ABSTRAK Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negara
berkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitus
meningkatkan risiko infeksi, hambatan konversi sputum dan kegagalan
pengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yang
mempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik pada
akhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM.
Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatan
terhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobat
pada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversi
sputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat.
Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik pada
pasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasien
tanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalan
konversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkat
bermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTA
sebelum terapi (p=0,021), HbA1c (p=0,014), GDP (p=0,047), GD 2jam PP
(p=0,030) dan kavitas pada foto toraks (p=0,033) sedangkan albumin serum lebih
rendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risiko
terkuat untuk kegagalan konversi sputum adalah kadar albumin serum yang
rendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputum
BTA mikroskopik sebelum terapi yang tinggi (p=0,009, aOR 2,313, KI95%
1,230-4,349) dan kadar HbA1c yang tinggi (p=0,018, aOR 1,298, KI 95% 1,047-
1,610).
Kesimpulan: Tingkat kepositifan sputum BTA sebelum terapi yang tinggi, status
kontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serum
yang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasien
TB dengan DM.
ABSTRACT Background: The link of DM and TB is more prominent in developing countries
where TB is endemic and the burden of DM is increasing. Diabetes mellitus
increases the risk of TB infection, delayed sputum smear conversion and TB
treatment failure. This study would like to evaluate factors associated with
delayed sputum smear conversion in the end of two months of TB treatment in
new cases TB with DM patients in Persahabatan Hospital.
Methods: This retrospective cohort study was conducted in Persahabatan
Hospital, included all new cases TB with DM patients in the period from July
2012 - June 2015. All the risk factors performed bivariate and multivariate
analysis in association with sputum smear conversion in the end of two months of
TB treatment.
Results: The proportion of sputum smear conversion failure is higher in TB-DM
than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the
relative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.
Bivariate analysis resulted in significant higher of initial sputum smear level
(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose
(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serum
albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in
risk factors strongly associated with sputum conversion failure are low albumin
level (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,
CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).
Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,
cavity at chest x-ray and lower albumin level associated with sputum smear
conversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countries
where TB is endemic and the burden of DM is increasing. Diabetes mellitus
increases the risk of TB infection, delayed sputum smear conversion and TB
treatment failure. This study would like to evaluate factors associated with
delayed sputum smear conversion in the end of two months of TB treatment in
new cases TB with DM patients in Persahabatan Hospital.
Methods: This retrospective cohort study was conducted in Persahabatan
Hospital, included all new cases TB with DM patients in the period from July
2012 - June 2015. All the risk factors performed bivariate and multivariate
analysis in association with sputum smear conversion in the end of two months of
TB treatment.
Results: The proportion of sputum smear conversion failure is higher in TB-DM
than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the
relative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.
Bivariate analysis resulted in significant higher of initial sputum smear level
(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose
(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serum
albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in
risk factors strongly associated with sputum conversion failure are low albumin
level (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,
CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).
Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,
cavity at chest x-ray and lower albumin level associated with sputum smear
conversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countries
where TB is endemic and the burden of DM is increasing. Diabetes mellitus
increases the risk of TB infection, delayed sputum smear conversion and TB
treatment failure. This study would like to evaluate factors associated with
delayed sputum smear conversion in the end of two months of TB treatment in
new cases TB with DM patients in Persahabatan Hospital.
Methods: This retrospective cohort study was conducted in Persahabatan
Hospital, included all new cases TB with DM patients in the period from July
2012 - June 2015. All the risk factors performed bivariate and multivariate
analysis in association with sputum smear conversion in the end of two months of
TB treatment.
Results: The proportion of sputum smear conversion failure is higher in TB-DM
than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the
relative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.
Bivariate analysis resulted in significant higher of initial sputum smear level
(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose
(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serum
albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in
risk factors strongly associated with sputum conversion failure are low albumin
level (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,
CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).
Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,
cavity at chest x-ray and lower albumin level associated with sputum smear
conversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countries
where TB is endemic and the burden of DM is increasing. Diabetes mellitus
increases the risk of TB infection, delayed sputum smear conversion and TB
treatment failure. This study would like to evaluate factors associated with
delayed sputum smear conversion in the end of two months of TB treatment in
new cases TB with DM patients in Persahabatan Hospital.
Methods: This retrospective cohort study was conducted in Persahabatan
Hospital, included all new cases TB with DM patients in the period from July
2012 - June 2015. All the risk factors performed bivariate and multivariate
analysis in association with sputum smear conversion in the end of two months of
TB treatment.
Results: The proportion of sputum smear conversion failure is higher in TB-DM
than non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with the
relative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.
Bivariate analysis resulted in significant higher of initial sputum smear level
(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose
(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serum
albumin (p=0,013) in non-conversion patients. Multivariate analysis resulted in
risk factors strongly associated with sputum conversion failure are low albumin
level (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,
CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).
Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,
cavity at chest x-ray and lower albumin level associated with sputum smear
conversion failure in TB-DM patients.
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