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"Unit Perawatan Intensif (UPI) merupakan bagian rumah sakit yang berfungsi untuk melakukan perawatan pada pasien yang mengalami penyakit dengan potensi mengancam nyawa. Data menunjukkan angka mortalitas pasien UPI dewasa di seluruh dunia memiliki rerata sekitar 10-29%, sedangkan di RSCM berada di kisaran 28,63-33,56%. Keadaan tersebut membuat kemampuan memprediksi luaran mortalitas menjadi penting untuk menentukan perawatan yang tepat. Logistic Organ Dysfunction System (LODS) merupakan salah satu metode skoring yang dapat digunakan untuk memprediksi luaran mortalitas pasien, namun penelitian untuk menguji hal tersebut belum pernah dilakukan di Indonesia. Penelitian ini bertujuan untuk menilai kemampuan skor LODS dalam memprediksi luaran mortalitas pasien dewasa UPI RSCM. Penelitian ini menggunakan 331 sampel data rekam medik pasien UPI RSCM, didapati hasil bahwa rerata pasien meninggal memiliki skor LODS yang lebih besar daripada pasien yang hidup, yaitu rerata 5,854 (median: 6) pada pasien meninggal, dan rerata 2,551 (median: 2) pada pasien yang hidup. Pada uji kalibrasi, didapati hasil Hosmer-Lemeshow test sebesar 0,524, yang menandakan hasil uji kalibrasi yang baik (>0,05). Sedangkan pada uji diskriminasi menggunakan kurva Receiver Operating Characteristic (ROC), nilai Area Under the Curve (AUC) sebesar 79,2%, yang menandakan kemampuan diskriminasi dari skor LODS cukup (70-80%). Hasil tersebut menunjukkan bahwa skor LODS dapat digunakan sebagai salah satu acuan dalam memprediksi luaran mortalitas pasien UPI RSCM.

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Intensive Care Unit (ICU) is the part of hospital that do the care for patients with disease that threaten their life. Data shows that the mortality rate in ICU in the whole world revolved aroung 10-29%, and in RSCM revolved around 28,63-33,56%. This condition makes the ability to predict mortality outcome become important to help decide the correct treatment. Logistic Organ Dysfunction System (LODS) is one of scoring method that is able to help predict patients mortality outcome, but there is still no study for this scoring method for adult patients in Indonesia. This study inteded to evaluate the ability of LODS scoring in predicting ICU RSCM patients mortality outcome. This study used 331 ICU RSCM patients as its samples, and the result shows that the mean LODS score of the patients that died is greater than the one that lives, the mean LODS score of the patients that died is 5,854 (median: 6), and the mean score of the patients that lives is 2,551 (median: 2). In calibration test using Hosmer-Lemeshow test, the result shows a good outcome that is 0,524 (P>0,05). While in discrimantion test using Receiver Operating Characteristic (ROC) curve, the Area Under the Curve (AUC) value is 79,2%, showing that the ability of LODS score to discriminate is sufficient. This results show that LOD score can be used as one of the refference to predict patients mortality outcome in ICU RSCM."

"Latar Belakang: Mortalitas pasien UPI lebih tinggi dari pasien rawat lainnya. Instrumen prediktor mortalitas pada pasien UPI dapat membantu untuk melakukan stratifikasi risiko dan pengambilan keputusan klinis dalam tatalaksana pasien. Skor LODS merupakan salah satu instrumen yang terbukti memiliki keunggulan dibandingkan intrumen prediktor yang saat ini digunakan di UPI RSCM. Meskipun demikian, komponen skor LODS membutuhkan pemeriksaan yang tidak murah sehingga sulit diaplikasikan terutama pada pasien tanpa jaminan kesehatan. Bersihan laktat merupakan alternatif yang lebih murah dan ditemukan memiliki kemampuan prediktor mortalitas yang baik pada penelitian sebelumnya.Tujuan: Mengetahui perbandingan kemampuan prediktor bersihan laktat dengan skor LODS terhadap mortalitas pasien dalam 30 hari pasien yang dirawat di UPI RSCM.Metode: Penelitian ini adalah studi kohort retrospektif menggunakan data rekam medis pasien UPI RSCM yang dirawat pada rentang Agustus 2015 – April 2018. Data yang di ambil berupa karakteristik, skor LODS hari pertama, laktat inisial, laktat 6-24 jam serta terjadi atau tidaknya mortalitas dalam 30 hari. Hubungan antara skor LODS dengan mortalitas dianalisis dengan regresi logistik sederhana, sementara hubungan antara bersihan laktat dan mortalitas dinilai dengan uji chi square. Kemampuan diskriminasi keduanya dinilai dengan analisis kurva ROC sementara kemampuan kalibrasi dinilai dengan uji goodness of fit Hosmer-Lemeshow. Kemampuan diagnostik dinilai dengan menghitung sensitivitas, spesifisitas, PPV, NPV, LR positif, serta LR negatif. Kemampuan diskriminasi, kalibrasi, serta diagnostik diantara skor LODS dan bersihan laktat kemudian dibandingkan.Hasil: Dari 388 subjek yang dianalisis, didapatkan bersihan laktat memiliki diskriminasi lemah (AUC 0,597), kalibrasi lemah (Uji Hosmer-Lemeshow p<0,001), sensitivitas 65% (IK95% 48,3% - 79,3%), spesifisitas 54,3% (IK95% 48,9% - 59,6%), PPV 14,1% (IK95% 11,2% - 17,4%), NPV 93,1% (IK95% 89,7% - 95,4%), LR positif 1,420 (IK95% 1,10 – 1,84), dan LR negatif 0,640 (IK95% 0,42 – 0,99), dalam memprediksi mortalitas pasien dalam 30 hari di UPI RSCM. Sementara Skor LODS memiliki diskriminasi baik (AUC 0,79), kalibrasi baik (Uji Hosmer-Lemeshow p=0,818), sensitivitas 77,5% (IK95% 64,6% - 90,4%), spesifisitas 63,8% (IK95% 58,8% - 68,8%), PPV 19,7% (IK95% 13,4% - 25,9%), NPV 96,1% (IK95% 93,6% - 98,6%), LR positif 2,140 (IK95% 1,72 – 2,66), dan LR negatif 0,353 (IK95% 0,20 – 0,63), dalam memprediksi mortalitas pasien dalam 30 hari di UPI RSCM.Kesimpulan: Performa bersihan laktat dari segi kemampuan diskriminasi, kalibrasi, atau diagnostik tidak lebih baik dari skor LODS dalam memprediksi mortalitas pasien dalam 30 hari di UPI RSCM.

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Backgrounds: The mortality rate of ICU patients is higher than other inpatients. The mortality predicting tools of ICU patients can help a physician stratify the risk and make the clinical decision in patient management. The LODS score is one of the tools that has been proven better than predictor instruments currently used at RSCM ICU. However, the component of the LODS score requires an expensive examination, so it is difficult to apply, especially to patients without health insurance. Lactate clearance is a cheaper alternative and was found to have a good predictive ability of mortality in previous studies.

Objective: This study aimed to compare the predictor ability of LODS scores with lactate clearance on 30-days-patient-mortality treated at RSCM ICU.

Method: This was a cohort retrospective study using the medical records of RSCM ICU patients who were treated between August 2015 – April 2018. The data were demographic characteristics, first-day LODS score, initial lactate, lactate in 6-24 hours, and 30-days-patient-mortality. The relationship between LODS scores and mortality was analyzed with simple logistic regression, while the chi-square test assessed the relationship between lactate clearance and mortality. Discrimination ability was assessed by ROC curve analysis, while the Hosmer-Lemeshow goodness of fit test assessed calibration ability. Diagnostic ability was assessed by calculating sensitivity, specificity, PPV, NPV, positive LR, and negative LR. Discrimination, calibration, and diagnostic capabilities between LODS scores and lactate clearance were then compared between groups.

Results: From 388 subjects analyzed, lactate clearance was found to have weak discrimination (AUC 0.597), weak calibration (Hosmer-Lemeshow test p<0.001), sensitivity 65% ​​(CI 95% 48.3% – 79.3%), specificity 54 ,3% (95% CI 48.9% – 59.6%), PPV 14.1% (95% CI 11.2% – 17.4%), NPV 93.1% (95% CI 89.7% – 95 0.4%), positive LR 1.420 (95% CI 1.10 – 1.84), and negative LR 0.640 (95% CI 0.42 – 0.99), in predicting patient mortality within 30 days at RSCM ICU. Meanwhile, the LODS score had good discrimination (AUC 0.79), good calibration (Hosmer-Lemeshow test p=0.818), sensitivity 77.5% (95% CI 64.6% – 90.4%), specificity 63.8% (95% CI 58.8% – 68.8%), PPV 19.7% (95% CI 13.4% – 25.9%), NPV 96.1% (95% CI 93.6% – 98.6%), positive LR 2.140 (95% CI 1.72 – 2.66), and negative LR 0.353 (95% CI 0.20 – 0.63), in predicting patient mortality within 30 days at RSCM ICU.

Conclusion: Lactate clearance performance in terms of discriminatory ability, calibration, or diagnostic performance was not better than the LODS score in predicting patient mortality within 30 days at RSCM ICU."

"Seluruh aspek kehidupan telah dipengaruhi oleh pandemi COVID-19 termasuk bidang kesehatan. Disisi lain, terdapat peningkatan jumlah penderita kanker setiap tahunannya. Hubungan karakteristik klinis kanker ginekologi dengan infeksi COVID-19 terhadap mortalitas belum banyak diteliti. Dalam penelitian ini digunakan metode retrospective cross-sectional yang menggunakan data pasien penderita kanker ginekologi dengan infeksi COVID-19 yang terdaftar pada Departemen Obstetri Ginekologi RSPUN Dr. Cipto Mangunkusumo pada tahun 2020-2022. Penelitian ini menggunakan analisis uji Chi Square untuk menentukan variable yang akan dimasukan kedalam analisis regresi logistik backward stepwise. Dalam penelitian ini ditemukan usia >59 (OR, 0.020; Cl 95% 0.001-0.577; P= 0.023), anemia(OR,0.053; Cl 95% 0.005-0.565; P= 0.015), ARDS (OR, 50,010; CL 95%, 1,145-2185.101; P = 0.042), Hyperkalemia (OR, 11,189; Cl 95% 1,491-83.992; P = 0.019), Sepsis (OR, 18,386; Cl 95% 2,220-152.253; P= 0.007), ECOG >2 (OR, 12.859; Cl 95% 2.582-64.020; P= 0.002), and Degree of Severe-Critical COVID-19 (OR, 111.310; Cl 95% 3.961-3128.117; P= 0.006). Dapat disimpulkan ARDS, hyperkalemia, sepsis, ECOG >2, dan derajat COVID-19 berat-kritis memiliki signifikansi baik terhadap statistik maupun klinis dengan mortalitas, namun usia > 59 dan anemia secara klinis tidak memiliki signifikansi.

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All aspects of life have been affected by the COVID-19 pandemic, including the health sector. On the other hand, the number of cancer patients is continuously increasing every year. The relationship between clinical characteristics of gynecological cancer with COVID-19 infection and mortality has not been widely studied. This study used a retrospective cross-sectional method using data on patients with gynecological cancer with COVID-19 infection registered in the gynecology department of Dr. Cipto Mangunkusumo Hospital in 2020-2022. This study used chi-squared test analysis to determine the variables to be included in backward stepwise logistic regression analysis. In this study, it was found that age >59 (OR, 0.020; Cl 95% 0.001-0.577; P = 0.023), anemia (OR, 0.020; Cl 95% 0.001-0.578; p= 0.023), ARDS (OR, 48.796;  Cl 95%, 1.131-2105.921; P=0.043), hyperkalemia (OR, 10.960; Cl 95% 1.462-82.187; p= 0.020), sepsis (OR, 18.087; Cl 95% 2.192-149.271; P= 0.007), ECOG >2 (OR, 12.629; Cl 95% 2.538-62.854; P= 0.002), and degree of severe-critical COVID-19 (OR, 108.771; Cl 95% 3.917-3020.095; P= 0.006). It can be concluded that ARDS, hyperkalemia, sepsis, ECOG >2 and degree of severe-critical COVID-19 have both statistical and clinical significance with mortality, but age >59 and anemia have no clinical significance."

"Latar Belakang: Di negara maju, angka mortalitas gastroskisis adalah 5-10%, berbeda dengan di negara berkembang. Angka mortalitas gastroskisis mencapai 52% di Brazil, 43% di Afrika Selatan, 35% di Iran, dan 79% di Jamaika. Di RSUPN Cipto Mangunkusumo (RSCM), sampai saat ini belum ada data mengenai angka mortalitas gastrosksis. Angka mortalitas gastroskisis di RSCM perlu diketahui karena karakteristik pasien yang diperkirakan berbeda dengan di negara maju. Tujuan dari penelitian ini adalah untuk mengetahui angka mortalitas gastroskisis di RSCM serta mengidentifikasi faktor risiko yang berpengaruh terhadap mortalitas gastroskisis, antara lain: usia kehamilan, berat badan lahir, jumlah operasi, usia saat operasi pertama kali, serta gastroskisis komplikata.Metode: Metode penelitian ini adalah studi kohort retrospektif dengan total sampling seluruh neonatus yang menjalani operasi penutupan defek di RSCM dari Januari 2015 – September 2020. Analisis bivariat dilakukan menggunakan uji Chi Square atau uji Fisher. Didapatkan 49 subjek neonatus dengan 7 data masuk kategori drop out sehingga 42 subjek diambil untuk dianalisis.Hasil: Angka mortalitas neonatus dengan gastroskisis di RSCM tahun 2015-2020 adalah 69% (29 dari 42 subjek). Pada penelitian ini didapatkan usia saat operasi (<1 hari) berpengaruh menurunkan angka mortalitas gastrosksis (p = 0,005). Usia kehamilan, berat badan lahir, jumlah operasi, dan gastroskisis komplikata didapatkan tidak berpengaruh terhadap angka mortalitas gastroskisis.Kesimpulan: Angka mortalitas gastrokisis di RSCM adalah 69% dan dipengaruhi oleh usia saat operasi.

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Background: Unlike developing countries, the mortality rate of gastroschizis in developed countries is much lower, accounting at 5-10%. In developing countries, for example, Brazil, the mortality rate can reach up to 52%, 43% in South Africa, 35% in Iran, and 79% in Jamaica. Until recently, there are no data regarding gastrochizis-related mortality rate in Cipto Mangkunkusumo National Referral Hospital, Indonesia. This is important as it reflects patient characteristics that is different with developed countries. The objective of this research is to find out the mortality rate of gastroschizis in Indonesia along with other possible influencing risk factors such as; gestational age, birth weight, number of operations, age at closure, and the presence of complicated gastroschizis.

Methods: A cohort retrospective study with total sampling is used to document all neonates who undergo defect closure surgery from January 2015 to September 2020. Bivariate analysis is done using Chi Square test or Fisher test. A total of 49 neonates were documented, however 7 neonates were excluded due to drop out criteria, resulting in 42 neonates who were included in the analysis.

Results: The mortality rate of gastroschizis in Cipto Mangkunkusumo National Referral Hospital is 69% (29 out of 42 subjects). The age at closure is related to lower mortality rate (p = 0.005), while other factors such as gestational age, birth weight, number of operations, and the presence of complicated gastroschizis has no impact on mortality.

Conclusions: The mortality rate of gastroschizis in Cipto Mangkunkusumo National Referral Hospital is 69% and is influenced by age at closure."

"Introduksi:Untuk menilai apakah kadar defisit basa inisial dapat menjadi prediktor mortalitas di UPIPasien dan metode:Studi retrospektif selama periode November 2004 sampai Oktober 2005 yang dilakukan di UPI medis-bedah. Data diarnbil dari rekam medik: defisit basa dan variabel untuk skor SAPS II serta dinilai keluaran pasien (mati atau hidup). Kurva Receiver Operating dibuat, titik potong optimal ditentukan dan dinilai prognostik dari defisit basa inisial dan SAPS II. Koefisien Pearson digunakan untuk menilai hubungan antara defisit basa inisial dan skor SAPS U.Hasil:Dui 456 pasien yang dievaluasi, 40 pasien (9,4%) meninggal di UPI. Kelompok survivor memiliki rerata defisit basa inisial yang lebih rendah dibandingkan kelompok nonsurvivor. Terdapat perbedaan yang bermakna antara defisit basa inisial dengan mortalitas UPI (p=0,000). Titik potong ditetapkan pada -4,2 mmolll. Analisa ROC menunjukkan defisit basa inisial (AUC=0,711) lebih buruk dibandingkan skor SAPS II (AUC=0,98) sebagai prediktor mortalitas_ Terdapat hubungan yang lemah antara defisit basa inisial dan skor SAPS II.Kesimpulan:Defisit basa inisial dan skor SAPS II yang tinggi secara independen berhubungan dengan peningkatan mortalitas di UPI RSCM.

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Introduction :

To examine initial base deficit could be used as a predictor of mortality in ICU

Patients & methods:

A retrospective study over a period from November 2004 until Oktober2005 was conducted in a medical-surgical ICU. Data were extracted from ICU medical records: the base deficits and variables for SAPS II score and also the outcome of those patients (survivor or nonsurvivor). Receiver Operating Curve were constructed, the optimal cut offpoint have been obtained and area under curve was used to asses the prognostic value of initial base deficit and SAPS IL The coefficient of Pearson were analyzed to asses the relation between initial base deficit and SAPS II score.

Main outcome:

Of the 456 evaluable patients, 40 patients (9,4%),were died in ICU Survivor had lower mean of initial base deficit than nonsurvivor. There are a significant differences between initial base deficit and ICU mortality (p= 0, 000). The cut off point was obtained at -4,2 mmol II. ROC analysis demonstrated that initial base deficit (AUC=O, 711) is worsen than SAPS II Score (A UC=0, 98) as predictor mortality. There is a weak correlation between initial base deficit and SAPS II score.

Conclusion:

A high initial base deficit and SAPS II score are independently associated with increased ICU mortality in Cipto Mangunkusumo Central Hospital."

"Pendahuluan:Peningkatan kadar laktat pada saat masuk UPI secara independent berhubungan dengan outcome yang buruk. Kadar laktat sebagai parameter prognostik di UPI RSCM belum pemah diteliti sebelumnya. Pada penelitian pendahulu, skor SAPS II menunjukkan kemampuan yang baik dalam memprediksi mortalitas di UPI. Penelitian ini bertujuan membandingkan kadar laktat arteri inisial dengan SAPS II sebagai prediktor mortalitas di UPI RSCM.Pasien & Metode:Suatu studi observasi yang prospektif selama periode bulan April sampai Juni 2006 yang dilakukan di UPI bedah-medik. Data dikumpulkan dari 153 pasien yang memenuhi kriteria penerimaan. Data dasar: kadar laktat arteri inisial pada sate jam pertama masuk UPI dan 24 jam pertama untuk skor SAPS II. Mortalitas UPI pun dicatat. Analisis statistik menggunakan Uji Student t and chi-square. Kurva ROC (Receiver Operating Curve) dibuat dan titik potong optimal ditetapkan serta luas daerah di bawah kurva dihitung, untuk menilai untuk nilai prognostik kadar laktat arteri inisial dan SAPS II. Koefisien Pearson digunakan un tuk menganalisa hubungan antara kadar laktat inisial dan skor SAPS II.Hasil:Dari 153 pasien yang memenuhi kriteria, 16 pasien (10,5%) mengalami kematian di UPI. Kelompok survivor memiliki rerata kadar laktat arteri inisial dan skor SAPS II yang lebih rendah dibandingkan kelompok nonsurvivor. Terdapat perbedaan yang berrnakna antara kadar laktat dan mortalitas UPI (p=0,001). Titik potong ditetapkan 3 mmolll. Analisis ROC menunjukkan bahwa kadar laktat arteri inisial (leas daerah di bawah kurva=0,732) tidak lebih baik bila dibandingkan dengan skor SAPS II (luas daerah di bawah kurva=0,915) sebagai prediktor mortalitas di UPI. Terdapat hubungan yang lemah antara kadar laktat arteri inisial dan SAPS II (p=0,002).Kesimpulan:Kadar laktat arteri inisial dan skor SAPS H yang tinggi secara independent berhubungan dengan peningkatan mortalitas UPI di UPI RSCM.

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Introduction:

Elevated lactate levels on ICU admission have been independently associated with poor outcome. The prognostic values of this value have not been investigated in Cipto Mangunkusumo Hospital's ICU

Patients & Methods:

A prospective observational study over a periode from April to June 2006 was conducted in a medical-surgical ICU. Data were extracted from ICU data base: arterial blood lactate at the first hour on admission and the worst clinical & laboratory findings in the first 24 hours for SAPS II scoring. ICU mortality are also recorded. Statistical analyses were performed using Student t-test and chi-square tests_ Receiver Operating Curve were constructed, the optimal cut off point have been obtained and area under curve was used to assess the prognostic value of initial arterial lactate and SAPS H. The coefficient of Pearson were analyzed to assess the relation between initial lactate levels and SAPS II score.

Main Outcome:

Of the 153 evaluable patients, 16 patients (10.5%) were died in ICU Survivor had a lower mean of arterial lactate levels and SAPS II score than nonsurvivor). The mean of initial arterial lactate in survivor group is low than the nonsurvivor. There are a sign{flcant differences between initial lactate level and ICU mortality (p=0,001). The cut off point was obtained at 3.0 mmolll. ROC analysis demonstrated that initial arterial lactate level (AUC=0.732) is worsen than SAPS II Score (AUC=0,915) as a predictor of ICU mortality. There is a weak correlation between initial lactate and SAPS II score.

Conclusion:

An high initial arterial lactate and SAP II score are independently associated with increased ICU mortality in Cipto Mangunkusumo Central Hospital."

"Latar Belakang: Stratifikasi risiko dan prediksi prognosis pasien yang menjalani perawatan di Unit Perawatan intensif (UPI) merupakan hal yang penting dalam tatalaksana pasien UPI. Logistic Organ Dysfunction System (LODS) merupakan sistem penilaian disfungsi organ yang mencatat skor penilaian hanya dari kondisi fisiologis pasien. LODS dikembangkan untuk stratifikasi tingkat keparahan penyakit dan dapat digunakan untuk memprediksi mortalitas pasien di unit perawatan intensif (UPI).Tujuan: Penelitian ini bertujuan untuk mengetahui kesahihan penilaian LODS dalam memprediksi mortalitas pasien-pasien yang dirawat di UPI RSCM.Metode: Penelitian ini adalah studi kohort retrospektif menggunakan data rekam medis pasien yang dirawat di UPI RSCM Januari-Desember 2017. Dilakukan pencatatan skor LODS hari pertama perawatan UPI, selanjutnya dinilai kondisi pasien 30 hari, apakah pasien meninggal atau bertahan hidup. Prediksi mortalitas penilaian LODS didapat melalui regresi logistik sederhana. Kemampuan prediksi mortalitas LODS dilakukan dengan analisis diskriminasi dengan ROC untuk mencari nilai AUC, dan ketepatan prediksi mortalitas dilakukan dengan analisis kalibrasi uji goodness of fit Hosmer Lemeshow. Dilakukan analisis bivariat dilanjutkan dengan analisis multivariat dengan persamaan regresi logistik berganda untuk melihat variabel yang paling bermakna dalam prediksi mortalitas.Hasil: Dari 498 subjek yang dirawat di UPI RSCM, mayoritas pasien merupakan kasus bedah elektif, didapatkan LODS mempunyai nilai diskriminasi dan kalibrasi yang baik dengan AUC= 0,81 (IK95% 0,74-0,87) dan hasil uji Hosmer-Lemeshow kalibrasi p=0,94. Nilai titik potong ditetapkan pada nilai LODS=3, dimana sensitivitas 80,8%, spesifisitas 63,2%, PPV 20,4%, NPV 96,6%, likelihood ratio positif 2,2 dan likelihood ratio negatif 0,3. Variabel LODS yang secara statistik mempunyai pengaruh kuat terhadap mortalitas 30 hari adalah penggunaan ventilasi mekanik dan rasio PaO2/FiO2, kreatinin dan bilirubin, dengan rumus model akhir regresi logistik y= -3,877 + (3,339 x PaO2/FiO2 <150) + (2,226 x kreatinin 1,2-1,59mg/dL) + ( 1,384 x bilirubin >2 mg/dL) + (1,369 x PaO2/FiO2 >150) + (1,33 x kreatinin <1,2mg/dL).Simpulan: Sistem penilaian LODS hari pertama sahih dalam memprediksi mortalitas 30 hari pasien di UPI RSCM.

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Background : Risk stratification and prognosis prediction for ICU patients are essentials for medical management. Logistic Organ Dysfunction System (LODS) is a scoring system which objectively evaluate ICU patients’ physiological condition and can be used to determine organ severity stratification and to predict mortality.Objective: This study was conducted to evaluate the validity of LODS in predicting mortality of ICU patients in Cipto Mangunkusumo Hospital (RSCM), Jakarta.Methods : We retrospectively reviewed medical records of ICU patients who were admitted in January-December 2017. We calculated LODS score from the first 24-hour ICU admission, and we recorded the patients’ outcome (mortality) in 30 days. Mortality prediction was calculated from simple logistic regression. The LODS performance was analyzed with Receiver Operating Characteristics (ROC) to evaluate area under the curve (AUC) for discrimination analysis, and the precision was analyzed with Hosmer Lemeshow goodness of fit. We evaluated bivariate analysis and multivariate logistic regression to determine the most significant variable as mortality predictor.Results: The majority case from 498 subjects admitted in ICU of Cipto Mangunkusumo Hospital were elective surgeries. LODS had a good discrimination and calibration, with AUC 0.81 (95% CI 0.74-0.87) and p = 0.94 with Hosmer Lemeshow goodness of fit test. Cut off LODS value was 3, with sensitivity 80.8%, specificity 63.2%, PPV 20.4%, NPV 96.6%, positive likelihood ratio 2.2, and negative likelihood ratio 0.3. Three variables were statististically significant in predicting 30 days mortality: mechanical ventilation and PaO2/FiO2, creatinine and bilirubin with final model equation y = -3,877 + (3,339 x PaO2/FiO2 <150) + (2,226 x kreatinin 1,2-1,59 mg/dL) + ( 1,384 x bilirubin >2 mg/dL) + (1,369 x PaO2/FiO2 >150) + (1,33 x kreatinin <1,2mg/dL).Conclusion: First day LODS score is valid in predicting 30 days mortality of ICU patients in RSCM"

"Latar Belakang: COVID-19 telah ditetapkan WHO sebagai Kedaruratan Kesehatan Masyarakat Yang Meresahkan Dunia dengan case fatality rate (CFR) di Indonesia mencapai 8,7% pada April 2020. Sampai saat ini belum ada biomarker prognosis untuk membedakan pasien yang membutuhkan perhatian segera dan menjadi prediktor mortalitas COVID-19 di ICU. Skor Simplified Acute Physiology Score 3 (SAPS 3) menilai kondisi pasien sejak pertama kali datang ke rumah sakit dan mengevaluasi data yang diperoleh saat masuk ICU dalam menentukan prediktor mortalitas 28 hari. Tujuan: Studi ini menganalisis hubungan skor SAPS 3 dengan mortalitas 28 hari pada pasien COVID-19 yang dirawat di ICU RSCM dan RSUI. Metode: Penelitian ini merupakan studi kohort retrospektif di Rumah Sakit Cipto Mangunkusumo selama bulan Maret-Agustus 2020. Sebanyak 208 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Data demografis dan penilaian skor SAPS 3 dicatat sesuai data rekam medis. Variabel SAPS 3 yang berpengaruh terhadap mortalitas 28 hari dilakukan analisis bivariat dan regresi logistik multivariat. Kesahihan dinilai menggunakan uji diskriminasi dengan melihat Area Under Curve (AUC) dan uji kalibrasi Hosmer Lemeshow. Titik potong optimal ditentukan secara statistik. Hasil: Angka mortalitas 28 hari akibat COVID-19 periode Maret-Agustus sebesar 43.8%. Variabel SAPS 3 yang secara statistik berpengaruh signifikan (p<0.05) terhadap mortalitas 28 hari pasien COVID-19 di ICU adalah usia, riwayat penggunaan obat vasoaktif sebelum masuk ICU, penyebab masuk ICU (defisit neurologis fokal dan gagal napas), kadar kreatinin dan trombosit. Skor SAPS 3 menunjukkan nilai diskriminasi yang baik (AUC 80.5% Interval Kepercayaan 95% 0.747-0.862) dan kalibrasi yang baik (Hosmer-Lemeshow p=0.395). Titik potong optimal skor SAPS 3 adalah 39 dengan sensitivitas 70.3% dan spesifisitas 74.4%. Kesimpulan: Skor SAPS 3 memiliki hubungan dengan mortalitas 28 hari pada pasien COVID-19 yang dirawat di ICU.

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Background: COVID-19 has been declared as a Public Health Emergency of International Concern by WHO with case fatality rate (CFR) of 8,7% in April 2020 in Indonesia. Until now, there is no prognostic biomarker to differentiate patients who require immediate attention and be a mortality predictor for COVID-19 patients in ICU. Simplified Acute Physiology Score 3 (SAPS 3) score assessed the patient’s condition since the first time he came to the hospital and evaluated the data obtained in the first hour of admission to the ICU in predicting 28-days mortality. Goals: This study aims to analyze the correlation between SAPS 3 score and 28-days mortality caused by COVID-19 in the ICU RSCM and RSUI.

Methods: This retrospective cohort study was conducted in Cipto Mangunkusumo Hospital from March to August 2020 on 208 subjects who met the inclusion criteria. Demographic data and SAPS 3 score were recorded, the data was taken from medical records. Bivariate and multivariate logistic regression was used to investigate the relationship between SAPS 3 variables and 28-days mortality. The validity of SAPS 3 score was assessed by measurement of the Area Under Curve (AUC) and Hosmer- Lemeshow calibration test. The optimal cut-off point was determined statistically.

Results: The mortality rate of COVID-19 in our study from March to August 2020 is 43.8%. Five SAPS 3 variables were found to be significantly associated with 28-days mortality of COVID-19 patients in the ICU (p<0.05) are age, use of vasoactive drugs before ICU admission, reason for ICU admission (focal neurologic defisit and respiratory failure), creatinine, and thrombocyte level. SAPS 3 showed a good discrimination ability (AUC 80.5% Confidence Interval 95% 0.747-0.862) and calibration ability (Hosmer-Lemeshow p=0.395). The optimal cut off point of SAPS 3 score was 39 with sensitivity 70.3% and specificity 74.4%.

Conclusion: SAPS 3 score have a correlation with 28-days mortality caused by COVID-19 in the ICU."

"ABSTRACTBackground: to identify other factors other than the TIMI scores that can be used as predictors of 30-day mortality in STEMI patients by including variables of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) at Cipto Mangunkusumo National Central General Hospital. Methods: a retrospective cohort study was conducted in 487 STEMI patients who were hospitalized at RSUPN Cipto Mangunkusumo between 2004 and 2013. Sample size was calculated using the rule of thumbs formula. Data were obtained from medical records and analyzed with bivariate and multivariate method using Coxs Proportional Hazard Regression Model. Subsequently, a new scoring system was developed to predict 30-day mortality rate in STEMI patients. Calibration and discrimination features of the new model were assessed using Hosmer-Lemeshow test and area under receiver operating characteristic curve (AUC). Results: bivariate and multivariate analyses showed that only two variables in the new score system model were statistically significant, i.e. the Killip class II to IV and GFR with a range of total score between 0 and 4,6. Thirty-day mortality risk stratification for STEMI patient included high, moderate and low risks. The risk was considered high when the total score was >3,5 (46,5%). It was considered moderate if the total score was between 2,5 and 3,5 (23,2%) and low if the total score was <2,5 (5,95%). Both variables of the score had satisfactory calibration (p > 0,05) and discrimination (AUC 0,816 (0,756-0,875; CI 95%). Conclusion: There are two new score variables that can be used as predictors of 30-day mortality risks for STEMI patients, i.e. the Killip class and GFR with satisfactory calibration and discrimination rate."

"ABSTRAKUdang windu (Penaeus monodon Fab.) mempunyai pertumbuhan yang baik pada salinitas 10-25 ppt. Tetapi di Indonesia hanya sedikit tambak yang selama setahun penuh dengan kisaran salinitas tersebut. Pada musim hujan, salinitas tambak cenderung turun menjadi 5-10 ppt dan di musim panas salinitas tambak naik menjadi 34-70 ppt.Penelitian ini bertujuan untuk mengetahui: (1) Mortalitas dan batas toleransi udang windu stadium juwana terhadap salinitas; (2) Kisaran preferensi udang windu stadium juwana terhadap salinitas; (3) Pengaruh salinitas terhadap jumlah pakan yang dikonsumsi dan lamanya pakan berada dalam tubuh udang windu stadium juwana.Dari grafik Lethal Dose 50 % (LD50) diketahui bahwa udang windu stadium juwana pada salinitas rendah mempunyai batas toleransi 3,6 ppt dan salinitas tinggi pada 44,5 ppt. Dari hasil uji preferensi dapat disimpulkan bahwa udang windu stadium juwana menyenangi kisaran salinitas 19-23 ppt. Sedangkan dari hasil uji anava satu faktor menunjukkan bahwa salinitas tidak berpengaruh terhadap jumlah pakan yang dikonsumsi dan lamanya pakan berada dalam tubuh udang windu stadium juwana.ABSTRACT"