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"ABSTRAKPendahuluan: Pneumonia komunitas CAP salah satu penyebab kematian tertinggi. Tujuan mengetahui respons pengobatan selama perawatan pasien CAP secara empiris serta faktor yang berkaitan dengan pola kuman, respons pengobatan, gejala klinis, laboratorium, foto toraks, lama rawat dan faktor komorbid di RS persahabatan.Metode: Kohort prospektif pasien pneumonia komunitas rawat inap di RS Persahabatan selama 15 bulan terkumpul 47 pasien. Gejala klinis, hasil laboratorium, foto toraks dan hasil mikrobiologi. Sampel mirkobiologi dikumpulkan sebelum dan sesudah pemberian antibiotik.Hasil: Terkumpul 47 pasien. laki-laki 74,5% dan perempuan 25,5%. Rerata umur 61 tahun. Gejala klinis awal paling banyak sesak napas 51% berkurang 27,7% dan batuk 32% berkurang 23,4%. Nilai awal leukosit rerata 15,27. sel/mm3 berkurang 12,0. sel/mm3. Foto toraks awal infiltrat 89,3% menurun 38,3%. Patogen pada sputum sebelum penggobatan Klebseiella pneumonia 34,0%. Hasil sputum pasca terapi empiris eradikasi 91.5%. Pengobatan antibiotik tersering seftriakson. Faktor komorbid tersering keganasan rongga toraks. Lama rawat minimal 4 hari dengan terapi sulih minimal 3 hari.Kesimpulan: Pasien CAP paling dominan menunjukan gejala klinis sesak napas dan batuk, gambaran infiltrat pada foto toraks dan gram-negatif Klebsiella pneumonia pada sputum. Terjadi penurunan leukosit setelah pemberian antibiotik. Terapi empiris dengan antibiotik tunggal masih sensitif.

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ABSTRACTIntroduction : Pneumonia is the first leading disease with the highest mortality in hospitalized patients. The purpose of this study is to determine treatment response for the empirical treatment of CAP patients and factors associated with patterns of bacteria, treatment response, clinical symptoms, laboratory and chest X-ray, length of stay and comorbidities in Persahabatan Hospital, Jakarta. Methods : Prospective cohort study in hospitalized community acquired pneumonia patients at Persahabatan Hospital while 15 month. Clinical symptoms, laboratory findings, chest x-ray and microbiologic. Microbiologic sample is before and after antibiotic administration.Results : There were 47 patients. Male accounted 74,5% and female 25,5%. The average age was 61 years old. Clinical symptoms before treatment were dyspnea 51% decreased to 27,7% and cough 32% decreased to 23,4%. Leukocytes count was 15,27 cell/mm3 decreased to 12,0 cell/mm3. Chest x-ray infiltrates 89,3% decreased to 38,3%. Before-treatment microbiological patterns were K. pneumoniae 34,0%. Result after empirical treatment was eradication 91,5%. The most frequent innitial antibiotic administration was ceftriaxone.The most frequent comorbidity was thoracic malignancy. The patients were hospitalized at least for 4 days with replacement therapy at least for 3 days.Conclusion: Patients with CAP predominantly showed symptoms of dypnea and cough, infiltrates on chest x-ray and gram-negative Klebsiella pneumonia in sputum samples. There were resolution of leucocyte counts after antibiotic administration. Empirical antibiotic treatments with single drug were still sensitive."

"Latar Belakang: Pneumonia berat adalah infeksi saluran napas yang masih memiliki angka mortalitas yang tinggi. Pasien pneumonia berat sering kali memerlukan intubasi untuk mencapai ventilasi yang adekuat. Terjadinya kegagalan ekstubasi dapat meningkatkan komplikasi dan mortalitas pada pasien, sehingga pasien dengan risiko gagal ekstubasi perlu dikenali sedini mungkin.Tujuan: Mengetahui faktor yang dapat memprediksi kegagalan ekstubasi pada pasien pneumonia beratMetode: Studi ini merupakan studi kohort retrospektif yang melibatkan pasien dengan pneumonia berat yang terintubasi dan dirawat di ICU/HCU RSCM pada tahun 2015-2019. Data pasien dan hasil pemeriksaan laboratorium diambil dari rekam medis. Analisis bivariat dilakukan dengan uji Chi-square atau uji Fischer, sementara analisis multivariat dilakukan dengan uji regresi cox.Hasil: Sebanyak 192 subjek pasien pneumonia berat dilibatkan dalam penelitian ini. Insidensi kegagalan ekstubasi pada pasien pneumonia berat di RSCM adalah 70,3%, dengan angka mortalitas pada pasien yang mengalami gagal ekstubasi adalah sebesar 85,2%. Dari analisis bivariat, didapatkan usia >60 tahun, merokok, Charlson Comorbidity Index sedang-berat, tidak adanya penyakit neuromuskular, terapi pengganti ginjal, prokalsitonin > 2 ng/mL, dan skor APACHE II ≥25 sebagai variabel yang berhubungan signifikan dengan kegagalan ekstubasi. Selanjutnya, analisis multivariat menemukan bahwa Charlson Comorbidity Index sedang-berat (p=0,002, HR 2,254, IK95% 1,353-3,755), dan prokalsitonin > 2 ng/mL (p<0,001, HR 1,859, IK95% 1,037-3,333) merupakan prediktor independen terhadap kegagalan ekstubasi pada pasien pneumonia berat.Kesimpulan: Faktor-faktor yang secara independen merupakan prediktor kegagalan ekstubasi pada pasien pneumonia berat adalah Charlson Comorbidity Index sedang-berat, dan kadar prokalsitonin > 2 ng/mL.

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Background: Severe pneumonia is a lower respiratory tract infection still presenting with a high a mortality rate. Patients with severe pneumonia often require intubation in order to achieve adequate ventilation. Extubation failure, however, is associated with increased complications and mortality. Therefore, it is crucial to recognize risk factors associated with extubation failure as soon as possible.

Objective: To determine the predictors associated with extubation failure in patients with severe pneumonia

Methods: A retrospective cohort study was conducted, which included patients with severe pneumonia who were intubated in ICU/HCU of Ciptomangunkusumo General Hospital over the period of 2015-2019. Patient characteristics and laboratory values were obtained from medical records. Bivariate analysis was performed with Chi-square or Fischer test, whereas multivariate analysis was performed with cox regression model.

Results: A total of 192 subjects with severe pneumonia was included in this study. Incidence of extubation failure among patients with severe pneumonia was 70,3%, with a mortality rate of 85,2%. Bivariate analyses found that age of >60 years, smoking history, moderate-to-severe Charlson Comorbidity Index, procalcitonin > 2 ng/mL, not having neuromuscular disease, renal replacement therapy, and APACHE II score of ≥25 were significantly associated with extubation failure. In multivariate analysis, moderate-to-severe Charlson Comorbidity Index (p=0,002, HR 2,254, 95% CI 1,353-3,755) and procalcitonin > 2 ng/mL (p<0,001, HR 1,859, 95% CI 1,037-3,333) were found to be independent predictors of extubation failure in patients with severe pneumonia.

Conclusion: Moderate-to-severe Charlson Comorbidity Index and procalcitonin level of > 2 ng/mL were independent predictors of extubation failure in patients with severe pneumonia."

"Community-Acquired Pneumonia CAP adalah penyakit sistem pernapasan yang menyerang jaringan parenkim paru. Penyakit ini banyak mengancam individu dewasa dengan penurunan sistem imun. Penderita CAP mengalami peningkatan setiap tahunnya akibat peningkatan polusi udara yang berada di wilayah perkotaan, terutama pada kawasan industri. Penderita CAP akan mengalami peningkatan produksi sputum yang berujung pada kesulitan dalam mengeluarkan sputum. Pasien dengan CAP sering mengalami penurunan refleks batuk yang membuat sputum terakumulasi di jalan napas sehingga menyebabkan peningkatan usaha untuk bernapas. Fisioterapi dada merupakan salah satu teknik pembersihan jalan napas pada pasien dengan penurunan refleks batuk. Karya Ilmiah Akhir Ners ini bertujuan untuk menganalisis intervensi fisioterapi dada untuk mengurangi gejala serta mencegah perburukan pada pasien dengan CAP. Metodologi yang digunakan adalah metode studi kasus dan analisa penelitian yang telah ada. Hasil analisa yang didapatkan menunjukkan fisioterapi dada dapat menurunkan usaha napas pasien, pengurangan episode demam, perubahan karakteristik sputum, serta penuruan persentase mortalitas melalui skoring CURB-65.

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Community Acquired Pneumonia CAP is a respiratory disease that attacks the pulmonary parenchymal tissue. This disease threatens many adults with decreased immune system. CAP sufferers are increasing every year due to increasing air pollution in urban areas, especially in industrial areas. CAP sufferers will experience an increase in sputum production that leads to difficulties in removing sputum. Patients with CAP often have decreased cough reflexes that make sputum accumulate in the airway causing increased effort to breathe. Chest physiotherapy is one of the airway cleansing techniques in patients with decreased cough reflexes.

This Final Scientific Work of Ners aims to analyze the interventions of chest physiotherapy to reduce symptoms and prevent worsening of patients with CAP. The methodology used is the case study method and the existing research analysis. The results obtained showed chest physiotherapy can decrease the patient 39 s breathing effort, reduction of febrile episodes, changes in sputum characteristics, as well as the percentage of mortality by scoring CURB 65."

"Latar Belakang. Hipoalbuminemia sudah diketahui merupakan faktor prediktor morbiditas dan mortalitas pada pasien usia lanjut dengan pneumonia dan CRP merupakan petanda klinis yang penting pada pneumonia. Namun hubungan antara kadar CRP dengan penurunan kadar albumin, sebagai protein fase akut negatif, saat infeksi akut belum pernah diteliti sebelumnya.Tujuan. Mendapatkan: (1) perbedaan kadar CRP awal perawatan antara pasien dengan daa tanpa penurunan albumin, (2) perbedaan risiko teradinya penurunan albumin antara pasien dengan kadar CRP awal tinggi dan rendah, dan (3) korelasi antara kadar CRP dan albumin saat awal perawatan pada pasien-pasien usia lanjut dengan pneumonia komunitas yang dirawat di rumah sakit.Metodalogi. Stuart potong-lintang dan kohort-prospektif dilakukan pada pasien-pasien usia lanjut (>60 tahun) dengan diagnosis pneumonia komunitas yang dirawat di RSCM, untuk diamati penurunan kadar albuminnya selama 5 hari perawatan. Pasien-pasien dengan keadaan-keadaan yang dapat mempengaruhi kadar albumin dan CRP, serta infeksi selain pn nimcnia komunitas dieksklusi dari penelitian. Penilaian kadar CRP dilakukan pada hari pertama perawatan (cut-off 20 mg/L), sementara penurunan albumin ditentukan dari perubahan kadar albumin selama 5 hari perawatan (cut-off 10%). Analisis statistik dilakukan dengan uji-t independen, uji chi-square, dan uji korelasi sesuai dengan tujuan penelitian.Hasil Utama. Selama periode April-Juni 2005 terkumpul 26 pasien usia lanjut dengan pneumonia komunitas yang masuk perawatan di RSCM. Hanya 23 pasien yang menyelesaikan penelitian sampai 5 hari dengan 17 pasien memiliki kadar CRP awal tinggi, dan didapatkan penurunan albumin >10% pada 7 pasien setelah 5 hari perawatan. Terdapat perbedaan rerata kadar CRP hari-1 diantara kedua kelompok (175,36 mgfL vs 75,67 mg/L; P = 0,026; 1K95% 13,25-186,13 mgfL). Namun tidak didapatkan perbedaan risiko bermakna antara pasien dengan kadar CRP tinggi dengan pasien dengan kadar CRP rendah scat awal dengan terjadinya penurunan albumin saat awal perawatan (RR = 2,12; P = 0,621; 11(95% 0,256-29,07). Tidak didapatkan pula korelasi antara kadar CRP dan albumin saat awal perawatan (r = 0,205, P = 0,314)Kesimpulan. Tingginya kadar CRP awal perawatan berhubungan dengan terjadinya penurunan kadar albumin selama perawatan, namun tidak ada perbedaan risiko terjadinya penurunan albumin selama perawatan antara pasien dengan CRP awal tinggi dan CRP awal rendah, serta tidak ada korelasi antara kadar CRP dan albumin scat awal perawatan pada pasien-pasien usia lanjut dengan pneumonia komunitas yang dirawat di rumah sakit.

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Backgrounds. Hypoalbuminemia widely known as a predictive factor for increasing morbidity and mortality in elderly patients, including with pneumonia; while CRP has known as a clinical marker for pneumonia. But relationship between CRP level with decrease of serum albumin level, as a negative acute-phase protein, during acute infection has never been studied before.

Objectives. To found: (1) CRP level difference between patient with and without decreased of serum albumin level, (2) risk for developing decreased of serum albumin level in patients with high CRP compared to patients with low CRP level, and (3) correlation between CRP and albumin level on admission in hospitalized elderly patients with community-acquired pneumonia.

Methods. Cross-sectional and prospective-cohort studies was conducted in hospitalized elderly patients with community-acquired pneumonia that admitted to RSCM, to observed the decreased of serum albumin level in five days of hospitalization. Conditions that known could influence CRP and albumin consentration have been excluded, and other infections as well. CRP level was determined on admission (cut-off 20 mgfL), while decreased of serum albumin was observed for 5 days of hospitalization (cu[-off 10%). Statistical analysis was done by using independent t-test, chi-square test, and correlation test appropriately accord-ing to the objectives of the study.

Main Results. During study period (April to June, 2005) 26 hospitalized elderly patients with community-acquired pneumonia had been included into study, but only 23 of them that finished the study for 5 days. There were 17 patients that have high level of CRP on admission, and 7 patiens that developing decreased of serum albumin level more than 10% in fifth day compared to their serum albumin level on admission. There was significant mean CRP difference among 2 groups (175,36 mgfL vs 75,67 mg/L; P = 0,026; 95%CI 13,25-186,13 mgfL), but there was no risk difference between patients with high and low CRP level on admission for developing decreased albumin level on fifth day of hospitalization (RR = 2,12; P = 0,621; 95%CI 0,256-29,07). And there was no correlation between CRP and albumin level on admission (r = 0,205, P = 0,314)

Conclusions. Patients with high CRP level on admission tend to have decreased of serum albumin level during hospitalization, but there was no risk difference for developing decreased of serum albumin level between patients with high and low CRP level, and there was no correlation between CRP and albumin level on admission in hospitalized elderly patients with community-acquired pneumonia."

"Pneumonia menjadi salah satu penyebab kematian tertinggi yang terjadi pada pasien anak yang menjalani rawat inap di RSUD Prof. Dr. Margono Soekarjo Purwokerto dari tahun 2010 - 2012.Penelitian bertujuan mengidentifikasi faktor-faktor risiko yang berhubungan dengan kejadian pneumonia pada balita di RSUD Prof. Dr. Margono Soekarjo Purwokerto. Jenis penelitian observasional menggunakan pendekatan kasus kontrol.Hasil penelitian menunjukkan ada hubungan antara karakteristik balita (umur, riwayat BBLR, jenis kelamin, status imunisasi campak, status pemberian vitamin A, status gizi balita, dan pemberian ASI eksklusif), karakteristik ibu (pendidikan, pekerjaan dan pengetahuan) serta kepadatan hunian dengan kejadian pneumonia pada balita di RSUD Prof. Dr. Margono Soekarjo Purwokerto. Pendidikan ibu merupakan faktor risiko paling dominan berhubungan dengan kejadian pneumonia pada balita (Exp ( ) = 4,509). Edukasi kepada orang tua yang disesuaikan dengan latar belakang pendidikan diperlukan sebagai upaya pencegahan pneumonia.

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Pneumonia has become one of the highest mortality contributors among paediatric patients who admitted to Inpatient Department in Margono Soekarjo Hospital Purwokerto (MSHP) from 2010 - 2012. There are several factors which influence the morbidity and mortality rate due to pneumonia in underfive children.

This study aimed to identified risk factors related to the prevalence of pneumonia in children underfive years old in Margono Soekarjo Hospital Purwokerto. This study was an observational study which used case control approah.

The results showed that there were association between underfive children characteristics (age, history of low birth weight, sex, measles immunization status, vitamin A supplementation record, nutritional status, and exclusive breastfeeding), mother characteristics (education, occupation, and knowledge) and overcrowding with the prevalence of pneumonia in MSHP. Among those variables, education was the most dominant risk factor associated with occurence of pnemonia (Exp (β) = 4,509)."

"Pneumonia merupakan infeksi saluran pernapasan akut yang mengenai jaringan paru-paru (alveoli). Pneumonia di Indonesia masih menjadi salah satu penyebab utama kematian balita dan terus menempati posisi teratas penyebab kematian pada balita. Menurut Riskesdas tahun 2018, prevalensi pneumonia pada balita sebesar 4,8%. Provinsi Nusa Tenggara Timur, Papua Barat, dan Papua yang berada di wilayah Indonesia Timur memiliki prevalensi pneumonia pada balita melebihi angka nasional. Penelitian ini bertujuan untuk menganalisis faktor-faktor (faktor lingkungan rumah, karakteristik balita, dan karakteristik ibu balita) yang berhubungan dengan gejala pneumonia pada balita di Wilayah Indonesia Timur. Data yang digunakan bersumber dari Survei Demografi dan Kesehatan Indonesia (SDKI) 2017 dengan sampel sebanyak 191 balita. Desain yang digunakan adalah cross-sectional. Hasil penelitian menunjukkan bahwa proporsi gejala pneumonia pada balita di wilayah Indonesia Timur adalah sebesar 14,1%. Tidak ada hubungan yang signifikan antara faktor lingkungan rumah, karakteristik balita, dan karakteristik ibu balita dengan gejala pneumonia pada balita. Terdapat 4 variabel yang memiliki risiko lebih tingi bagi balita untuk memiliki gejala pneumonia, yaitu jenis dinding (OR=1,64), status imunisasi (OR=1,83), pemberian vitamin A (OR=1,83), dan pendidikan ibu (OR=1,96).

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Pneumonia is an acute respiratory infection that affects the lung tissue (alveoli). Pneumonia in Indonesia is still one of the main causes of under-five deaths and continues to occupy the top position as the cause of under-five deaths. According to the 2018 Riskesdas, the prevalence of pneumonia in children under-five is 4.8%. The provinces of East Nusa Tenggara, West Papua and Papua, which are in the eastern part of Indonesia, have a prevalence of pneumonia in children under-five exceeding the national figure. This study aims to analyze the factors (home environment factors, characteristics of children under-five, and characteristics of mothers) that are associated with the symptoms of pneumonia in children under-five in Eastern Indonesia Region. The data used comes from the 2017 Indonesian Demographic and Health Survey (IDHS) with a sample of 191 children under-five. The design used is cross-sectional. The results showed that the proportion of pneumonia symptoms in children under-five in Eastern Indonesia was 14.1%. There is no significant relationship between home environmental factors, the characteristics of children under-five, and characteristics of mothers with pneumonia symptoms in children under-five. There are 4 variables that have a higher risk for children under-five to have pneumonia symptoms, namely the type of wall (OR=1.64), immunization status (OR=1.83), administration of vitamin A (OR=1.83), and mother's education (OR=1.96). "

"Community-acquired pneumonia (CAP) adalah suatu peradangan akut pada parenkim paru yang disebabkan oleh mikroorganisme dan didapat dari masyarakat. Terapi optimal antibiotik extended empiric sering diperdebatkan sehingga penatalaksanaan CAP merupakan tantangan besar bagi para klinisi. Penelitian ini bertujuan menganalisis perbandingan luaran terapi, efektivitas biaya dan pilihan terapi antibiotik yang baik serta hubungan ketepatan penggunaan dengan biaya antibiotik extended empiric monoterapi dan dualterapi CAP. Desain penelitian ini adalah kohort prospektif dengan waktu pengambilan sampel Juni-September 2018 di ruang boarding IGD RSUP Fatmawati Jakarta. Diperoleh hasil dualterapi tertinggi diberikan pada komorbid gangguan kesadaran. Nilai P=0,643 untuk perbaikan klinis setelah hari ke-5 pemberian antibiotik extended empiric monoterapi dengan dualterapi. Nilai ACER monoterapi lebih rendah (Rp.256.896,36) dibandingkan dualterapi (Rp.609.505,56) dengan antibiotik terbaik yaitu seftriakson serta kombinasi siprofloksasin dan seftriakson. Terdapat hubungan antara ketepatan penggunaan dengan biaya antibiotik extended empiric (r=0,282;P=0,005). Dari hasil penelitian tersebut dapat disimpulkan bahwa antara penggunaan antibiotik monoterapi dengan dualterapi tidak berbeda signifikan dalam luaran klinis setelah hari ke-5 pemberian antibiotik extended empiric, efektivitas biaya monoterapi lebih baik dibandingkan dualterapi dengan pilihan monoterapi terbaik adalah seftriakson dan dapat dipertimbangkan pemberian kombinasi siprofloksasin dan seftriakson pada komorbid gangguan kesadaran serta terdapat kekuatan hubungan sedang antara ketepatan penggunaan dengan biaya antibiotik extended empiric.

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Community-acquired pneumonia (CAP) is an acute inflammation of the pulmonary parenchyme caused by microorganisms and obtained from community. Optimal therapy for extended empirical antibiotics is debated so CAP management is still a major challenge. This study aims to analyze the comparison of therapeutic outcomes, cost effectiveness and the best choice of antibiotic therapy also the correlation between the accuracy of use and cost of monotherapy and dualtherapy extended empirical antibiotics in prospective cohort. The sampling time was June-September 2018 in the ED boarding room Fatmawati Hospital, Jakarta. Highest dualtherapy results for unconsciousness comorbid. P value=0,643 for clinical improvement after the 5th day of extended empiric monotherapy and dualtherapy. Monotherapy ACER is lower (Rp 256.896,36) than dualtherapy (Rp.609.505,56), the best antibiotics are ceftriaxone and ciprofloxacin-ceftriaxone. There is a relationship between the accuracy of use and cost of extended empiric antibiotics (r=0,282;P=0,005). It can be concluded that between the use of monotherapy and dualtherapy did not differ significantly in clinical outcomes after the 5th day, cost effectiveness of monotherapy was better than dualtherapy with the best choice was ceftriaxone and consideration of ciprofloxacin-ceftriaxone for unconsciousness comorbid, there is a moderate relationship between the accuracy of use and cost of extended empirical antibiotics."

"Latar belakang : Pneumonia komunitas (PK) merupakan penyakit dengan angka kejadian morbiditas dan mortalitas yang tinggi secara global. Sebagai penyakit infeksi maka respons inflamasi bisa diukur melalui beberapa serum biomarker yang bisa digunakan sebagai prediktor untuk lama rawat. Identifikasi pasien risiko tinggi lama rawat yang panjang dengan menggunakan kombinasi beberapa serum biomarker diharapkan bisa menjadi acuan dalam intervensi yang cepat dan tepat termasuk didalamnya penggunaan antibiotik sehingga berpengaruh pada luaran klinis pasien PK.Tujuan : Studi ini bertujuan untuk mendapat sistem skoring dengan menggunakan beberapa serum biomarker seperti prokalsitonin, C-reactive protein (CRP), leukosit, asam laktat, D-dimer dan albumin terhadap lama rawat pasien PK sedang beratMetode : Studi ini menggunakan desain kohort prospektif pasien PK sedang berat yang dirawat di IGD/ICU/HCU RSUPN dr. Cipto Mangunkusumo periode Mei 2022 s/d Juli 2023. Variabel-variabel prediktor lama rawat pasien PK sedang berat didapatkan dari hasil analisis multivariat dengan regresi logistik.Hasil : Dari total 360 subjek yang memiliki lama rawat > 14 hari sebanyak 204 subjek (56,67%) dan ≤ 14 hari sebanyak 156 subjek (44,44%). Variabel prediktor yang secara konsisten mempengaruhi lama rawat adalah asam laktat dengan RR 1,305 (IK 95% 1,097 – 1,551, p=0,003) dan albumin dengan RR 2,234 (IK 95% 1,164– 2,156, p=0,003). Performa determinan dengan analisis kurva ROC menunjukkan kemampuan prediksi lemah (AUC=0,629). Performa kalibrasi dengan uji Hosmer-Lemeshow test menunjukkan validasi baik (0,562). Biomarker lain yang dianggap signifikan dalam analisis bivariat yaitu prokalsitonin dengan RR 1,481 (IK 95% 1,121-1,954, p=0,006) dan C-reactive protein RR 2,465 (IK 95% 1,141-5,326). Leukosit dan D-dimer tidak dinilai signifikan sebagai biomarker PK sedang berat (p = 0,947).Simpulan : Terdapat hubungan antara asam laktat dan albumin dengan lama rawat pasien PK sedang berat. Tidak terdapat model skoring lama rawat pasien PK sedang berat.

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Background: Community-acquired pneumonia (CAP) is a disease with a high global incidence of morbidity and mortality. As an infectious disease, the inflammatory response can be measured through several serum biomarkers that can be used as predictors for the length of hospital stay (LOS). The identification of patients at high risk for prolonged hospitalization using a combination of several serum biomarkers is expected to serve as a reference for prompt and accurate interventions, including the use of antibiotics, thereby influencing the clinical outcomes of CAP patients.

Objective: This study aims to establish a scoring system using several serum biomarkers such as procalcitonin, C-reactive protein (CRP), leukocytes, lactic acid, D-dimer, and albumin for the length of hospital stay in patients with moderate to severe CAP.

Method: This study employs a prospective cohort design involving patients with moderate to severe CAP treated in the Emergency Department (ED), Intensive Care Unit (ICU), and High-Care Unit (HCU) at RSUPN dr. Cipto Mangunkusumo from May 2022 to July 2023. Variables to predict for the length of hospital stay in patients with moderate to severe CAP were obtained from multivariate analysis using logistic regression.

Results: A total of 360 subjects were included in this study, including 204 subjects (56.67%) with LOS more than 14 days, while 156 subjects (44.44%) had LOS of 14 days or less. The consistently influencing predictor variables for the length of hospital stay were lactate with RR 1.305 (95% CI 1.097–1.551, p=0.003) and albumin with RR 2.234 (95% CI 1.164–2.156, p=0.003). Determinant performance with ROC curve analysis showed weak predictive ability (AUC=0.629). Calibration performance with the Hosmer-Lemeshow test indicated good validation (0.562). Other biomarkers considered significant only in bivariate analysis were procalcitonin with RR 1.481 (95% CI 1.121–1.954, p=0.006) and C-reactive protein with RR 2.465 (95% CI 1.141–5.326). Leukocytes an D-dimer were not considered significant as a biomarker for moderate to severe CAP (p=0.947).

Conclusion: There is a relationship between lactate and albumin with the length of hospital stay in patients with moderate to severe CAP. However, there is no scoring model for the length of hospital stay in these patients."

"Pneumonia merupakan salah satu penyebab kematian terbanyak pada balita di Indonesia. Tingginya tingkat kejadian pneumonia pada balita dapat berhubungan dengan rendahnya pengetahuan, sikap serta perilaku orangtua terhadap pneumonia dan pencegahannya. Penelitian ini dilakukan untuk mengetahui hubungan antara pengetahuan dan sikap dengan perilaku orangtua balita tentang pneumonia. Penelitian ini merupakan penelitian cross-sectional. Data diambil dari wawancara berdasarkan kuesioner terhadap orangtua pasien balita berusia 9 bulan - 5 tahun tahun di RSCM Kiara tahun 2015. Analisis data dilakukan menggunakan uji Chi Square atau Fisher. Penelitian ini merupakan penelitian cross-sectional. Data diambil dari wawancara berdasarkan kuesioner terhadap orangtua pasien balita berusia 9 bulan - 5 tahun tahun di RSCM Kiara tahun 2015. Analisis data dilakukan menggunakan uji Chi Square atau Fisher. Dari 96 subjek didapatkan 51 orang (53,1%) memiliki kategori pengetahuan cukup baik, 74 orang (77,1%) memiliki sikap positif, dan 49 orang (51%) berperilaku baik terhadap pencegahan pneumonia. Tidak ditemukan hubungan yang bermakna antara tingkat pengetahuan dengan perilaku orangtua tentang pneumonia (p= 0,712). Hubungan tidak bermakna juga didapatkan antara sikap dengan perilaku orangtua (p=0,649). Lebih dari setengah subjek memiliki pengetahuan dan perilaku yang baik, sedangkan tiga perempat subjek memiliki sikap postitif tentang pneumonia. Tidak terdapat hubungan yang bermakna antara pengetahuan dan sikap dengan perilaku orangtua tentang pneumonia.

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Pneumonia is one of the most leading causes of death among under 5 children in Indonesia. The high incidence of pneumonia among under 5 children might be related to parents low level of knowledge, attitude, and behavior regarding pneumonia and its prevention.. This study was a cross-sectional study. Data was collected from parents of children aged 9 months - 5 years, using guided questionnaire, in RSCM Kiara during September 2015. The data was analyzed by Chi Square or Fisher test. There were 96 subjects recruited and 51 subjects (53,1 %) had fair knowledge, 74 subjects (77,1 %) had positive attitude, and 49 subjects (51 %) had good behavior regarding pneumonia. There were no significant associations between the level of knowledge toward parents’ behavior (p = 0,712), nor between the level of attitude toward parents’ behavior (p = 0,649) regarding pneumonia. Based on the research, more than a half of the subjects had good knowledge and behavior, while three quarters of the subjects had positive attitude regarding pneumonia. There were no significant associations between knowledge and attitude toward parents’ behavior regarding pneumonia."

"Studi ini bertujuan untuk mengetahui gambaran karakteristik penderita pneumonia balita dan faktor resiko yang berhubungan dengan kejadian pneumonia balita. Studi ini dilakukan pada bulan Februari sampai Maret 2014 di 1 Puskesmas kecamatan dan 5 Puskesmas kelurahan yang ada di wilayah Kecamatan Ciracas. Desain Studi yang digunakan adalah desain potong lintang (cross sectional).Jumlah sampel pada studi ini adalah 556 responden. Sampel diambil secara proportional stratified random sampling. Dari studi ini diketahui balita yang menderita pneumonia sebesar 152 balita (27,3%) dan yang tidak menderita pneumonia sebanyak 404 balita (72,7%).Hasil analisis multivariat menunjukan terdapat beberapa faktor yang berhubungan dengan kejadian pneumonia yaitu, ASI Eksklusif OR 3,630 (95% CI: 2,266-5,818), status gizi balita OR 2,126 (95% CI: 1,191-3,777), riwayat imunisasi campak OR 2,372 (95% CI: 1,326-4,245), pengetahuan ibu OR 2,126 (95% CI: 1,197-3,777), sosial ekonomi OR 1,948 (95% CI 1,216-3,121), dan polusi rumah tangga OR 2,466 (95% CI: 1,405-4,330). Upaya intervensi terhadap perbaikan status gizi balita, promosi ASI eksklusif, status imunisasi campak, polusi dalam rumah tangga, dan peningkatan pengetahuan ibu, mempunyai peranan yang penting bagi pencegahan penyakit pneumonia pada balita.

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This study aims to reveal the characteristics of pneumonia on children under five years old and factors associated with the occurrence of pneumonia on children under five years old. This study was conducted from February to March 2014 in six public health centers (Puskesmas) Ciracas sub-district, Eastern Jakarta. Cross sectional design was used in this study with the sample size of 556 respondents (mothers of children). Sample was taken by proportional stratified random sampling method.

It was found that 27.3% among respondent`s children were diagnosed with pneumonia. Result of multivariate analysis showed that there are some factors associated with the occurrence of pneumonia on children under five years old including exclusive breast-feeding with OR 3.630 (95% CI: 2.266-5.818), nutrition status OR 2.126 (95% CI: 1.191-3.777), measles immunization OR 2.372 (95% CI: 1.326-4.245), mother`s knowledge OR 2.126 (95% CI: 1.197-3.777), socio-economy OR 1.948 (95% CI 1.216-3.121), and indoor pollution OR 2.466 (95% CI: 1.405-4.330). Intervention efforts such as enhancing children`s nutritional status, promotion of exclusive breast feeding, measles immunization, mother`s knowledge, socio-economy and indoor pollution play an important role in the prevention of pneumonia on children under five years old."