidence of mortality during intensive care. Chi Square test was used to analyze the relationship between tracheostomy timing with intensive care unit mortality. Multivariate analysis with logistic regression was used to calculate adjusted odds ratios ( and 95% confidence intervals ) between early and late tracheostomy group to the intensive care mortality by including confounding variables as covariates .
Results
There is no significant association between early and late tracheostomy with the intensive care unit mortality ( p = 0.07 ) with a risk ratio (RR) of 0.67 ( CI 95 % 0.51 to 1.05 ) . The incidence of mortality in early and late tracheostomy was 28.4 % and 42 % .
Conclusion
Early tracheostomy group tended to have a lower mortality incidence compared with late tracheostomy. Association between timing to tracheostomy with the intensive care unit mortality was not statistically significant."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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UI - Tesis Membership Universitas Indonesia Library

I Putu Arsana

Hubungan Usia, Tekanan Darah Sistolik Pradialisis, Interdialytic Weight Gain, dan Ultrafiltrasi dengan Hiperhidrasi pada Pasien Hemodialisis Kronik Dua Kali Seminggu di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo = Relationship of Age, Predialytic Systolic Blood Pressure, Interdialytic Weight Gain, and Ultrafiltration with Hyperhydration in Twice-Weekly Hemodialysis Patients at Dr. Cipto Mangunkusumo National General Hospital.

"Pendahuluan: Hiperhidrasi meningkatkan risiko kematian pada pasien hemodialisis (HD) kronik. Hiperhidrasi berdasarkan brain-type natriuretic peptide(BNP) plasma >356 pg/ml berisiko tinggi kematian pada pasien dengan HD kronik. Pengeluaran akumulasi air berlebih seminggu pada prosedur HD kronik dua kali seminggu lebih sedikit dibandingkan HD kronik tiga kali seminggu sehingga berpotensi lebih mudah mengalami hiperhidrasi. Penelitian ini bertujuan mengetahui proporsi pasien dengan hiperhidrasi serta hubungan usia, tekanan darah sistolik(TDS)pradialisis, interdialytic weight gain(IDWG), dan ultrafiltrasi(UF) dengan hiperhidrasipada pasien HD kronik dua kali seminggudi Rumah Sakit Umum Pusat Nasional(RSUPN)Dr. Cipto Mangunkusumo.

Metode: Penelitian ini merupakan studi potong lintang untuk mengetahui proporsi pasien dengan hiperhidrasi,serta hubungan usia, TDS pradialisis, IDWG, dan UF dengan hiperhidrasi pasien HD kronik dua kali seminggu di RSUPNCiptoMangunkusumo. Hiperhidrasi berdasarkan BNP plasma >356 pg/ml. Analisis bivariat dan multivariat dilakukan untuk mengetahui hubungan usia, TDS pradialisis, IDWG, dan UF dengan hiperhidrasi. Hasil: Sebanyak 129 pasien yang dianalisis. Hiperhidrasi didapatkan sebesar 62%. Pada analisis multivariat menunjukkan bahwa TDS pradialisis berhubungan dengan hiperhidrasi (adjusted OR=3,84; IK 95%: 1,51-9,74; p<0,005) Kesimpulan: Proporsi pasien dengan hiperhidrasi pada HD kronik dua kali seminggu sebesar 62%. Pada analisis multivariat didapatkan hanya TDS pradialisis berhubungan dengan hiperhidrasi.

Introduction: Hyperhydration is an independent higher mortality risk factor in maintenance hemodialysis (MHD) patients. In Indonesia, twice-weekly HD is the most common of MHD. Twice-weekly HD patients may have higher risk of interdialytic water accumulation lead hyperhydration than thrice-weekly HD patients.The aim of study was identifying the proportion of patients with hyperhydration, and relationship of age, predialytic systolic blood pressure (SBP), interdialytic weight gain (IDWG), and ultrafiltration (UF) to hyperhydration in twice-weekly HD patients at Dr. Cipto Mangunkusumo National General Hospital. Methods: A cross sectional study in twice-weekly HD patients at Dialysis Unit-Dr. Cipto Mangunkusumo National General Hospital. Hyperhydration was based on plasma brain-type natriuretic peptide (BNP) >356 pg/ml. Bivariate and multivariate analysis was done to analyze relationship of age, predialytic SBP, IDWG, and UF with hyperhydration. Results:One hundred twenty-nine patients were analyzed, proportion of patients with hyperhydration in twice--weekly HD patients was 62%. In multivariate analysis, predialytic SBP was related to hyperhydration (adjusted OR= 3.84; 95% CI, 1.51-9.74; p=0.005).
Conclusion: The proportion of patients with hyperhydration in twice-weekly HD patients was 62%. In multivariate analysis the predialytic SBP was related to hyperhydration in twice-weekly HD patients at Dr. Cipto Mangunkusumo National General Hospital."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019

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UI - Tesis Membership Universitas Indonesia Library

Yusuf Huningkor

Hubungan antara kadar high sensitivity C-reactive protein dengan Skor SYNTAX sebagai gambaran derajat aterosklerosis pada penderita Penyakit Jantung Koroner Sstabil = The Association between high sensitivity C-reactive protein level and SYNTAX score as representation of atherosclerosis severity in patients with stable coronary artery disease

"Latar Belakang: Kadar hsCRP berhubungan dengan mayor adverse cardiac events. Pada PJK stabil, hubungan antara kadar hsCRP dengan skor SYNTAX sebagai gambaran derajat aterosklerosis koroner belum jelas.

Tujuan: Mengetahui hubungan antara kadar hsCRP dengan skor SYNTAX pada penderita PJK stabil, dan mengetahui titik-potong kadar hsCRP yang dapat membedakan antara kelompok skor SYNTAX rendah dengan yang tinggi.

Metode: Observasional potong-lintang pada consecutive 93 subjek penderita PJK stabil dewasa yang menjalani angiografi koroner di RSUPNCM pada bulan Mei sampai September 2018, untuk memperoleh skor SYNTAX. Diambil darah dari arteri perifer sebelum tindakan angiografi untuk pemeriksaan hsCRP dan laboratorium dasar. Dieksklusi penderita infeksi berat, trauma, PGK, sirosis hati, keganasan, pengobatan steroid. Selanjutnya data dikumpulkan dan dianalisis. Skor SYNTAX dikelompokkan tinggi bila > 27, dan rendah bila nilai < 27. Untuk menilai titikpotong kadar hsCRP dipakai uji Sperman karena distribusi data tidak normal.

Hasil: Ditemukan rerata umur 60,23 tahun (SB 8,984), IMT 26,30 Kg/m2 (SB 3,903), kol-LDL 117,74 mg/dL (SB 36,31). Kadar hsCRP dan skor SYNTAX tidak dipengaruhi oleh IMT atau kol-LDL (hsCRP-IMT: r:0,032; p:0,772; skor SYNTAX-IMT: r:-0,021; p:0,849; hsCRP-kol LDL: r:-0,149; p:0,266; skor SYNTAX-kol LDL: r:0,159; p:0,234). Ditemukan korelasi positif lemah hsCRP dengan skorSYNTAX (r:0,270; p:0,009) dan Titik-potong pada kadar hsCRP 2,35 mg/L (sensitifitas 0,69; spesifisitas 0,53). Nilai AUC 0,554, IK 95%, p: 0,472, merupakan diskriminasi yang kurang baik.

Simpulan: Pada penderita PJK stabil, kadar hsCRP berkorelasi positif lemah dengan skor SYNTAX sebagai gambaran derajat aterosklerosis. Kadar hsCRP dengan titik-potong > 2,35 mg/L dapat membedakan kelompok yang mempunyai skor SYNTAX rendah dengan kelompok skor SYNTAX tinggi, namun nilai prediksinya relatif rendah.

Background: High sensitivity C-reactive protein levels are associated with mayor adverse cardiac events. In stable CAD, the association of baseline hcCRP level with coronary atherosclerosis severity assessed by SYNTAX score were not clear.
Objective: To investigate the association between hsCRP level and SYNTAX score in patients with stable CAD, and to know cut-off point of hsCRP level which can differentiated between the group of low SYNTAX score and of high SYNTAX score.
Methods: Cross-sectional observation to the consecutive 93 subject adult patients of stable CAD, undergoing coronary angiography in Cipto Mangunkusumo General Hospital on May to September 2018 to obtain SYNTAX score. The blood tests were taking from pheripheral artery prior to carrying out of coronary angiography to obtain level of hsCRP and laboratory data base. The exclusion were severe infection, trauma, CKD, cirrhosis hepatis, malignancy, and steroid therapy. The SYNTAX score will be differentiated between the group of high if the value > 27, and the group of low if the value < 27. Sperman analysis will be used to evaluate hsCRP cut-off point.
Results: Average age was 60,23 year (SD 8,984), BMI 26,30 Kg/m2 (SD 3,903), and LDL-chol 117,74 (SD 36,31). The Level of hsCRP and SYNTAX score were not influenced by BMI or LDL-chol (hsCRP - BMI: r:0,032; p:0,772; SYNTAX score - BMI: r:-0,021; p:0,849; hsCRP- LDL-chol: r:-0,149; p:0,266; SYNTAX score - LDL-chol: r:0,159; p:0,234). We found positif corelation (weak) between hsCRP and SYNTAX Score (r:0,270; p:0,009). Cut-off point was found in the hsCRP level 2,35 mg/L (sensitivity 0,69; spesivisity 0,53). AUC 0,554, CI 95%, p: 0,472, were the poor discrimination.
Conclusions: There were positif (weak) correlation between hsCRP level and SYNTAX score in stable CAD patients. Cut-off point in the hsCRP level > 2,35 mg/L can differentiated between the group of low SYNTAX score and of high SYNTAX score, but the prediction value is low-grade."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018

SP-Pdf

UI - Tugas Akhir Universitas Indonesia Library

Dwi Rahayu Nur Laila Praptiwi

Faktor-faktor yang berhubungan dengan tertundanya inisiasi terapi antiretroviral pada pasien dengan infeksi human immunodeficiency virus = Factors associated with delayed initiation of antiretroviral therapy in human immunodeficiency virus infected patients

"Latar Belakang: Cakupan pemberian obat antiretroviral (ARV) yang semakin luas berdampak positif dengan menurunnya angka kematian dan kesakitan pasien HIV/AIDS. Waktu inisiasi pemberian terapi ARV pada pasien HIV juga berhubungan erat dengan penurunan angka kematian dan kesakitan. Tertundanya inisiasi terapi ARV pada pasien HIV menyebabkan angka kematian yang lebih tinggi yaitu 10% dibanding yang tidak tertunda. Faktor-faktor yang berhubungan dengan tertundanya inisiasi terapi ARV penting untuk diketahui sehingga dapat dilakukan upaya pengendalian terhadap faktor-faktor tersebut sehingga dapat menurunkan angka kesakitan dan kematian pada pasien HIV.

Tujuan: Mengetahui faktor-faktor yang berhubungan dengan tertundanya inisiasi terapi ARV pada pasien HIV.

Metode: Penelitian ini merupakan studi potong lintang pada pasien HIV rawat jalan dewasa di UPT/HIV RSUPNCM yang memulai ARV pertama kali selama periode Januari 2013-Desember 2014. Data klinis dan laboratorium didapatkan dari rekam medis pasien. Tertundanya inisiasi terapi ARV dinyatakan bila pasien belum memulai terapi ARV 10 minggu setelah diagnosis HIV. Faktor-faktor yang diteliti adalah jenis kelamin, status pernikahan, tingkat pendidikan, pekerjaan, Indeks Massa Tubuh (IMT), status fungsional, stadium klinis HIV, dan infeksi oportunistik. Uji regresi logistik digunakan untuk mengetahui hubungan faktor-faktor tersebut dengan tertundanya inisiasi terapi ARV.

Hasil: Terdapat 444 pasien yang memulai terapi ARV pertama kali, 107 pasien (24,1%) yang tertunda inisiasi terapi ARV dan 337 pasien (75,9%) tidak tertunda. Berdasarkan hasil analisis bivariat didapatkan 3 variabel yang memiliki kemaknaan statistik yaitu stadium klinis lanjut (p<0,001), status fungsional rendah (p<0,001) dan adanya infeksi oportunistik (p<0,001). Pada analisis multivariat lebih lanjut terdapat dua variabel yang berhubungan dengan tertundanya inisiasi terapi ARV pada pasien HIV yaitu stadium klinis lanjut (OR: 2,92, IK95% 1,53-7,40, p=0,02) dan adanya infeksi oportunistik (OR 1,99, IK95% 1,21-3,29, p=0,01).

Simpulan: Stadium klinis lanjut menurut WHO dan adanya infeksi oportunistik merupakan faktor-faktor yang berhubungan dengan tertundanya inisiasi terapi ARV pada pasien HIV.

Background: Increase access towards antiretroviral therapy (ART) contribute to global decrease of HIV/AIDS-associated morbidity and mortality. Time to initiation of ART in eligible HIV-infected patients is associated with reduction of mortality and morbidity. Delayed initiation of antiretroviral therapy can lead to increase of mortality rate more than 10% compared to early initiation. It is important to identify factors associated with delayed initiation ART among HIV patient in order to control these factors and thus lower the mortality and morbidity in HIV patients.
Objectives: To identify factors associated with delayed initiation of ART in HIV patients.
Methods: This study was a cross sectional study among adult HIV patients in Out-patient Clinic of HIV Integrated Clinic Cipto Mangunkusumo General Hospital who started ARV therapy for the first time (ART-naïve patients) enrolled from January 2013 to December 2014. Clinical and laboratory data were extracted from medical records. Delayed initiation ART was defined as eligible patients didn?t initiate ART within 10 weeks after the diagnosis of HIV infection. Factors identified were gender, education level, employment, marital status, WHO clinical stage, BMI, functional status, and the presence of opportunistic infection. Logistic regression test was used to find factors associated with delayed initiation of ART.
Results: There were 444 subjects in this study, which consisted of 107 patients (24.1%) who delayed initiation of ART and 337 patients (75.9%) who didn?t delayed initiation of ART. Based on the bivariate analysis, there were three variables statistically significance, which were advanced WHO clinical stage (p<0.001), lower functional status (p<0.001) and the presence of opportunistic infection (p<0.001). Further multivariate analysis showed that there were two variables associated with delayed initiation of ART, which were advanced WHO clinical stage (OR: 2.92, 95%CI 1.53-7.40, p=0.02) and the presence of opportunistic infection (OR 1.99, 95%CI 1.21-3.29, p=0.01).
Conclusion: Advanced WHO clinical stage and the presence of opportunistic infections are factors associated with delayed initiation of ART among HIV patients."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Herikurniawan

Korelasi antara distribusi lemak tubuh dengan lebar celah sendi tibiofemoral medial pada pasien osteoartritis lutut dengan obesitas = The Correlation between body fat distribution and medial tibiofemoral joint space width in obese knee osteoarthritis patients

"Latar Belakang: Obesitas merupakan faktor risiko utama osteoartritis (OA). Penelitian terdahulu mendapatkan bahwa faktor mekanik saja tidak cukup untuk menjelaskan hubungan OA dengan obesitas. Saat ini faktor metabolik yang berkaitan dengan massa lemak tubuh dianggap memiliki peranan penting, tetapi lemak mana yang paling berperan masih kontroversial apakah lemak viseral atau lemak subkutan. Tujuan penelitian ini untuk mendapatkan korelasi antara distribusi lemak tubuh dengan lebar celah sendi tibiofemoral medial.

Metode: Penelitian ini merupakan studi potong lintang pada penderita OA lutut dengan obesitas yang berobat di poliklinik Reumatologi, Geriatri dan Penyakit Dalam RSCM periode Januari-Maret 2016. Diagnosis OA lutut berdasarkan kriteria American College of Rheumatology (ACR) 1986. Pemeriksaan distribusi lemak tubuh menggunakan bioelectrical impedance analysis (BIA). Pemeriksaan radiologi lutut menggunakan radiologi konvensional (foto polos) untuk menilai lebar celah sendi tibiofemoral medial. Analisis statistik bivariat digunakan untuk mendapatkan korelasi antara distribusi lemak tubuh dengan lebar celah sendi tibiofemoral medial.

Hasil: Sebanyak 56 orang pasien yang memenuhi kriteria inklusi dan bersedia ikut dalam penelitian, mayoritas subjek berjenis kelamin perempuan (73,2%). Median kadar lemak viseral adalah 12% (7.5-16,5) median lemak subkutan adalah 30,2% (16,5-37,9) dan median rasio lemak viseral/subkutan adalah 0,40 (0,26-0,80). Rerata lebar celah sendi tibiofemoral medial adalah 2,34 mm (SB 0,78). Korelasi antara lemak viseral dengan lebar celah sendi tibiofemoral medial (r: -0,474 p: < 0,001). Tidak didapatkan korelasi antara lemak subkutan dengan lebar celah sendi tibiofemoral medial (r: -0,187 p: 0,169) serta tidak didapatkan korelasi antara rasio lemak viseral/subkutan dengan lebar celah sendi tibiofemoral medial (r: -0,225 p: 0,09).

Simpulan: Lemak viseral berkorelasi negatif sedang dengan lebar celah sendi tibiofemoral medial (r: -0,474 p: < 0,001). Tidak didapatkan korelasi antara lemak subkutan dan rasio lemak viseral/subkutan dengan lebar celah sendi tibiofemoral.

Background: Obesity is a major risk factor for knee osteoarthritis. The relationship between obesity and OA may not simply due to mechanical factor. Evidence suggests that metabolic factors related to body fat play important roles, but the specific type of fat that contributes to OA is unclear. The objective of this study was to examine the possible correlation between body fat distributions with knee OA.
Method: This study was a cross sectional study in OA patients with obesity visiting Rheumatology, Geriatric, Internal Medicine clinics in Cipto Mangunkusumo Hospital between January-March 2016. Samples were collected using consecutive sampling method. Knee OA was diagnosed from clinical and radiologic evaluation based on American College of Rheumatology 1986 criteria. Body fat distribution was measured by bioelectrical impedance analysis (BIA). Radiographs of the knee was measured by conventional radiography to evaluate joint space narrowing (JSN). The correlation between body fat distributions with joint space width was analyzed by bivariate analysis.
Result: A total of 56 subjects were recruited, with majority of subjects were women (73,2%). Median of visceral fat was 12% (7.5-16,5), median of subcutaneous fat was 30,2% (16,5-37,9) and median of visceral to subcutaneous fat ratio was 0,40 (0,26-0,80). Mean of medial tibiofemoral joint space width was 2,34 mm (SB 0,78). In bivariate analysis we found correlation between visceral fat and medial tibiofemoral joint space width (r: -0,474 p: < 0,001). There is no correlation between subcutaneous fat and medial tibiofemoral joint space width (r: -0,187 p: 0,169) and also visceral to subcutaneous fat ratio and medial tibiofemoral joint space width (r: -0,225 p: 0,09).
Conclusion: Visceral fat is correlated with medial tibiofemoral joint space width (r: -0,474 p: < 0,001). There is no correlation between neither subcutaneous fat nor visceral to subcutaneous fat ratio and medial tibiofemoral joint space width."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

SP-Pdf

UI - Tugas Akhir Universitas Indonesia Library

Barry Anggara Putra

Korelasi skor model for end-stage liver disease meld dengan critical flicker frequency off pada pasien sirosis hati = The correlation between model for end stage liver disease meld score with critical flicker frequency cff in patient with liver cirrhosis

"ABSTRAK

Latar Belakang: Ensefalopati hepatikum minimal (EHM) adalah spektrum teringan dari abnormalitas neuropsikologis yang merupakan komplikasi dari sirosis hati yang berimplikasi pada kualitas hidup pasien. Namun, saat ini modalitas untuk mendiagnosis EHM masih terbatas. Salah satu modalitas pemeriksaan EHM adalah Critical Flicker Frequency (CFF), namun tidak semua fasilitas kesehatan memiliki alat ini. Model for End-Stage Liver Disease (MELD) adalah suatu sistem skoring yang dikembangkan untuk mengetahui prognosis pasien yang akan menerima transplantasi hati dan berdasarkan beberapa studi, berkorelasi dengan EHM. Penelitian ini bertujuan untuk mengetahui korelasi antara MELD dengan CFF pada pasien sirosis hati.

Metode: Penelitian dilakukan secara potong lintang. Pengambilan data dilakukan sejak Maret hingga Mei 2016 di poliklinik Hepatologi RSUPN Cipto Mangunkusumo. Kriteria inklusi meliputi pasien sirosis hati dengan nilai Glasgow

Coma Scale (GCS) 15. Kriteria eksklusi meliputi pasien dengan ensefalopati hepatikum, hematemesis melena, stroke, gangguan penglihatan dan sirosis alkoholik, Subjek penelitian kemudian dilakukan pemeriksaan dengan alat CFF dan dihitung skor MELD masing masing.

Hasil: Sebanyak 60 pasien memenuhi kriteria inklusi dan eksklusi. Didapatkan 28 pasien tanpa EHM dan 32 pasien dengan EHM. Rata rata usia pasien 54,8 tahun. Jumlah hepatitis terbanyak adalah hepatitis B sejumlah 34 pasien dan skor Child Pugh terbanyak adalah Child Pugh A sebanyak 39 pasien. Nilai rerata CFF 36,9 ± 8,57 Hz dan skor MELD 10,3 ± 3,6. Didapatkan nilai r -0,097.

Simpulan: Tidak terdapat korelasi antara skor MELD dan skor CFF.

ABSTRACT
Background: Minimal hepatic encephalopathy (MHE) is the mildest spectrum of neuropsychological abnormality as a complication of liver cirrhosis which has implication in quality of life. Meanwhile, there are only few modalities to diagnose MHE. One of them is Critical Flicker Frequency(CFF), but this modality is not available in every health center. Model for End-Stage Liver Disease (MELD)-a scoring system developed to determine the prognosis of patients who receive liver transplant-is correlated with EHM according to several studies. This study aimed to determine the correlation between MELD with CFF in cirrhotic patients.
Method:
This was a cross sectional study. Data were collected from March until May 2016 in Hepatological outclinic RSUPN Cipto Mangunkusumo. Inclusion criteria consist of cirrhosis pasien with Glasgow Coma Scale (GCS) 15. Exclution criteria consist of patient with hepatic encephalopathy, hematemesis melena, stroke, visual impairment, and alcoholic cirrhosis. All subjects were examined using CFF and MELD scores.
Results:
A total of 60 patients met the inclusion and exclusion criteria for the study. There are 28 patients with EHM and 32 patients without EHM. r value of -0,097. The mean age were 54.8 years old. Most subjects were diagnosed with hepatitis B (34 patients) and most subjects were scored A based on Child Pugh scoring(39 patients). Mean value of CFF and MELD are 36,9 ±8,57 Hz and 10,3 ±3,6 consecutively. The correlation score between two modalities were r -0,097.
Conclusion:
There was no correlation between MELD score and CFF score."

2016

SP-Pdf

UI - Tugas Akhir Universitas Indonesia Library

Ni Made Hustrini

Kemampuan osmolalitas urin sore hari dalam memprediksi status hidrasi optimal pada populasi sehat = Diagnostic performance of afternoon urine osmolality to assess optimal hydration status in healthy population

"ABSTRAK

Latar Belakang: Hidrasi optimal merupakan hidrasi yang mencukupi untuk menggantikan kehilangan cairan, menjamin produksi urin cukup untuk mengurangi risiko urolitiasis dan penurunan fungsi ginjal, serta mencegah keluarnya arginin vasopresin AVP . Osmolalitas urin 24 jam diketahui dapat mengukur status hidrasi seseorang, namun dirasakan memberatkan karena kemungkinan urin tercecer dan membatasi aktivitas kerja. Oleh karena itu, dibutuhkan metode yang lebih sederhana untuk menggantikan pemeriksaan tersebut. Penelitian sebelumnya menunjukkan osmolalitas urin sore memiliki nilai terdekat dengan osmolalitas urin 24 jam. Namun, belum ada penelitian yang mengukur kemampuan urin sore hari sebagai penentu status hidrasi optimal.

Tujuan: Mengetahui peranan pemeriksaan osmolalitas urin sore hari untuk menilai status hidrasi optimal dibandingkan dengan osmolalitas urin 24 jam.

Metode: Studi diagnostik dengan desain studi potong lintang terhadap subjek sehat berusia 18-59 tahun dengan menganalisa kurva ROC untuk mendapatkan titik potong dan akurasi osmolalitas urin sore hari dalam menilai status hidrasi optimal.

Hasil: Antara bulan Agustus-September 2016 terkumpul 120 subjek 73,8 perempuan, median usia 32 tahun yang memenuhi kriteria penelitian dengan median osmolalitas urin 24 jam 463,5 95 IK, 136-1427 mOsm/kg H2O dan median osmolalitas urin sore hari 513 95 IK, 73-1267 mOsm/kg H2O. Pada analisis didapatkan korelasi sedang r= 0,59; p

ABSTRACT
Background: Optimal hydration representing adequate total daily fluid intake to compensate for daily water losses, ensure urinary output to reduce the risk of urolithiasis and renal function decline, and also avoid production of arginine vasopressin AVP . Twenty four hour urine osmolality has known to assess hydration status, but it is challenging because of the possibility of spilling urine and limiting time for daily activities. So that, we need easier method to determine optimal hydration status to replace 24 hour urine osmolality. Previous studies showed afternoon urine osmolality have an association with 24 hour urine osmolality. However, no studies measure the performance of afternoon urine osmolality to assess optimal hydration status.
Objective: To determine the performance of afternoon urine osmolality to assess the optimal hydration status compared with 24 hour urine osmolality.
Methods: Diagnostic study with cross sectional study design was conducted to healthy subjects aged 18 59 years by analyzing the ROC curve to obtain the optimal cutt off point and accuracy of afternoon urine osmolality in assessing the optimal hydration status.
Results: Between August September 2016 there were 120 subjects 73.8 female, median age 32 years who met the study criteria with a median 24 hour urine osmolality 463.5 95 CI, 136 1427 mOsm kg H2O and median afternoon urine osmolality 513 95 CI, 73 1267 mOsm kg H2O. From the analysis, we found the correlation was moderate r 0.59 p"

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

T58714

UI - Tesis Membership Universitas Indonesia Library

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