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"Latar Belakang: Indonesia merupakan negara peringkat keempat penyumbang kasus TB terbanyak di dunia. TB adalah penyebab kematian kedua terbanyak di Indonesia. Pasien TB mempunyai tingkat kematian yang lebih tinggi saat dirawat dibandingkan pasien non-TB. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien dan mengetahui prognosis pasien. Studi-studi tentang faktor prediktor mortalitas pasien tuberkulosis saat rawat inap menunjukkan hasil yang berbeda-beda dan tidak ada penelitian yang komprehensif di Indonesia. Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien tuberkulosis saat rawat inap di RSCM. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien rawat inap di RSCM selama kurun waktu 1 Januari 2008 sampai dengan 31 September 2013. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat menggunakan tes Chisquare dilakukan pada 13 variabel prognostik, yaitu kelompok usia, jenis kelamin, riwayat pengobatan TB sebelumnya, tingkat keparahan TB, status BTA, hipoalbuminemia, IMT, status HIV, adanya konkomitan pneumonia, sepsis, gagal napas, gambaran radiologis toraks, komorbiditas (skor Charlson Comorbidity Index). Adanya data yang tidak lengkap dilakukan imputasi mengunakan teknik multiple imputation. Variabel yang memenuhi syarat disertakan pada analisis multivariat dengan regresi logistik. Hasil: Subjek penelitian terdiri atas 470 pasien. Angka mortalitas selama perawatan sebesar 25,1%. Sebanyak 339 (72,1%) pasien adalah laki-laki dan 131 (27,9%) pasien adalah perempuan. Median usia pasien 34 (rentang 18 sampai 86) tahun dan median lama perawatan adalah 10 (rentang 1 sampai 97) hari. Faktor prediktor independen mortalitas yang bermakna pada analisis multivariat adalah kadar albumin < 3 g/dL (OR 5,12; IK 95% 1,80 sampai 14,57), gambaran radiologis toraks lesi kavitas (3,91; 1,53 sampai 9,97) adanya sepsis (23,31; 8,95 sampai 60,68), adanya gagal napas (177,39; 27,09 sampai 1161,55). Kesimpulan: Adanya gagal napas, adanya sepsis, hipoalbuminemia (kadar albumin < 3 g/dL), serta gambaran radiologis toraks lesi kavitas merupakan faktor prediktor independen mortalitas pasien tuberkulosis saat rawat inap.

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Background: Indonesia is the world’s fourth highest tuberculosis burden in the world. Tuberculosis is the second leading cause of death for all age in the country, according to the Health Ministry. Mortality remains high among tuberculosis hospitalized patients compare to the non-TB patients. The prediction of patients outcome is important in decision-making process and in the effort reducing mortality rate. Studies exploring predictors of mortality in patients with pulmonary tuberculosis produced conflicting results and there are no comprehensive reports in Indonesia.

Objective: To determine predictors of mortality among hospitalized tuberculosis patients in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Methods: We performed a retrospective cohort study among hospitalized tuberculosis patients in Cipto Mangunkusumo Hospital between January 2008 - September 2013. Data were collected at initiation of inpatients period and the main outcome was all-cause mortality during hospitalization. We analyzed age, sex, history of previous anti-tuberculosis treatment, tuberculosis severity, sputum smear positivity, hypoalbuminemia, BMI, HIV status, concomitant pneumonia, sepsis, respiratory failure, pulmonary radiographic lesion, comorbidity (CCI score) in bivariate analysis using Chi-square test. Missing data were handled using multiple imputation methods. Multivariate logistic regression analysis was performed to identify independent predictors of mortality.

Results: A total of 470 patients were evaluated in this study. In-hospital mortality rate was 25.1%. There were 339 (72.1%) male and 131 (27.9%) female patients. Median age of the population was 34 (range 18 to 86) years old and median length of stay was 10 (range 1 to 97) days. The independent predictors of mortality in multivariate analysis were hypoalbuminemia (OR 5,12; 95% CI 1,80 - 14,57), cavitary lesion (3,91; 1,53-9,97), sepsis (23,31; 8,95-60,68), and respiratory failure (177,39 ; 27,09-1161,55).

Conclusion: Respiratory failure, sepsis, hypoalbuminemia, and cavitary lesion were independent predictors of in-hospital mortality among hospitalized tuberculosis patients."

"Latar Belakang. Peran infeksi sebagai penyebab kematian telah banyak diteliti namun peran infeksi sebagai prediktor mortalitas pada pasien lupus eritematosus sistemik (SLE systemic lupus erythematosus) yang dirawat inap masih kontroversi pada penelitian luar negeri dan belum pernah diteliti di Indonesia. Tujuan. Mengetahui peran infeksi sebagai prediktor mortalitas pasien SLE yang dirawat inap. Metodologi. Penelitian dengan desain kohort retrospektif dilakukan terhadap 181 episode perawatan pasien SLE yang dirawat di RSCM pada kurun waktu Januari 2008 - Desember 2012. Data dikumpulkan dari rekam medik. Variabel bebas infeksi dan perancu lupus neuropsikiatri, lupus nefritis, steroid ≥ 1mg/kgBB/hari 2 minggu sebelum keluar RS, onset muda dan jenis kelamin laki-laki serta variabel tergantung mortalitas pasien SLE dianalisis bivariat dengan Chi-square. Variabel yang memiliki nilai p<0,25 dimasukkan dalam analisis multivariat regresi logistik langkah demi langkah dari variabel infeksi dan perancu sehingga didapatkan crude OR serta adjusted OR. Hasil. Mortalitas pasien SLE yang dirawat inap 22%. Pasien SLE yang dirawat dengan infeksi 90 orang (49,7%) dan 91 orang( 50,3%) tanpa infeksi. Jenis infeksi dari yang terbanyak pada pasien SLE yang dirawat inap adalah community acquired pneumonia.(CAP) (64,4%), HAP (18,8%), HCAP (5,6%), skin and soft tissue infection (5,6%). Pasien SLE yang dirawat dengan TB paru ada 14 orang(7,7%), riwayat TB paru 7 orang (3,9%). Penyebab kematian pada 40 pasien SLE yang dirawat yaitu syok sepsis irreversible 25 (62,5%), gagal napas 9 (22,5%), dan herniasi cerebri 2 (5%). Pada analisis bivariat infeksi, lupus neuropsikiatri, lupus nefritis, dan steroid ≥ 1mg/kgBB/hari 2 minggu sebelum keluar RS memiliki nilai p<0,25 sehingga dimasukkan dalam analisis multivariat regresi logistik langkah demi langkah. Infeksi berperan sebagai prediktor mortalitas pada pasien SLE dengan adjusted OR adalah 7,4 (IK 95% 2,8 – 19,6). Kesimpulan. Infeksi berperan sebagai prediktor mortalitas pada pasien SLE yang dirawat inap.

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Background. The role of infection as a cause of death is well known but the role of infection as a predictor of mortality in hospitalized patients with systemic lupus erythematosus (SLE) is debatable due to variable results from prior studies in foreign country and never been done in Indonesia.

Objective. Investigating the role of infection as a predictor of mortality in hospitalized patients with SLE.

Methods. A retrospective cohort study was conducted in 181 hospitalization episode of patients with SLE in Cipto Mangunkusumo Hospital, Jakarta from January 2008 until December 2012. Data was collected from medical records. The independent variable was infection, confounders such as neuropsychiatric lupus, nephritis lupus, use of steroid ≥ 1mg/kg BW/day 2 weeks before hospital discharge, young onset, and male gender. Those variables were analysed bivariately using Chi-square test with mortality as the dependent variable. Variables with p<0.25 were analysed using multivariate logistic regression step by step until we got crude OR and adjusted OR of infection.

Results. Mortality of hospitalized patients with SLE is 22%. Infection was found in 90 patients (49.7%). The most common infection was community acquired pneumonia (64.4%). The most common cause of death was irreversible septic shock. Bivariate analysis showed that infection, neuropsychiatric lupus, nephritis lupus, and use of steroid ≥ 1mg/kg BW/day 2 weeks before hospital discharge had p<0.25. Multivariate analysis showed that infection had crude OR 8.60 (CI 95% 3.39 – 21.83) and adjusted OR 7.4 (CI 95% 2.8 – 19.6).

Conclusion. Infection is a predictor of mortality in hospitalized patients with SLE."

"Latar belakang. Tuberkulosis (TB) ekstra paru merupakan penyakit yang banyak ditemukan di Indonesia, disamping TB paru. Belum banyak penelitian mengenai TB ekstra paru di Indonesia, khususnya keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS. Belum didapatkan laporan penelitian mengenai faktor prediktor yang mempengaruhi keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS di Indonesia. Tujuan. Mengetahui faktor prediktor keberhasilan terapi tuberkulosis ekstra paru seperti usia, jenis kelamin, diabetes mellitus, HIV dan riwayat antituberkulosis. Mengetahui tingkat keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS, bila diberikan selama minimum 9 bulan. Hasil. Penelitian kohort retrospektif dengan data register DOTS TB dan data rekam medis dari 1 Januari 2008 sampai 31 Desember 2012. Didapat 542 pasien TB ekstra paru, 279 pasien TB kombinasi ekstra paru dan TB paru, 70 pasien data tidak lengkap, dan hanya 193 pasien TB ekstra paru murni. Mayoritas pasien berjenis kelamin perempuan (52,3%). Umumnya usia muda (18-60 tahun (95.9%)), rerata 31,34 + 11,64 tahun. TB ekstra paru yang paling banyak didapat adalah limfadenitis TB. Keberhasilan terapi TB ekstra paru pada usia 18-60 tahun terjadi pada 49,7% pasien (OR 2,968, 95% CI 0,584-15,087, p 0,313). Keberhasilan terapi TB ekstra paru untuk jenis kelamin perempuan didapat 55,4% pasien (OR 1,768, 95% CI 0,999-3,131, p0,05). Keberhasilan terapi TB ekstra paru pada pasien diabetes mellitus 33,3% (OR 1.957, 95% CI 0.475-8.062, p 0,546) dan pada riwayat TB sebelumnya sekitar 55,6% (OR 0.738, 95% CI 0.278-1.959, p 0,717). Keberhasilan terapi TB ekstra paru pada pasien HIV 32,1% (OR 2.588, 95% CI 1.330-5.038, p 0,007). Pada analisis multivariate, keberhasilan terapi TB ekstra paru dengan faktor koinfeksi HIV, OR 2.588, CI 95% 1.330-5.038, p 0,005. TB ekstra paru pada pasien HIV mempunyai keberhasilan terapi rendah dengan menggunakan strategi DOTS dan berhubungan dengan kegagalan terapi, serta prognosis buruk. Angka keberhasilan TB ekstra paru yang diterapi dengan menggunakan strategi DOTS selama < 9 bulan adalah 20,2%. Sebanyak 94,6% pasien TB ekstra paru berhasil diterapi dengan menggunakan strategi DOTS selama > 9 bulan. Kesimpulan. HIV merupakan faktor prediktor yang dapat menurunkan keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS. Tingkat keberhasilan terapi TB ekstra paru yang menggunakan strategi DOTS selama minimum 9 bulan baik (94,6%).

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Background. Extrapulmonary tuberculosis (EPTB) is common presentation found in Indonesia, besides Tuberculosis (TB). We found that no more research about EPTB in Indonesia, especially EPTB success treatment using the DOTS strategy and its predictor factors.

Aims. To determine predictors of TB treatment success factors such as age, sex, diabetes mellitus, HIV and anti-tuberculosis records. To acknowledge the success rate of EPTB treatment using DOTS strategy, when administered for a minimum of 9 months.

Result. A retrospective cohort study was conducted from 1 January 2008 through 31 December 2012. A total of 542 patients of EPTB were identified, 193 patients were pure EPTB while 279 were mixed ones and 70 were incomplete data. The majority of patients were female (52.3%). Generally young age (18-60 years old (95.9%), mean 31,34 + 11,64 years old. The most common type of EPTB were lymph node. Success treatment rate of EPTB among age of 18-60 years was 49.7% (OR 2.968, 95% CI 0.584 to 15.087, p 0.313). Success treatment rate of EPTB among female sex was 55.4% (OR 1.768, 95% CI 0.999 to 3.131, p0,05). Success treatment rate using DOTS strategy among diabetes mellitus was 33,3% (OR 1.957, 95% CI 0.475-8.062, p 0.546) and the one that had tuberculosis record previously was 55,6% (OR 0.738, 95% CI 0.278-1.959, p 0.717) Success treatment rate in extrapulmonary patient among HIV-seropositive was 32,1% (OR 2.588, 95% CI 1.330-5.038, p 0.007). In multivariate analysis, the success rate for EPTB with HIV co-infection factor, had OR 2.588, CI 95% 1.330-5.038, p 0.005. EPTB among HIV-seropositive patients had lower therapy success rate using DOTS strategy and were associated with unsuccessful therapy and poor prognosis. The success rate of EPTB treatment using DOTS strategy for < 9 months was 20.2%. There were 94.6% EPTB patients successfully treated with the DOTS strategy for > 9 months.

Conclusion. HIV was a predictor factor that may decrease therapy success rate of EPTB using DOTS strategy. Success rate of extrapulmonary TB treatment using DOTS strategy for minimum 9 months was good (94,6%)."

"Latar Belakang: Pasien TB-HIV yang mengalami lost to follow-up dapat menjadi sumber penularan, resistensi obat, meningkatnya angka morbiditas dan mortalitas. Dibutuhkan data tentang proporsi lost to follow-up pasien TB-HIV, serta faktor-faktor yang memengaruhi. Tujuan : Mengetahui profil lost to follow-up pasien TB-HIV dan faktor-faktor yang memengaruhi. Metode: Desain penelitian menggunakan kohort retrospektif terhadap pasien TB-HIV rawat jalan di RSCM tahun 2015-2017. Analisis univariat untuk mendapatkan data profil pasien TB-HIV. Analisis bivariat dan multivariat untuk mengetahui besar pengaruh faktor-faktorr terkait lost to follow-up pasien TB-HIV. Analisis multivariat untuk mendapatkan Odds Ratio (OR) dari setiap faktor. Hasil: Hasil analisis univariat menunjukkan proporsi lost to follow-up pasien TB-HIV sebesar 39% dengan karakteristik sebagai berikut, laki-laki (74,4%), usia ≥30 tahun (76,9%), jumlah penghasilan dibawah upah minimum regional Jakarta (87,2%), status fungsional ambulatory-bedridden (51,3%), frekuensi ganti transportasi 2 kali (51,3%), lama menunggu pengobatan ≥ 2jam (87,2%), jumlah obat <12 (56,4%), tempat tinggal di Jakarta (92,3%), mengalami efek samping obat (56,4%) dan status imunodefisiensi berat (84,6%). Lost to follow-up TB-HIV paling banyak terjadi pada bulan ke-2 pengobatan TB. Hasil analisis multivariat menunjukkan jumlah penghasilan dibawah upah minimum regional Jakarta (OR 6,58; IK 95%(2,27-19,08); nilai p=0,001) paling berpengaruh terhadap lost to follow-up pasien TB-HIV. Kesimpulan : Proporsi lost to follow-up pasien TB-HIV sebesar 39%. Lost to follow-up TB-HIV paling banyak terjadi pada bulan ke-2 pengobatan TB. Jumlah penghasilan dibawah upah minimum regional Jakarta menjadi faktor paling memengaruhi lost to follow-up pasien TB-HIV

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Background. TB-HIV patients whose lost to follow-up can be followed up for transmission, drug resistance, patients and mortality. We required data for proportion of lost to follow up TB-HIV, factors associated within.

Aim.To find out the profile of lost to follow-up in TB-HIV patients and influencing factors.

Methods. The study design used a retrospective cohort of outpatient TB-HIV patients at the RSCM in 2015-2017. Univariate analysis to obtain profile data for TB-HIV patients. Bivariate and multivariate analysis to determine the effect of factors related to lost to follow-up of TB-HIV patients. Multivariate analysis to get Odds Ratio (OR) from each factor.

Results. The results of univariate analysis were the proportion of lost to follow-up TB-HIV patients by 39%. The basic characteristics of each patient lost to follow-up TB-HIV were: Men (74.4%), age ≥30 years (76.9%), total income under the regional minimum wage of Jakarta (87.2%), functional status of ambulatory bedridden (51.3%), frequency of change transportation twice (51.3%), long waiting for treatment ≥2 hours (87.2%), number of drugs <12 (56.4%), place of residence in Jakarta (92.3%), experiencing drug side effects (56 , 4%), severe immune status (84.6%). Most lost during the second month of TB treatment. The results of multivariate analysis of income under the minimum regional of Jakarta (OR 6.58; IK 95%(2.27-19.08)) most influence the lost to follow-up of TB-HIV patients.

Conclusion. The proportion of lost to follow-up for TB-HIV patients was 39%. Most were lost on the second month of TB treatment. Total income of under the minimum regional of Jakarta was the most influential factor in lost to follow-up of TB-HIV patients."

"Latar Belakang: Pasien yang menggunakan ventilator mekanik (VM) merupakan pasien dengan penyakit kritis dan memiliki angka mortalitas yang tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien dan mengetahui prognosis pasien. Studi-studi tentang faktor prediktor mortalitas pasien yang menggunakan VM menunjukkan hasil yang berbeda-beda dan tidak ada penelitian yang komprehensif di Indonesia. Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien yang menggunakan VM di RSCM. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien di Unit Perawatan Intensif (UPI) RSCM yang menggunakan VM selama tahun 2010 –2012. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel usia, keganasan, Acute Respiratory Distress Syndrome (ARDS), renjatan, pasca operasi, riwayat henti jantung, hiperglikemia, CVD, gangguan ginjal akut, sepsis dan hipoalbuminemia. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat dengan regresi logistik. Hasil: Sebanyak 242 pasien diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan sebesar 45,4%. Kelompok usia, keganasan, ARDS, renjatan, pasca operasi, riwayat henti jantung, stroke, gangguan ginjal akut, sepsis dan hipoalbuminemia merupakan variabel yang berbeda bermakna pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah gangguan ginjal akut (OR 1,91; IK 95% 1,08 sampai 3,39; p = 0,002), renjatan (OR 2,13; IK 95% 1,18 sampai 3,85; p = 0,012), CVD (OR 3,39; IK 95% 1,65 sampai 6,95; p = 0,01), ARDS (OR 2,19; IK 95% 1,10 sampai 4,35; p = 0,025) dan riwayat henti jantung (OR 4,85; IK 95% 1,56 sampai 15,07; p = 0,006). Kesimpulan: Gangguan ginjal akut, renjatan, CVD, ARDS, dan riwayat henti jantung merupakan prediktor independen mortalitas pada pasien yang menggunakan VM.

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Background: Mechanical ventilation (MV) is one of the most essential modality that supports many critically ill patients in the intensive care unit (ICU). A high mortality rate was observed in mechanically ventilated patients. The prediction of patients outcome at initiation of MV is important in decision-making process and in the effort reducing mortality rate. This study was designed to determine early predictors of mortality in patients with MV.

Objective: To determine early predictors of mortality in patients with MV in Cipto Mangunkusumo Hospital.

Methods: We performed a retrospective cohort study on 242 ICU patients who used MV for more than 48 hours between January 2010 – June 2012. Data were collected at initiation of mechanical ventilation and the main outcome was all-cause mortality during ICU. We analyzed age, sepsis, hypoalbuminemia, shock, post surgical, Acute Kidney Injury (AKI), hyperglicemia, CVD, malignancy, cardiac arrest, Acute Respiratory Distress Syndrome (ARDS) at initiation of MV. Multivariate logistic regression analysis was performed to identify independent predictors of mortality.

Results: A total of 242 patients were evaluated in this study. In-hospital mortality rate was 45.4%. The independent predictors of mortality in multivariate analysis were AKI (OR: 1.91; 95% CI 1.08 to 3.39; p = 0.02), shock (OR: 2.13; 95% CI 1.18 to 3.85; p = 0.012), stroke (OR: 3.39; 95% CI 1.65 to 6.95; p = 0.01), ARDS (OR: 2.19; 95% CI 1.10 to 4.35; p = 0.025) and cardiac arrest (OR: 4.85; 95% CI 1.56 to 15.07; p = 0.006).

Conclusion: Shock, CVD, ARDS, cardiac arrest, and AKI were independent predictors of mortality due to patients with MV."

"Penelitian ini bertujuan untuk mendapatkan profil polimorfisme I/D gen ACE, konsentrasi ACE serum, tebal KIM Arteri Karotis serta hubungan antara ketiganya pada populasi anak kandung DM tipe 2 di Jakarta. Metode yang digunakan adalah potong lintang, melibatkan 96 anak kandung subjek DM tipe 2 berusia 20-40 tahun. Dilakukan pengumpulan data berupa karakteristik subjek, pemeriksaan fisik, pemeriksaan darah (polimorfisme I/D gen ACE, aktivitas ACE, TTGO) dan pemeriksaan tebal KIM Arteri Karotis menggunakan ultrasonografi (USG) B-mode. Analisis polimorfisme I/D gen ACE dilakukan pada 73 sampel. Pemeriksaan tebal KIM Arteri Karotis dilakukan pada 62 sampel. Proporsi alel D dan alel I secara berturutan adalah 28,8 % dan 71,2 %. Proporsi genotip DD, ID dan II secara berturutan adalah 9,6 %; 38,4 % dan 52 %. Konsentrasi ACE serum pada genotip DD lebih tinggi daripada genotip II (2,66±0,38 IU/L v 2,10±0,33 IU/L, p<0,01). Konsentrasi ACE serum pada genotip ID lebih tinggi daripada genotip II (2,76±0,43 IU/L vs 2,10±0,33 IU/L, p<0,01). Tidak ada perbedaan konsentrasi ACE serum yang bermakna antara genotip DD dan ID (p=0,528). Tidak ada perbedaan tebal KIM arteri karotis yang bermakna antara ketiga genotip gen ACE (p=0,984). Simpulan yang dapat ditarik dari penelitian ini adalah polimorfisme I/D gen ACE berhubungan dengan konsentrasi ACE serum, namun tidak dengan tebal KIM arteri karotis pada populasi anak kandung subjek DM tipe 2 di Jakarta.

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The aims of this research are to determine the ACE gene I/D polymorphism profile, serum ACE level, the carotid intima media thickness and the association of them among offspring of type 2 DM in Jakarta.

Cross sectional study was conducted among 96 offspring of type 2 DM whose aged 20-40 years. Data collection consists of characteristics of subjects, physical examination, laboratory examination (ACE gene I/D polymorphism, serum ACE level and oral glucose tolerance test) and ultrasonography examination to evaluate the carotid intima media thickness.

Analysis of ACE gene I/D polymorphism was done among 73 subjects. The carotid intima media thickness examination was done among 62 subjects. Proportion of D alel and I alel were 28,8 % and 71,2 % respectively. Proportion of DD, ID and II genotypes were 9,6 %; 38,4 % and 52 % respectively. Serum ACE level among DD genotype was higher than that of II genotype (2,66±0,38 IU/L vs 2,10±0,33 IU/L, p<0,01).

Serum ACE level among ID genotype was higher than that of II genotype (2,76±0,43 IU/L vs 2,10±0,33 IU/L, p<0,01). There was no significant difference of serum ACE level between DD genotype and ID genotype (p=0,528). There was no difference of the carotid intima media thickness among the ACE gene genotypes (p=0,984).

This research concluded that there is association between ACE gene I/D polymorphism and serum ACE level but not with the carotid intima media thickness among offspring of type 2 DM in Jakarta"

"Latar Belakang: Laktat merupakan penanda pada sepsis untuk stratifikasi risiko, target resusitasi, dan prediktor kematian. Interpretasi bersihan laktat dinilai lebih baik dibanding laktat tunggal untuk menilai kecukupan resusitasi dan menentukan prognosis. Studi ini dimaksudkan untuk mengetahui apakah pada pasien sepsis berat dan syok sepsis ada beda rerata bersihan laktat 6, 12, dan 24 jam antara yang mengalami mortalitas fase akut dengan yang tidak, serta mencari titik potongnya. Metode: Disain studi adalah kohort prospektif. Subyek dikumpulkan dengan metode konsekutif dari Unit Gawat Darurat, Ruang Rawat Inap, dan Unit Perawatan Intensif Rumah Sakit Cipto Mangunkusumo. Pemeriksaan laktat dilakukan pada jam ke-0, 6, 12, dan 24, kemudian subyek diikuti untuk diketahui kematian 3 harinya. Hasil: Terinklusi 81 subyek pada studi ini, 80 subyek diikuti sampai jam ke-12, dan 72 subyek diikuti sampai jam ke-24. Dua puluh lima subyek meninggal dalam 3 hari (31%). Beda median hanya didapatkan pada bersihan laktat 24 jam (median -17,0% vs. 15,2% pada yang meninggal dan hidup; p 0,034). Titik potong bersihan laktat 24 jam terbaik adalah -6,0% (AUC 0,744, sensitivitas 62,5% dan spesifisitas 87,5%, nilai duga positif 58,8% dan nilai duga negatif 89,1%, risiko relatif 5,39). Dalam analisis multivariat, APACHE II bermakna sebagai perancu. Simpulan: Median bersihan laktat 24 jam lebih rendah pada pasien sepsis berat dan syok sepsis yang mengalami mortalitas fase akut. Titik potong dari bersihan laktat tersebut adalah -6,0%.

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Background: Lactate is one of biomarkers in sepsis, used for risk stratification, resuscitation target, and death prediction. Interpretation of lactate clearance was proven to be better than single lactate measurement to evaluate resuscitation adequacy and to determine prognosis. This study was aimed to find out if in severe sepsis and septic shock patients there are mean differences of 6, 12, and 24 hour lactate clearance between patients with and without acute phase mortality, and also to find its cut off.

Methods: Study design was prospective cohort. Subjects were collected by consecutive sampling from Emergency Department, hospital ward, and Intensive Care Unit of Cipto Mangunkusumo Hospital. Lactate levels were measured on 6, 12, and 24 hour, then subjects were followed to evaluate their 3-day mortality.

Results: Eighty one subjects were incuded in this study, 80 subjects were followed until 12 hours, and 72 subjects were followed until 24 hours. Twenty five subjects were died within 3 days (31%). Only 24-hour lactate clearance had median difference (median -17.0% vs. 15.2% in mortal and survive group; p 0.034). The best cut off for 24 hour lactate clearance was -6.0% (AUC 0.744, sensitivity 62.5% and specificity 87.5%, positive predictive value 58.8% and negative predicitive value 89.1%, relative risk 5.39). In multivariate analysis, APACHE II was proven to be a confounder.

Conclusions: Median of 24-hour lactate clearance was lower in severe sepsis and septic shock patients who were died within three days. Its cut off was -6.0%."

"Latar Belakang: Usia lanjut dan hubungannya dengan kesintasan kanker paru karsinoma bukan sel kecil sudah diteliti sebelumnya, namun kesintasannya di rumah sakit di Indonesia belum diteliti. Belum banyak penelitian lain yang memperhitungkan faktor perancu antara lain derajat keparahan penyakit, status fungsional, komorbiditas, dan indeks massa tubuh dalam meneliti pengaruh pertambahan usia dengan kesintasan kanker paru karsinoma bukan sel kecil. Tujuan: Mengetahui adakah perbedaan kesintasan satu tahun pasien kanker paru karsinoma bukan sel kecil usia lanjut dan bukan usia lanjut yang diterapi di semua stadium dengan mempertimbangkan functional status, indeks massa tubuh, dan komorbiditas. Metode: Kohort retrospektif dengan pendekatan analisis kesintasan terhadap 227 pasien kanker paru karsinoma bukan sel kecil yang berobat jalan maupun rawat inap di RS Cipto Mangunkusumo dan RS Kanker Dharmais tahun 2002-2012, terbagi 2 kelompok berdasarkan usia saat diagnosis (<60 tahun dan >60 tahun). Kurva Kaplan-Meier digunakan untuk mengetahui kesintasan satu tahun masingmasing kelompok. Analisis bivariat menggunakan uji log-rank, analisis multivariat menggunakan cox proportional hazard regression. Besarnya hubungan variabel usia dengan kesintasan dinyatakan dengan crude HR dan IK 95% serta adjusted HR dan IK 95% setelah dimasukkan variabel perancu. Hasil dan Pembahasan: Terdapat 227 pasien adalah kanker paru karsinoma bukan sel kecil yang diterapi dimana karakteristik kedua kelompok (<60 tahun dan >60 tahun) sebanding kecuali jenis kelamin, merokok, ada tidaknya komorbiditas, dan jumlah komorbiditas. Persentase mortalitas satu tahun adalah 68,0% dan 61,9% untuk kelompok usia <60 dan >60 tahun dengan median kesintasan 8 dan 9 bulan bulan. Analisis bivariat tidak menunjukkan hubungan bermakna antara usia dengan kesintasan satu tahun. Simpulan: Tidak ada pengaruh usia terhadap kesintasan satu tahun pasien kanker paru karsinoma bukan sel kecil yang diterapi di RS Cipto Mangunkusumo dan RS Kanker Dharmais di semua stadium dengan mempertimbangkan functional status, indeks massa tubuh, dan komorbiditas.

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Background: Old age and its relations to non-small cell lung carcinoma survival has been studied before but its survival in Indonesia has not been studied before. Not many studies that have considered confounders, such as stage, functional status, comorbidities and body mass index, in the study between advancing age and non-small cell lung cancer carcinoma survival.

Aim: To evaluate differences of treated non-small cell lung carcinoma one year survival between non-elderly and elderly considering stages, functional status, body mass index and comorbidities.

Methods: Retrospective cohort design and survival analysis were used to 227 patients with non-small cell lung cancer that being treated at Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital between 2002 and 2012 that divided into 2 groups according to age at diagnosis (<60 years and >60 years). Kaplan-Meier curve was used to evaluate the one year survival of each group. Bivariate analysis was conducted using log-rank test, multivariate analysis was conducted using cox proportional hazard regression. The extend of relation between advancing age and survival was expressed with crude HR with 95% CI and adjusted HR with 95% CI after adjusting for confounders.

Results and Discussion: There were 227 non-small cell lung carcinoma being treated whereas the characteristics between two groups (<60 years and >60 years) were the same except for sex, smoking status, comorbidities and number of comorbidities. One year mortality percentage were 68.0% and 61.9% to <60 years and >60 years groups, respectively, with the survival median of 8 and 9 months. Bivariate analysis didn’t find statistically significant relation between age and one year survival.

Conclusion: Age didn’t influence one year survival of treated non-small cell lung carcinoma at Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital considering stage, functional status, comorbidities and body mass index."

"Pasien tuberkulosis paru yang dirawat inap memiliki kondisi nutrisi yang bervariasi. Sebuah metode skrining nutrisi yang sederhana dibutuhkan untuk memprediksi prognosis buruk, terutama mortalitas. Malnutrition Screening Tool (MST) merupakan sebuah metode skrining nutrisi yang sederhana, cepat dan valid untuk mengidentifikasi pasien dengan risiko malnutrisi. Penelitian ini dimaksudkan untuk mengetahui peran skor MST untuk memprediksi mortalitas pasien tuberkulosis paru selama perawatan inap.Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien tuberkulosis paru yang dirawat inap di RSCM dalam kurun waktu Januari 2011 sampai dengan September 2013. Skor MST didapatkan dari rekam medis saat masuk rawat inap, dilakukan pengamatan sampai selesai rawat inap, kemudian dikelompokkan menjadi: hidup atau meninggal. Data penyerta yang dikumpulkan adalah data demografis, status BTA, gambaran radiologis toraks, status HIV, skor Charlson Comorbidity Index, dan kondisi sepsis.Hasil: Sebanyak 345 subjek diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan inap sebesar 25,8%. Median skor MST pasien tuberkulosis paru yang dirawat inap di RSCM adalah 3 (rentang 0 sampai 5). Hasil analisis ROC mendapatkan skor MST > 3 sebagai titik potong skor MST yang terbaik untuk mendeterminasi mortalitas pasien tuberkulosis paru selama perawatan inap dengan AUC 0,644 (IK 95% 0,581-0,707). Skor MST > 3 meningkatkan risiko kematian pasien tuberkulosis paru selama perawatan inap (RR 2,288; IK 95% 1,507-3,474; p < 0,001). Hasil analisis multivariat, dengan menyertakan variabel perancu, mendapatkan bahwa skor MST > 3 meningkatkan risiko kematian pasien tuberkulosis paru selama perawatan di rumah sakit, namun tidak bermakna secara statistik (fully adjusted OR 2,227; IK 95% 0,994-4,988; p = 0,052).Simpulan: Skor MST > 3 berhubungan dengan mortalitas pasien tuberkulosis paru yang lebih tinggi selama perawatan inap.

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Pulmonary tuberculosis patients who are hospitalized have varying nutritional conditions. A simple nutrition screening method is needed to predict a poor prognosis, especially mortality. Malnutrition Screening Tool (MST) is a simple, rapid and valid nutrition screening method for identifying patients at risk of malnutrition. This study was aimed to know the role of MST for predicting in-hospital mortality in pulmonary tuberculosis patients.

Methods: This study was a retrospective cohort study among pulmonary tuberculosis patients who were hospitalized in Cipto Mangunkusumo Hospital between January 2011 and September 2013. MST scores were obtained from medical records at admission, subjects were observed to evaluate their in-hospital mortality. The other collected data are demographic data, sputum smear status, pulmonary radiological lesion, HIV status, Charlson Comorbidity Index, and condition of sepsis.

Results: As many 345 subjects met the inclusion criteria. The in-hospital mortality rate was 25.8%. Median MST score of hospitalized pulmonary tuberculosis patients was 3 (range 0-5). ROC analysis got MST score > 3 as the best cut-off for determination in-hospital mortality in pulmonary tuberculosis patients (AUC 0.644; 95% CI 0.581-0.707). MST score > 3 increased the risk of in-hospital mortality in pulmonary tuberculosis patients (RR 2.288; 95 % CI 1.507-3.474, p < 0.001). Multivariate analysis found that the MST score > 3 increased the risk of in-hospital mortality in pulmonary tuberculosis patients, but was not statistically significant (fully adjusted OR 2.227; 95 % CI 0.994-4.988, p = 0.052).

Conclusion: MST score > 3 increased the risk of in-hospital mortality in pulmonary tuberculosis patients."

"[ABSTRAK Latar Belakang : Isu yang berkembang pada donor ginjal hidup adalah penurunan fungsi ginjal dan terjadinya hipertensi setelah dilakukan nefrektomi. Satu minggu setelah nefrektomi pola tekanan darah sirkadian berubah menjadi non dipper. Selanjutnya terjadi kompensasi sehingga fungsi ginjal akan stabil dalam 12 minggu. Namun belum diketahui apakah perbaikan fungsi ginjal akan diikuti oleh pola tekanan darah sirkadian kembali menjadi dipper.Tujuan : Untuk mengetahui perubahan pola sirkadian tekanan darah donor ginjal hidup setelah 12 minggu nefrektomi unilateral.Metode Penelitian : Studi Pre-experimental dengan before and after design. Subyek sebanyak 18 orang donor ginjal hidup sehat yang berusia 18-50 tahun . Peneltian dilakukan di RSCM pada bulan Januari 2015 sampai dengan Mei 2015. Tekanan darah diukur dengan 24 jam ABPM . Pemeriksaan kreatinin darah, eLFG epi dan uACR dilakukan sebelum nefrektomi, pada 1 minggu dan 12 minggu setelah nefrektomi.Hasil :Terdapat 18 subyek yang memiliki pola dipper sebelum dilakukan nefrektomi unilateral. Tujuh belas subyek mengalami pola non dipper setelah 1 minggu nefrektomi. Pada 12 minggu setelah nefrektomi 16 diantaranya kembali menjadi pola dipper yang bermakna secara statistik (p<0.001).Simpulan : Terdapat perubahan pola sirkadian tekanan darah non dipper kembali menjadi pola dipper pada donor ginjal hidup 12 minggu setelah nefrektomi unilateral.ABSTRACT Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.

Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.

Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.

Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)

Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy., Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.

Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.

Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.

Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)

Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy.]"