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UI - Tesis Membership :: Kembali

Faktor-faktor prognostik mortalitas pasien sepsis berat fase lanjut di Ruang Rawat Intensif Rumah Sakit DR. Cipto Mangunkusumo = Prognostic factors of mortality from late phase of severe sepsis in intensive care unit at DR.Cipto Mangunkusumo General Hospital / Arif Sejati

Arif Sejati; Ceva Wicaksono Pitoyo, supervisor; Suhendro, co-promotor; Imam Subekti, examiner; Kuntjoro Harimurti, examiner; Anna Uyainah Z.N., supervisor; Sarwono Waspadji, promotor (Fakultas Kedokteran Universitas Indonesia, 2014)

 Abstrak

ABSTRAK
Latar Belakang. Terdapat gangguan sistem imun pada sepsis. Fase awal ditandai
dengan hiperinflamasi, sedangkan fase lanjut ditandai dengan imunosupresi.
Kematian kumulatif lebih banyak pada fase lanjut. Saat ini belum terdapat
penelitian yang secara khusus meneliti faktor prognostik mortalitas sepsis fase
lanjut dan mengembangkan model prediksi mortalitasnya.
Tujuan. Mengetahui faktor prognostik mortalitas sepsis berat fase lanjut di ICU
dan mengembangkan sistem skor untuk memprediksi mortalitas.
Metode. Penelitian kohort retrospektif dilakukan pada pasien dewasa yang
mengalami sepsis berat di ICU RSCM pada periode Oktober 2011 – November
2012 dan masih bertahan setelah > 72 jam diagnosis sepsis ditegakkan di ICU.
Tujuh faktor prognostik diidentifikasi saat diagnosis sepsis berat ditegakkan di
ICU. Prediktor independen diidentifikasi dengan analisis Cox’s proportional
hazard. Prediktor yang bermakna secara statistik dikuantifikasi dalam model
prediksi. Kalibrasi model dinilai dengan uji Hosmer-Lemeshow dan kemampuan
diskriminasi dinilai dari area under curve (AUC) dari receiver operating curve.
Hasil. Subjek penelitian terdiri atas 220 pasien. Mortalitas 28 hari sepsis berat
fase lanjut adalah 40%. Faktor prognostik yang bermakna adalah alasan masuk
ICU (medis (HR 2,75; IK95%:1,56-4,84), pembedahan emergensi (HR 1,96;
IK95%:0,99 – 3,90), indeks komorbiditas Charlson > 2 (HR 2,07; IK95%:1,32-
3,23), dan skor MSOFA > 4 (HR 2,84; IK95%:1,54-5,24). Model prediksi
memiliki kemampuan diskriminasi yang baik (AUC 0,844) dan kalibrasi yang
baik (uji Hosmer-Lemeshow p 0,674). Berdasarkan model tersebut risiko
mortalitas dapat dibagi menjadi rendah (skor 0, mortalitas 5,4%), sedang (skor 1 –
2,5, mortalitas 20,6%), dan tinggi (skor > 2,5, mortalitas 73,6%).
Simpulan. Alasan masuk medis dan pembedahan emergensi, indeks komorbiditas
Charlson > 2, dan skor MSOFA > 4 merupakan faktor prognostik mortalitas
sepsis berat fase lanjut di ICU RSCM. Sebuah model telah dikembangkan untuk
memprediksi dan mengklasifikasikan risiko mortalitas.

ABSTRACT
Background. Immune system derrangement occurs during the course of sepsis,
characterized by hyperinflamation in early phase and hypoinflamation and
immunosupression in late phase. The number of patient die during late phase is
larger than early phase. Until now, there is no study specifically addressing
prognostic factors of mortality from late sepsis and developing a mortality
prediction model.
Aim. To determine prognostic factors of mortality from late phase of severe
sepsis in ICU and to develop scoring system to predict mortality.
Method. A retrospective cohort study was conducted to identify prognostic
factors associated with mortality. Adult patients admitted to ICU during
November 2011 until October 2012 who developed severe sepsis and still alive
for minimum 72 hours were included in this study. Seven predefined prognostic
factors were indentified at the onset of severe sepsis in ICU. Cox’s proportional
hazard ratio was used to identify independent prognostic factors. Each
independent factors was quantified to develop a prediction model. Calibration of
the model was tested by Hosmer-Lemeshow, and its discrimination ability was
calculated from area under receiver operating curve.
Result. Subjects consist of 220 patients. Twenty eight-day mortality was 40%.
Significant prognostic factors indentified were admission source (medical (HR
2.75; CI95%: 1.56 – 4.84), emergency surgery (HR 1.96; CI95%:0.99 – 3.90),
Charlson comorbidity index > 2(HR 2.07; CI95%:1.32 – 3.23), and MSOFA score
> 4 (HR 2.84; CI95% : 1.54 – 5.24). Prediction model developed has good
discrimination ability (AUC 0.844) and good calibration (Hosmer-Lemeshow test
p 0.674). Based on the model mortality risk can be classified as low (score 0,
mortality 5.4%), moderate (score 1 – 2.5, mortality 20.6%), and high (score > 2.5,
mortality 73.6%).
Conclusion. Medical and emergency surgery admission, Charlson comorbidity
index > 2, and MSOFA score > 4 were prognostic factors of mortality from late
phase of severe sepsis in ICU at Dr.Cipto Mangunkusumo general hospital. A
model has been developed to predict and classify mortality risk.

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 Metadata

Jenis Koleksi : UI - Tesis Membership
No. Panggil : T-Pdf
Entri utama-Nama orang :
Entri tambahan-Nama orang :
Entri tambahan-Nama badan :
Program Studi :
Subjek :
Penerbitan : Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
Bahasa : ind
Sumber Pengatalogan : LibUI ind rda
Tipe Konten : text
Tipe Media : computer
Tipe Carrier : online resource
Deskripsi Fisik : xiv, 99 pages : illustration ; 28 cm + appendix
Naskah Ringkas :
Lembaga Pemilik : Universitas Indonesia
Lokasi : Perpustakaan UI
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T-Pdf 15-23-43811908 TERSEDIA
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