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Ditemukan 161989 dokumen yang sesuai dengan query

Lisa Safira

Gambaran kadar ICAM-1 dan S100β plasma pada pasien sepsis anak = ICAM-1 dan S100β plasma value in children with sepsis

"Latar belakang. Selama sepsis, terjadi penglepasan ICAM-1 yang dipercaya berperan dalam kerusakan otak. Sedangkan S100β telah diteliti sebagai penanda kerusakan sel otak.

Tujuan. Mengetahui rerata nilai ICAM-1, protein S100β, korelasi antara ICAM-1 dengan skala koma Glasgow (GCS), korelasi antara protein S100β dengan GCS, dan korelasi antara ICAM-1 dengan S100β.

Metode. Deskriptif analitik potong lintang pada 34 anak sepsis, pengukuran kadar ICAM-1 dan S100β dalam darah pada hari pertama dan ketiga sejak sepsis ditegakkan.

Hasil. Median ICAM-1 hari pertama 548,1 (158,6 – 1256,1) ng/mL dan ketiga 596,5 (185,5 – 1264,5) ng/mL (p=0,164). Median S100β pada sepsis berat lebih tinggi secara signifikan dibandingkan sepsis ringan pada hari pertama maupun ketiga (p=0,008 dan p=0,021). Hari ketiga, kadar S100β berkorelasi negatif dengan GCS (r= - 0,452; p=0,003). Korelasi antara ICAM-1 dan S100β pada hari pertama r=0,146 (p=0,409) dan ketiga r=0,184 (p=0,298).

Simpulan. Prevalens ensefalopati sepsis 5,9%. Median ICAM-1 hari ketiga sepsis lebih tinggi dibandingkan hari pertama. Median S100β pada sepsis berat lebih tinggi secara signifikan dibandingkan sepsis ringan. Tidak terdapat korelasi antara ICAM-1 dengan GCS pada kelompok sepsis ringan maupun berat. Terdapat korelasi negatif antara S100β dengan skor GCS pada hari ketiga sepsis. Tidak terdapat korelasi antara ICAM-1 dan S-100β pada hari I dan III sepsis.

Background: ICAM-1 release during sepsis is perceived to be related to brain injury. Whereas S100β has been known as one of brain injury markers.
Objective: To measure mean value of ICAM-1, S100β, to find correlation between ICAM-1 and Glasgow Coma Scale (GCS), between S100β and GCS, also ICAM- 1 and S100β.
Methods. Analytical cross sectional study in 34 sepsis children, measurement of ICAM-1 and S100β plasma levels within day 1 and 3 since diagnosis of sepsis.
Results. Median level of ICAM-1 day one 548,1 (158,6 – 1256,1) ng/mL and day three 596,5 (185,5 – 1264,5) ng/mL (p=0,164). S100β median is significantly higher in severe than mild sepsis (p=0,008 dan p=0,021). On third day S100β was negatively related to GCS (r= - 0,452; p=0,003). The correlation observed between ICAM-1 and S100β on day one was r=0,146 (p=0,409) while on third day was r=0,184 (p=0,298).
Conclusion. The prevalence of encephalopathy sepsis is 5.9%, Median ICAM-1 is higher on day three. Median of S100β is higher in severe than mild sepsis.There is no correlation between ICAM-1 and GCS in both sepsis. There was negative correlation between S100β and GCS on 3rd day of sepsis. No correlation between ICAM-1 and S100β on both measurement days."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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UI - Tugas Akhir Universitas Indonesia Library

Ronald Chandra

Hubungan kadar plasma citrullinated histone H3 (CIT H3) terhadap derajat keparahan sepsis klinis pada anak dan prognosis survivalnya: studi pendahuluan = Association of plasma citrullinated histone H3 (CIT H3) level with disease severity and prognostic survival in pediatric clinically sepsis: pilot study

"Latar belakang: Sepsis merupakan salah satu penyebab morbiditas dan mortalitas pada anak. Untuk optimalisasi tatalaksana sepsis diperlukan penanda yang dapat memprediksi kejadian sepsis, derajat keparahan dan luaran sepsis klinis.

Tujuan penelitian: Mengetahui kadar plasma Cit H3 sepsis klinis pada anak dan menganalisa hubungannya terhadap derajat keparahan penyakit dan prognostik survivalnya.

Metode penelitian: Penelitian observasional pendekatan kohort prospektif dilakukan pada anak usia satu bulan sampai 18 tahun dengan diagnosis sepsis klinis sejak Pebruari - Mei 2018 di RSUPN Cipto Mangunkusumo, Jakarta. Penilaian skor PELOD-2, pSOFA dan Cit H3 dilakukan saat diagnosis ditegakkan dan 48 jam kemudian. Mortalitas dipantau selama tujuh hari.

Hasil: Diperoleh 67 anak memenuhi kriteria dengan median kadar plasma Cit H3 1.210 800-32.160 ng/mL. Berdasarkan sepsis-3, kadar plasma Cit H3 pasien sepsis lebih tinggi dibandingkan curiga sepsis. Sensitivitas dan spesifisitas kadar plasma Cit H3 ge; 1.200 ng/mL sebagai penanda kejadian sepsis adalah 83,3 dan 75,7.

Perubahan kadar plasma Cit H3 dalam 48 jam berhubungan dengan progresifitas sepsis klinis. Citrullinated histone H3 berkorelasi dengan skor PELOD-2 r=0,338;P

Background: Sepsis is a life threatening organ dysfunction causing high morbidity and mortality in children thus, a highly predictive septic marker to forecast its severity and predict mortality is needed.
Aim: To determine plasma Cit H3 levels in clinically sepsis children and analyze its correlation with disease severity and survival rate.
Method: A prospective observational study was conducted in one month ndash 18 years old children with diagnosed clinically sepsis during February ndash April 2018 in Cipto Mangunkusumo Hospital, Jakarta. Evaluation of PELOD 2, pSOFA score, and Cit H3 were done when diagnosis initially made and 48 hours after. Patient rsquo s survival was observed for 7 days.
Results: Sixty seven children with clinically sepsis had median plasma Cit H3 level 1,210 800 ndash 32,160 ng mL. The plasma Cit H3 level in patients who diagnosed with sepsis sepsis 3 was higher than suspected sepsis. As marker sepsis event, plasma Cit H3 level with cut off point ge 1,200 ng mL has sensitivity 83,3 and specificity 75.5. Changes in plasma Cit H3 level in the first 48 hours was significantly correlated with changes in clinical outcome. Plasma Cit H3 level also correlated with PELOD 2 and pSOFA score. Using survival analysis, plasma Cit H3 level ge 1,200 ng mL significantly increased mortality rate.
Conclusion: Plasma Cit H3 level correlates with severity and survival rate of clinically diagnosed sepsis."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018

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UI - Tesis Membership Universitas Indonesia Library

Tuty Rahayu

Kadar C peptida pada anak sepsis dan syok septik dengan hiperglikemia = Levels of C peptide in children with sepsis and septic shock with hyperglycemia

"Latar belakang Hiperglikemia pada anak sepsis dan syok septik merupakan keadaan yang sering ditemukan serta mempunyai luaran yang buruk. Patofisiologinya belum jelas mungkin berbeda dengan dewasa yaitu terdapatnya hipofungsi sel beta pankreas dibandingkan dengan resistensi insulin.

Tujuan Mengetahui adanya hipofungsi sel beta pankreas dengan didapatnya penurunan kadar insulin melalui pemeriksaan kadar C peptida pada anak sepsis dan syok septik dengan hiperglikemiaMetode. Penelitian dilakukan di PICU Pediatric Intensive Care Unit dan IGD Instalasi Gawat Darurat. Penelitian ini merupakan suatu uji deskriptif analitik dengan memeriksa kadar C peptida pada anak sepsis dan syok septik dengan hiperglikemia Kadar gula darah dan C peptida diperiksa secara periodik selama 48 jam

Hasil Hiperglikemia dan penurunan kadar C peptida ditemukan pada 59 dan 52 pasien anak dengan sepsis dan syok septik Keadaan hiperglikemia hanya ditemukan pada 12 jam pertama perawatan. Perbedaan kadar gula darah dan C peptide tampak pada 1 jam pertama yaitu 229 vs 192 mg dl dan 0 5 vs 1 5 ng ml nilai p 0 409 p 0 025 Skor PELOD lebih tinggi pada kadar C peptida rendah 11 vs 1. Penggunaan ventilator inotrops kortikosteroid dan lama rawat PICU tidak terdapat perbedaan pada kedua kelompok.

Simpulan Terdapat penurunan kadar C peptida di bawah normal pada anak sepsis dan syok septik dengan hiperglikemia dan meningkat ke normal dalam 48 jam Penurunan gula darah terjadi 12 jam pertama hal ini menunjukkan perlunya infus glukosa pada keadaan akut sepsis. Apakah hiperglikemia merupakan respons normal tubuh dan hipofungsi sel beta pankreas akibat beratnya penyakit pada anak sepsis perlu dilakukan penelitian lebih lanjut

Background Hyperglycemia in children sepsis is a condition that is often found Pathophysiology is unclear may differ from the adult that the presence of hypofunction of pancreatic beta cells compared with insulin resistance.

Objective To determine the hypofunction pancreatic beta cells with decreased levels of C peptide insulin in children with sepsis hyperglycemiaMethods The study was conducted in the PICU and ER. This study was a descriptive analytic test by examining the levels of C peptide in children with sepsis hyperglycemia Checked blood sugar levels and C peptide during 48 hours on a periodic basis.

Results Hyperglycemia and decreased levels of C peptide were 59 and 52 in children with sepsis respectively Hyperglycemia was found only in the first 12 hours Differences in blood sugar levels 229 vs 192 mg dl p value 0 409 and C peptide 0 5 vs 1 5 ng ml p value 0 025 appeared at the first 1 hour. Further analysis between normal and low C peptide showed PELOD score was higher in low C peptide level 11 vs 1. Ventilators inotrops corticosteroids and PICU LOS was should no difference in the two groups.

Conclusions There was a decrease in C peptide level below normal in children with sepsis hyperglycemia and increased to normal within 48 hour. The decrease in blood sugar occurs in the first 12 hours which demonstrates the need for infusions of glucose in acute sepsis Further research whether hyperglycemia was a normal response of the body and hypofunction pancreatic beta cells due to the severity of the disease in children sepsis."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

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UI - Tugas Akhir Universitas Indonesia Library

Mery Nitalia

Studi pendahuluan status vitamin D pada pasien infeksi tanpa sepsis sepsis dan sepsis berat = Pilot study vitamin d status at infection without sepsis sepsis and severe sepsis patient

"ABSTRAK

Berbagai studi terkini menunjukkan hubungan antara vitamin D dan sepsis. Vitamin D berperan sebagai stimulator produksi peptida antimikroba dan mencegah inflamasi yang berlebihan. Insufisiensi dan defisiensi vitamin D berhubungan dengan risiko terjadinya sepsis. Saat ini belum terdapat data mengenai hubungan status vitamin D dengan pasien infeksi tanpa sepsis, sepsis, dan sepsis berat. Tujuan penelitian ini dilakukan untuk mendapatkan hubungan antara proporsi status vitamin D dengan pasien infeksi tanpa sepsis, sepsis, dan sepsis berat.

Desain penelitian potong lintang, terdiri dari 60 pasien infeksi terbagi menjadi kelompok infeksi tanpa sepsis, sepsis, dan sepsis berat masing-masing 20 pasien. Diagnosis sepsis berdasarkan modifikasi SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference 2001. Status vitamin D ditetapkan menurut rekomendasi Holick. Pada ketiga kelompok tersebut dicatat data karakteristik subjek dan dilakukan pemeriksaan 25(OH)D.

Status vitamin D pada subjek penelitian ini didapatkan sebanyak 5 (8,33%) orang insufisiensi dan 55 (91,67%) orang defisiensi vitamin D Proporsi insufisiensi pada kelompok infeksi tanpa sepsis adalah 5%, sepsis 10%, dan sepsis berat 10%. Proporsi defisiensi pada kelompok infeksi tanpa sepsis adalah 95%, sepsis 90%, dan sepsis berat 90%. Didapatkan perbedaan tidak bermakna proporsi insufisiensi dan defisiensi vitamin D pada kelompok infeksi tanpa sepsis, sepsis, dan sepsis berat.

Kami menyimpulkan status vitamin D tidak berhubungan dengan beratnya sepsis. Proporsi insufisiensi dan defisiensi pada pasien infeksi tanpa sepsis, sepsis, dan sepsis berat masing-masing didapatkan 5% dan 95%; 10% dan 90%; 10% dan 90%.

ABSTRACT

Recent studies have shown that there is a relationship between vitamin D and sepsis. Vitamin D has a a role as a potent stimulator of antimicrobial peptides and prevent an over reaction of the inflammatory response. Insufficiency and deficiency of vitamin D have been associated with sepsis event. Nevertheless, there is no data about the relationship between vitamin D status with infection without sepsis, sepsis, and severe sepsis patient. The aim of this study was to obtain the relationship between proportions of vitamin D with infection without sepsis, sepsis, and severe sepsis patient.

This was a cross-sectional study, 60 patients with infection were divided into groups of infection without sepsis, sepsis, and severe sepsis, each consisted of 20 patients. Diagnosis of sepsis was based on modified SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference 2001. Vitamin D status was defined according to Holick recommendations. Baseline characteristics of subjects were recorded and 25(OH)D concentrations were measured in subjects of each groups.

According to status of Vitamin D, 5 (8,33%) subjects were insufficiency and 55 (91,67%) were deficiency. The proportions of vitamin D insufficiency at infection without sepsis group were 5%, sepsis 10%, and severe sepsis 10%. The proportions of vitamin D deficiency at infection without sepsis group were 95%, sepsis 90%, and severe sepsis 90%. The proportions of insufficiency and deficiency at infection without sepsis, sepsis, and severe sepsis patient were not significantly different (p > 0.05).

It is concluded that vitamin D status were not related to infection severity. The proportions of vitamin D insufficiency and deficiency at infection without sepsis, sepsis, and severe sepsis, i.e. 5% and 95%; 10% and 90%; 10% and 90%, respectively."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013

T58562

UI - Tesis Membership Universitas Indonesia Library

Darwin Harpin, examiner

Pengaruh elektroakupunktur terhadap kadar prokalsitonin, ureum dan kreatinin pada tikus Wistar model sepsis = Effect of electroacupuncture on plasma procalcitonin, ureum and creatinine in septic Wistar rats

"Sepsis merupakan suatu keadaan disfungsi organ yang mengancam jiwa yang disebabkan oleh gangguan respon sistem imun pasien terhadap infeksi. Syok sepsis adalah suatu kondisi yang paling berkontribusi terhadap terjadinya gagal ginjal akut pada pasien kritis. Pada sepsis, terjadi produksi yang berlebihan dari sitokin - sitokin proinflamasi yang disebabkan oleh endotoksin bakteri dan suatu keadaan dimana terjadi ketidakseimbangan mediator proinflamasi dan antiinflamasi. Elektroakupunktur diketahui dapat meregulasi sistem neuro endokrin imun melalui stimulasi nervus vagus dan saraf kolinergik yang mempunyai efek antiinflamasi, dengan efek samping minimal. Penelitian ini menilai pengaruh elektroakupunktur pada titik ST36 Zusanli bilateral terhadap kadar prokalsitonin dan fungsi ginjal melalui pemeriksaan ureum dan kreatinin. Dua puluh delapan tikus Wistar jantan dibagi secara acak kedalam empat kelompok, kelompok kontrol (n=7), kelompok sepsis (n=7), kelompok elektroakupunktur (n=7) dan kelompok elektroakupunktur sham (n=7). Tindakan elektroakupunktur diberikan 30 menit sebelum induksi bakteri hidup Eschericia coli ATCC 25922. Enam jam kemudian, dilakukan pemeriksaan kadar prokalsitonin, ureum dan kreatinin dengan memberikan hasil yang signifikan pada perbedaan rerata kadar ureum (p<0,001, CI 95% 57,1-76,6) dan kreatinin p=0,005, CI 95% 0,14-0,62) pada kelompok sepsis dengan kelompok elektroakupnktur dan ditemukan rerata kadar prokalsitonin yang lebih rendah pada kelompok elektroakupunktur (0,53 ± 0,11 ng/ml) dibandingkan dengan kelompok sepsis (0,69 ± 0,09 ng/ml). Hasil penelitian ini menunjukkan bahwa tindakan elektroakupunktur pada ST36 Zusanli dapat mengurangi inflamasi dan mencegah kerusakan ginjal.

Sepsis is life threatening organ dysfunction caused by dysregulated host response to infection. Septic shock is the most common contributing factor to acute kidney injury in critically patients. It is considered that the pathogenesis is closely related to an excessive production of pro-inflammatory cytokines caused by bacterial endotoxins and an imbalance between pro-inflammatory and anti-inflammatory mediators. Electroacupuncture can regulate nerve endocrine immune system with less side effects. It is known that electroacupuncture stimulates the vagus nerve and regulate inflammatory responses through the cholinergic anti-inflammatory pathways. This study investigates the effect of electroacupuncture at ST36 Zusanli bilateral on plasma procalcitonin and renal function by measuring the plasma ureum and creatinine. Twenty eight male Wistar rats were divided randomly into four groups, control group (n=7), sepsis group (n=7), electroacupuncture group (n=7) and sham acupuncture group (n=7). Electroacupuncture was carried out once for 30 minutes before the administration of live bacteria Eschericia coli ATCC 25922 by intraperitoneal route. Six hours later after the bacteria administration was chosen as the study endpoint. The result shows there is a statiscally significant difference in mean different on ureum (p<0,001, CI 95% 57,1-76,6) and creatinine (p=0,005, CI 95% 0,14-0,62) between the sepsis and control group. The electroacupuncture group also shows decreased on plasma procalcitonin compared to the sepsis group (0,53 ± 0,11 ng/ml; 0,69 ± 0,09 ng/ml). These findings suggest electroacupuncture pretreatment at ST36 Zusanli attenuated the bacteria induced inflammatory response and mitigated acute kidney injury."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019

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UI - Tugas Akhir Universitas Indonesia Library

Fatimah Saidah

Hubungan kadar Syndecan-1 dengan skor PELOD-2 dan Mortalitas pada anak dengan Sepsis = Correlation of Syndecan-1 with PELOD-2 Score and Mortality in Pediatric Sepsis

"Mortalitas anak dengan sepsis masih tinggi dengan penyebab yang belum banyak diketahui patofisiologinya. Kerusakan lapisan glikokaliks pada permukaan endotel pembuluh darah dapat menyebabkan peningkatan permeabilitas pembuluh darah yang mengakibatkan syok sepsis dan disfungsi organ pada pasien sepsis. Peningkatan kadar syndecan-1 dalam darah merupakan salah satu penanda kerusakan lapisan glikokaliks. Penelitian ini bertujuan untuk mengetahui hubungan kadar syndecan-1 dengan disfungsi organ yang dinilai dengan skor PELOD-2 dan mortalitas 28 hari pada pasien anak dengan sepsis. Hubungan kadar syndecan-1 dengan skor PELOD-2 merupakan studi potong lintang, sementara hubungan syndecan-1 dengan mortalitas merupakan studi prospektif. Penelitian dilakukan pada 55 anak berusia 1 bulan-<18 tahun dengan sepsis yang dirawat di RSCM pada bulan Maret-Agustus 2019 dengan cara consecutive sampling. Evaluasi syndecan-1 dan skor PELOD-2 dilakukan pada hari pertama dan kelima setelah diagnosis sepsis. Pasien diikuti selama 28 hari untuk evaluasi mortalitas. Didapatkan peningkatan syndecan-1 pada seluruh pasien sepsisdengan peningkatan yang lebih tinggi pada pasien dengan syok sepsis (p=0,01). Terdapat korelasi positifantara kadar syndecan-1 dengan skor PELOD-2 pada 24 jam pertama setelah diagnosis sepsis dengan koefisien korelasi 0,32 (p=0,01). Terdapat korelasi positif antara perubahan kadar syndecan-1 dengan perubahan skor PELOD-2 dengan koefisien korelasi 0,469 (p=0,002). Tidak didapatkan hubungan antara kadar syndecan-1 dengan skor PELOD-2 pada hari kelima (p=0,6). Peningkatan kadar syndecan-1 didapatkan tidak berhubungan dengan mortalitas 28 hari (p=0,49).Nilai titik potongsyndecan-1 ≥688 ng/mLpada hari pertama dapat memprediksi skor PELOD-2 ≥8 dengan AUC 73,8%, sensitivitas 67%, spesifisitas 77%, NDP 44,4%, dan NDN 89,2% (p=0,012).

Sepsis still contributes significantly to morbidity and mortality inpediatric patients. Disruption of glycocalyx layer on vascular endothelium has been described as one of the main pathophysiological events that leads to increased vascular permeability, contributing to organ failure and septic shock. The role of glycocalyx disruption in pediatric sepsis has not been widely studied. Increased syndecan level in blood marks disruption of glycocalyx integrity. This study was aimed to analyze the correlation ofserum syndecan-1 with organ dysfunction assessed by PELOD-2 score, and to evaluate its association with mortality in pediatric sepsis. Correlation of syndecan-1 and PELOD-2 score was a cross sectional study, while association of syndecan-1 with mortality was a prospective study. The study was conducted in pediatric intensive care unit, emergency unit, and pediatric ward of Cipto Mangunkusumo Hospital, Jakarta, on March-August 2019. The subjects were 55 patients aged 1-month to 18-year-old with sepsis that fulfilled the inclusion criteria consecutively. Serum syndecan-1 level and PELOD-2 score were evaluated on day 1 and 5 after diagnosis of sepsis. Survival was assessed after 28 days. There was increased level of syndecan-1 in all subjects, with significantly higher level found in patients with septic shock (p=0,01). There was positive correlation of syndecan-1 with PELOD-2 score in the first 24 hours after diagnosis of sepsis with correlation coefficient of 0.32 (p=0.01). Changes in syndecan-1 level within 5 days positively correlated with changes of PELOD-2 score with correlation coefficient of 0.469 (p=0.002). Syndecan-1 level and PELOD-2 score on day 5 was not significantly correlated (p=0.6). There was no association of increased syndecan-1 level with mortality in 28 days (p=0.49). Cut-off point of syndecan-1 ≥688 ng/mL in the first 24 hours can predictsignificant organ dysfunction (PELOD-2 score of ≥8) with AUC of 73.8%, sensitivity 67%,specificity 77%, positive predictive value 44.4%, and negative predictive value 89.2% (p=0.012)."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019

T58692

UI - Tesis Membership Universitas Indonesia Library

Kania Adhyanisitha

Hubungan kadar plasminogen activator inhibitor type 1( PAI-1) dengan luaran pada pasien sepsis anak = The relationship between plasminogen activator inhibitor type 1 (PAI-1) and clinical outcome in children with sepsis

"Latar belakang: Koagulasi intravaskular diseminata (KID) merupakan komplikasi dari sepsis yang ditandai oleh perdarahan dan trombosis mikrovaskular dan berkaitan erat dengan terjadinya disfungsi organ multipel. KID terjadi akibat ketidakseimbangan antara sistem koagulasi dengan sistem fibrinolisis. Plasminogen activator inhibitor type 1 (PAI-1) merupakan protein fase akut yang berperan penting penekanan sistem fibrinolisis. Peningkatan PAI-1 pada sepsis diketahui memiliki korelasi dengan luaran yang buruk.

Tujuan: Untuk mengetahui hubungan kadar PAI-1 dengan kejadian KID dan kematian pada pasien sepsis anak.

Metode: Penelitian analitik prospektif dilakukan pada 35 subjek sepsis yang dirawat di PICU, Instalasi Gawat Darurat serta Ruang perawatan anak RS Cipto Mangunkusumo antara bulan Januari-April 2015. Pengukuran kadar PAI-1 dilakukan pada hari pertama dan keempat sejak sepsis ditegakkan. Pemeriksaan profil koagulasi sistemik dilakukan pada hari keempat sepsis. Diagnosis KID overt menggunakan skor KID berdasarkan International Society of Thrombosis and Haemostasis. Subjek diikuti sampai hari ke 28 perawatan untuk menilai luaran kematian.

Hasil: Kadar PAI-1 lebih tinggi secara bermakna pada sepsis berat. Terdapat perbedaan yang bermakna antara kadar PAI-1 hari keempat dengan hari pertama pada KID non overt (95,25 (SB 46,57) ng/mL vs 60,36 (SB 37,31) ng/mL, p=<0,001) dan subjek hidup (82,47 (SB 44,43) ng/mL vs 58,39 (SB 32,98) ng/mL, p=0,021). Terdapat perbedaan kadar PAI-1 hari keempat dengan hari pertama pada subjek KID overt (111,25 (SB 32,93) ng/mL vs 96,26 (SB 52,84) ng/mL) dan subjek meninggal (99,33 (SB 47,53) ng/mL vs 128,58 (SB 37,12) ng/mL), namun tidak bermakna secara statistik. Korelasi kadar PAI-1 dengan skor KID adalah r = 0,606 (p = <0,001).

Simpulan: Kadar PAI-1 mengalami penurunan yang bermakna pada hari keempat sepsis dibanding hari pertama pada subjek yang mengalami KID non-overt dan subjek yang bertahan hidup. Sedangkan pada subjek yang mengalami KID overt dan subjek yang meninggal, kadar PAI-1 hari keempat sepsis tetap tinggi. Terdapat korelasi kuat berbanding lurus antara kadar PAI-1 dengan skor KID.

Background: Sepsis-induced disseminated intravascular coagulation (DIC) is characterized by massive bleeding and microvascular thrombosis and it is closely related to the development of multiple organ dysfunctions. The imbalance between activation of coagulation system and inhibition of the fibrinolysis system in sepsis leads to the development of DIC. The acute-phase protein, plasminogen activator inhibitor type 1 (PAI-1) is a key element in the inhibition of fibrinolysis. Elevated levels of PAI-1 have been related to worse outcome in sepsis.

Objective: To investigate the relationship between plasma PAI-1 level and clinical outcome in children with sepsis.

Methods: A total of 35 children with sepsis admitted to Cipto Mangunkusumo hospital between January and April 2015 were enrolled to this analitic prospective study. Plasma PAI-1 was measured on day 1 and 4 since sepsis was diagnosed. Systemic coagulation profile was measured on day 4. The Diagnosis of overt DIC was made using the International Society of Thrombosis and Haemostasis scoring system. Subjects were followed up until death or 28 days of care.

Results: PAI-1 levels were significantly higher in severe sepsis. There were significant difference between PAI-1 levels on day 4 compared to day 1 in non- overt DIC subjects (95.25 (SB 46.57) ng/mL vs 60.36 (SB 37.31) ng/mL, p=<0.001) and survivors (82.47 (SB 44.43) ng/mL vs 58.39 (SB 32.98) ng/mL, p=0.021). There were no significant difference between PAI-1 levels on day 4 compared to day 1 in overt DIC subjects (111.25 (SB 32.93) ng/mL vs 96.26 (SB 52.84) ng/mL) and nonsurvivors (99.33 (SB 47.53) ng/mL vs 128.58 (SB 37.12) ng/mL). The correlation observed between PAI-1 and DIC score was r=0.606 (p= < 0.001).

Conclusions: There were significant decrease of PAI-1 levels on day 4 compared to day 1 in non-overt DIC subjects and survivors. Meanwhile, in overt DIC subjects and nonsurvivors there were no differences. PAI-1 levels were positively correlated with DIC score."

Depok: Universitas Indonesia, 2015

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Ressa Yuneta

Kadar hypoxia inducible Factor-1α (HIF-1α) dan Intercellular Adhesive Molecule-1 (ICAM-1) pasca bevacizumab intravitreal pada retinopati diabetik proliferatif = Levels of hypoxia inducible factor-1α (HIF-1α) and Intercellular Adhesive Molecule-1 (ICAM-1)after intravitreal bevacizumab injection in proliferative diabetic retinopathy

""ABSTRAK

Tujuan: menilai kadar Hypoxia-inducible Factor-1? HIF-1? dan Intercellular Adhesion Molecule-1 ICAM-1 vitreus pada retinopati diabetik proliferatif yang diberikan bevacizumab intravitreal, serta hubungan keduanya terhadap ketebalan makula sentral previtrektomi.Metode: tiga puluh dua mata dirandomisasi menjadi 2 kelompok, yaitu yang mendapatkan suntikan bevacizumab intravitreal 1-2 minggu previtrektomi dan kelompok kontrol langsung dilakukan vitrektomi . Penghitungan kadar HIF-1? dan ICAM-1 dilakukan dengan metode enzyme-linked immunosorbent assay ELISA . Ketebalan makula sentral diukur saat awal, previtrektomi, serta 2, 4, dan 12 minggu pascavitrektomi dengan menggunakan Stratus OCT.Hasil: rerata kadar HIF-1? vitreus dalam ng/mg protein pada kelompok kontrol dan bevacizumab intravitreal masing-masing 0,020 0,006;0,077 dan 0,029 0,016;0,21 . Kadar ICAM-1 vitreus dalam ng/mL adalah 20,10 3,41;40,16 dan 23,33 0,63;68,5 . Rerata kadar HIF-1? dan ICAM-1 vitreus didapatkan tidak berbeda bermakna antara kedua kelompok.Simpulan: bevacizumab intravitreal 1-2 minggu previtrektomi belum dapat membuat kadar HIF-1? lebih rendah daripada kelompok kontrol. Kadar ICAM-1 kelompok bevacizumab didapatkan lebih tinggi pada kelompok kontrol. Tidak didapatkan hubungan yang bermakna antara ketebalan makula sentral previtrektomi terhadap kadar HIF-1? dan ICAM-1.Kata kunci: retinopati diabetic proliferatif, HIF-1?, ICAM-1, bevacizumab

"ABSTRACT

"Purpose to assess the levels of Hypoxia inducible factor 1 HIF 1 and intercellular adhesion molecule 1 ICAM 1 in vitreous of proliferative diabetic retinopathy patients which were given intravitreal bevacizumab IVB , as well as its relation to the central macular thickness CMT measured prior to vitrectomy.Method this was post test only randomized clinical trial open label, in which thirty two eyes were randomized into two groups, one that received an IVB injection at 1 2 weeks previtrectomy and the control group. Measurement of HIF 1 and ICAM 1 was conducted using enzyme linked immunosorbent assay ELISA . The CMT were measured at the initial visit, prior to vitrectomy, and at follow up time 2, 4, and 12 weeks postoperative using Stratus OCT.Result The mean levels of HIF 1 vitreous ng mg protein in the control group and IVB respectively 0.020 0.006 0.077 and 0.029 0.016 0.21 . Vitreous levels of ICAM 1 ng mL in control group and IVB group were 20.10 3.41 40.16 and 23.33 0.63 68.5 . The mean levels of HIF 1 and ICAM 1 vitreous obtained did not differ significantly between the two groups.Conclusion Intravitreal bevacizumab 1 2 weeks prior to vitrectomy was not enough to make the levels of HIF 1 lower in IVB group. Median of ICAM 1 level in IVB group was higher than control group. There were no correlation between CMT with HIF 1 and ICAM 1 levels. "

Fakultas Kedokteran Universitas Indonesia, 2016

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UI - Tugas Akhir Universitas Indonesia Library

Indra Ihsan

Uji Diagnostik & Nilai Prognostik Presepsin sebagai Biomarker Sepsis pada Anak = Diagnostic & Prognostic Value of Presepsin as Sepsis Biomarker in Children

"Latar belakang: Sepsis sulit dibedakan dengan respon inflamasi non infeksi secara klinis dan kultur darah yang merupakan gold standar diagnosis sepsis memiliki banyak keterbatasan. Presepsin merupakan suatu biomarker baru namun belum banyak data tentang efektifitas penggunaanya pada anak.

Tujuan: Mengetahui nilai diagnostik dan prognostik presepsin dibandingkan dengan leukosit, PCT dan CRP pada pasien anak yang dicurigai sepsis

Method: The latitude cut study was conducted during March-December 2020 at RSCM Jakarta on 56 patients aged 2 months - 10 years with suspicion of sepsis Diagnosis of sepsis is established based on the criteria of sepsis-3 and blood culture. Biomarker examination and PELOD-2 score are performed at the beginning and after 72 hours, mortality assessment is conducted on day 7. Presepsin levels are checked using the PATHFAST® method.
Result: The median value of precessine levels in the proven sepsis group (1183 pg/ml was higher than that of the unproven group of sepsis (369 pg/ml, p=0.001). Precessine has a good diagnostic value (AUC of 0.862), with a cut of 711 pg/ml having a sensitivity of 75.8%, specificity of 82.6%, positive guess value of 86.2% and negative guess value of 70.4%, better than leukocytes, PCT, and CRP. Presepsin levels increased linearly with the severity of sepsis and were moderately correlated with PELOD-2 scores (r=0.548; p=0.001). Survival analysis showed precessine levels of ≥ 1,250 pg/ml were significantly associated with early mortality (HR 6.31; 95%CI; 1.67-23.83; p=0.007). Presepsin levels after 72 hours of antibiotic therapy decreased significantly in the improved sepsis group and increased in the worsening sepsis group.
Inference: Presepsin is a reliable biomarker and can be used to help diagnose sepsis, predict severity, death and evaluate therapies in tertiary hospital services."

Depok: Fakultas Kedokteran Universitas Indonesia, 2021

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UI - Tugas Akhir Universitas Indonesia Library

Segal Abdul Aziz

Kadar procalcitonin dan perannya sebagai biomarker sepsis pada pasien tumor padat dengan metastasis jauh = Level of procalcitonin and its role as a sepsis biomarker in patient with metastatic solid tumor

"ABSTRAK

Latar Belakang: Pengaruh metastasis sebagai penyebab peningkatan procalcitonin

(PCT) pada pasien tumor padat nonsepsis masih belum jelas. Studi-studi

sebelumnya memberikan hasil yang tidak konklusif. Nilai titik potong PCT untuk

diagnosis sepsis pada tumor padat metastasis juga belum diketahui.

Tujuan: Mengetahui peran PCT dalam diagnosis sepsis pada pasien tumor padat

dengan metastasis.

Metode: Studi potong lintang terhadap pasien tumor padat yang berobat di RSCM

September-Desember 2015. Pada pasien ditentukan ada tidaknya sepsis

menggunakan kriteria sepsis ACCP/SCCM 2001, dilakukan pemeriksaan darah

perifer, serta PCT. Dilakukan analisis untuk mengetahui perbedaan kadar PCT

pasien tumor padat metastasis dan tanpa metastasis yang tidak sepsis. Selain itu,

dilakukan pula pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasien

tumor padat metastasis dengan menggunakan ROC.

Hasil dan Pembahasan: Didapatkan 112 pasien tumor padat, pria sebanyak 51%,

dengan rerata usia 47,9 ±12,47 tahun. Sebanyak 71 (63,4%) pasien sudah

didapatkan metastasis, 36 (32,1%) diantaranya sepsis, dan 6 (5,3%) mengalami

SIRS. Dari 41 (36,6%) pasien tanpa metastasis, 9 (8%) mengalami sepsis, dan 5

(4,4%) SIRS. Terdapat perbedaan bermakna kadar PCT pada pasien tumor padat

metastasis dibandingkan tanpa metastasis pada kondisi nonsepsis [0,25 ng/mL

(0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Pasien tumor padat metastasis

yang mengalami sepsis memiliki kadar PCT lebih tinggi dibandingkan nonsepsis

[3,5 ng/mL (0,66-189,4) vs. 0,25 ng/mL (0,07-1,76); p<0,001]. Dari kurva ROC

kadar PCT pada tumor padat metastasis, didapatkan AUC [0,956, IK 0,916-0,996]

untuk mendiagnosis sepsis. Nilai titik potong PCT untuk diagnosis sepsis pada

pasien tumor padat metastasis adalah 1,14 ng/mL dengan sensitivitas 86% dan

spesifisitas 88%.

Kesimpulan: Pada kondisi nonsepsis, kadar PCT pasien tumor padat metastasis

lebih tinggi dibandingkan pasien tanpa metastasis. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis adalah 1,14 ng/mL. ABSTRACT

Background: The effect of metastasis as a cause of increased procalcitonin (PCT)

in patients with solid tumors without sepsis remains unclear. Previous studies did

not provide conclusive results. Cut off point of PCT for sepsis diagnosis in

metastatic solid tumors is also unknown.

Objective: To determine the role of PCT in the diagnosis of sepsis toward

metastatic solid tumors patients.

Methods: A cross sectional study was conducted in solid tumor patients who were

admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December

2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in

patients. Procalcitonin level, as well as routine blood examination, was performed

to determine the differences of PCT level among solid tumor patients with and

without metastasis. Cut off point of PCT for diagnosing sepsis in patients with

metastatic solid tumors was determined using ROC curve.

Results and Discussion: There were 112 patients with solid tumors, 51% male,

with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,

while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41

(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In

the absence of sepsis, the PCT level was significantly higher in patients with

metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)

vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis

had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.

0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis

in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT

for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a

sensitivity of 86% and specificity of 88%.

Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid

tumors is higher than patients without metastasis. Cut off point of PCT for sepsis

diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)