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"Latar Belakang: Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif. Tujuan: Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode: Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox.Hasil: Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan: Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

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Background: Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives: Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM. Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results: Of the 126 subjects, there was 1 subject who lost to follow up. The 30- days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298- 5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion: Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."

"Latar Belakang. Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif.Tujuan. Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode. Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox. Hasil. Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan. Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

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Background. Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives. Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM.

Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results. Of the 126 subjects, there was 1 subject who lost to follow up. The 30-days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298-5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion. Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."

"Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo.

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Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia.

Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo.

Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test.

Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86.

Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital."

"ABSTRAKLatar Belakang: Pasien cedera kepala sedang (CKS) dan cedera kepala berat (CKB) memerlukan perawatan di rumah sakit sehingga beresiko terkena infeksi nosokomial seperti pneumonia yang dapat memperburuk keluaran. Karena banyaknya faktor yang dapat mempengaruhi keluaran pasien cedera kepala dengan pneumonia, diperlukan suatu sistem skoring untuk menilai derajat keparahan pneumonia.Tujuan: Untuk mengetahui apakah sistem skoring CURB-65 dapat dipakai untuk memprediksi keluaran pasien CKS dan CKB yang mengalami pneumonia.Metode: Penelitian ini merupakan studi prospektif. Subjek penelitian adalah seluruh pasien CKS dan CKB yang dirawat di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta selama periode penelitian. Diagnosis pneumonia ditegakkan sesuai kriteria The Center for Disease Control (CDC). Penilaian derajat keparahan pneumonia dilakukan dengan skoring CURB-65. Keluaran yang dinilai adalah hidup atau meninggal.Hasil: Dari 176 pasien CKS dan CKB, terdapat 26 pasien yang menderita pneumonia. Rentang usia subjek penelitian adalah 15 - 71 tahun. Sebagian besar berjenis kelamin laki-laki dan berusia < 65 tahun. Nilai maksimal dari CURB-65 pada penelitian ini adalah 3. Sedangkan nilai yang terbanyak adalah 2. Nilai CURB-65 ditemukan tidak bermakna sebagai prediktor keluaran pasca cedera kepala. Keluaran pasien cenderung dipengaruhi variabel usia, penurunan kesadaran, peningkatan kadar BUN, dan peningkatan frekuensi napas. Diantara 5 pasien yang meninggal, ada 2 pasien yang memiliki nilai CURB-65 = 3, sehingga tampak adanya kecenderungan peningkatan mortalitas pada pasien-pasien dengan nilai CURB-65 = 3.Kesimpulan: Walaupun skoring CURB-65 tidak bermakna sebagai prediktor keluaran pada pasien CKS dan CKB dengan pneumonia, penelitian pendahuluan ini menemukan adanya kecenderungan pengaruh masing-masing komponen CURB-65 (penurunan kesadaran, frekuensi napas, kadar BUN, serta usia) terhadap resiko kematian pasien

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ABSTRACTBackground: Patients with moderate and severe traumatic brain injury (TBI) require hospitalization, therefore they have higher risk in developing nosocomial infections such as pneumonia which can worsen their outcomes. Since there are many factors that can affect outcome of head-injured patients with pneumonia, a scoring system for evaluating the severity of pneumonia is needed.Objective: To know whether the CURB-65 scoring system can be used to predict the outcome of moderate and severe TBI patients who developed pneumonia during hospitalization.Methods: This was a prospective study. The study subjects were all moderate and severe TBI patients who had been hospitalized in Cipto Mangunkusumo Hospital during the research period. Diagnosis of pneumonia was confirmed if the patient fulfiled the criteria from The Center for Disease Control (CDC). The severity of pneumonia was determined by using CURB-65 scoring system. The outcome would either be dead or alive.Results: Of 176 patients with moderate and severe TBI, there were 26 patients who developed pneumonia. The age of the subjects ranged between 15 to 71 years. Most of them were male and over the age of 65. The maximum score of CURB-65 was 3. The mode of CURB-65 score was 2. CURB-65 was shown to be not useful in predicting outcome of head-injured patients with pneumonia. The outcome was seemingly associated with age, loss of consciousness, BUN, and respiratory rate. Among 5 patients who were dead, there were 2 patients who had a CURB-65 score of 3, thus there was a trend of increasing mortality in patients with a CURB-65 score of 3.Conclusions: Although the CURB-65 scoring system was not found to be useful in predicting outcome of moderate and severe TBI patients, this preliminary study have found that there were a tendency that each component of CURB-65 (loss of consciousness, respiratory rate, BUN, age) have some effects on mortality. "

"Pneumonia komunitas adalah penyebab kematian terbesar di Indonesia. Sistem skor PSI dan CURB-65 telah digunakan dalam menentukan keparahan penyakit dan keputusan tempat rawat berdasarkan risiko kematian dalam 30 hari. Tujuan penelitian ini adalah membandingkan sistem skor modifikasi PSI dan modifikasi CURB-65 pada pasien CAP sebagai prediktor mortalitas 30 hari di RS Persahabatan. Penelitian ini adalah kohort prospektif yang dilakukan pada pasien CAP yang dirawat di RS Persahabatan sejak bulan Oktober 2012-Maret 2013. Gejala klinis nilai laboratorium, foto toraks, penyakit penyerta skor PSI dan CURB-65 serta hasil akhir berupa kematian dicatat untuk dianalisis. Selama 30 hari subjek penelitian diikuti. Sebanyak 167 pasien CAP mengikuti penelitian ini didapatkan angka kematian sebesar 18,6%. Sensitivitas PSI sama dengan CURB-65 yaitu sebesar 77,4%. Spesifisitas PSI sedikit lebih tinggi dari pada CURB-65 (58,1% vs 53,7% p < 0,001). Risiko relatif mortalitas berdasarkan PSI pada kelompok risiko tinggi sebesar 3,64 kali dibandingkan kelompok risiko rendah, sedangkan risiko relatif mortalitas berdasarkan CURB-65 pada kelompok risiko tinggi sebesar 3,15 kali dibandingkan kelompok risiko rendah. Skor CURB-65 dapat dipertimbangkan sebagai prediktor mortalitas pada pasien CAP yang di rawat inap.

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Community Acquired Pneumonia (CAP) is the first leading disease with the highest mortality in hospitalized patient in Indonesia. Pneumonia severity assessment systems such as the pneumonia severity index (PSI) and CURB-65 were designed to predict severity of illness and site of care base on 30-d mortality. The purpose of this study is to comparing the PSI with CURB-65 in patient admitted with CAP as predictor 30 days mortality in Persahabatan Hospital, Jakarta. This is a prospective cohort study in hospitalized community acquired pneumonia patients in Persahabatan Hospital since October 2012- Maret 2013. Clinical symptoms, laboratory findings, chest x-ray , comorbidities, score of PSI and CURB-65, 30 days mortality were recorded for analysis. Thirty days mortality outcome were recorded to analysis which score system as the best to predict 30 days mortality. One hundred and sixtty seven patients CAP were studied with an overall 30-d mortality of 18,6%. Sensitivity of PSI were simillar with CURB-65 for predicting patients who died within 30 d (77,4% ; p < 0.001). Specificity of PSI was slighty higher than CURB-65 (58,1% vs 53,7% p < 0,001). Score PSI have risk mortality 3,64 times in high risk group CAP than low risk group CAP. Score CURB-65 have risk mortality 3,15 times in high risk group CAP than low risk CAP. CURB-65 modification was considerable to predict mortality in CAP patients hospitalized."

"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."

"ABSTRAKPendahuluan Infeksi pneumonia nosokomial (PN) merupakan masalah utama di negara berkembang terutama pada pasien yang menjalani bedah jantung dan mendapat perawatan di intensive care unit (ICU). Aspirasi mikroorganisme dari kolonisasi rongga mulut merupakan salah satu faktor risiko PN yang perlu diperhatikan. Tujuan penelitian ini adalah untuk mengetahui dapat tidaknya kondisi rongga mulut menjadi prediktor terjadinya PN. Metode Penelitian ini adalah penelitian kohort prospektif. Subjek penelitian merupakan pasien bedah jantung elektif. Kondisi rongga mulut diwakili oleh oral hygiene index - simplified (OHI-S), decay missing filled - teeth (DMF-T) serta laju aliran saliva tanpa stimulasi (LASTS) diukur pada prabedah dan pascabedah. Terjadinya PN dinilai melalui dua parameter diagnosis yaitu clinical pulmonary infection score (CPIS) dan PN yang didiagnosis berdasarkan pengkajian klinis dokter (diagnosis klinis PN). Hasil Pada penelitian ini didapatkan 35 subyek penelitian yang memenuhi kriteria inklusi selama Desember 2012 hingga Maret 2013. Hasil analisis statistik tidak menunjukkan kemaknaan hubungan antara OHI-S, DMF-T, LASTS dengan CPIS(p=0,420; p=0,268; p=0,949). Demikian pula dengan OHI-S, DMF-T tidak terbukti mempunyai hubungan dengan diagnosis klinis PN (p=0,484; p=0,656). Namun, LASTS mempunyai hubungan signifikan dengan diagnosis klinis PN (p=0,017). Rerata LASTS pascabedah mengalami penurunan bermakna dibandingkan dengan prabedah (p=0,000). Kesimpulan Dalam penelitian ini, kondisi rongga mulut belum dapat terbukti sebagai prediktor terjadinya PN walaupun terdapat hubungan antara LASTS dengan PN yang didiagnosis melalui pengkajian klinis dokter.

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ABSTRACTIntroduction Nosocomial pneumonia (NP) is a major problem in developing countries, particularly in patients undergoing cardiac surgery and who received treatment in the intensive care unit (ICU). Aspiration of oral microorganism colonization is one of the substantial risk factors. The aim of this study was to determine whether the condition of the oral cavity can be a predictor of NP. Methods A cohort prospective study was performed in this study. Subjects are elective cardiac surgery patients. Oral conditions examination defined by oral hygiene index ? simplified (OHI-S), decay missing filled - teeth (DMF-T) and unstimulated salivary flow rate (SFR) was implemented pre-surgery and post-surgery. Diagnosis of NP was evaluated through two parameters. There were clinical pulmonary infection score (CPIS) and clinical assessment of NP. Results There were 35 subjects participating in this study who meet inclusion criteria since December, 2012 to March, 2013. Statistic analyses have not been able to confirm the link between OHI-S, DMF-T, SFR to CPIS (p=0.420; p=0.268; p=0.949). Similarly, relation of OHI-S, DMF-T and clinical NP has not proven (p=0.484; p=0.656). However, SFR was significantly related to clinical assessment of NP (p=0.017). The mean of post-surgery SFR was remarkably lower than pre-surgery (p=0.000). Conclusions In this study, the oral conditions have not been shown to be predictors of the occurrence of PN although there is a link between SFR and clinical assessment of NP."

"Latar Belakang: Ventilator-associated pneumonia (VAP) merupakan infeksi yang sering terjadi di intensive care unit (ICU) dan memiliki angka mortalitas yang tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Studi-studi tentang faktor prediktor mortalitas VAP menunjukkan hasil yang berbeda-beda dan tidak ada penelitian yang komprehensif di Indonesia.Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien VAP di RSCM.Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien ICU RSCM yang didiagnosis VAP selama tahun 2003-2012. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, infeksi kuman risiko tinggi, komorbiditas, renjatan sepsis, kultur darah, prokalsitonin, ketepatan antibiotik empiris, acute lung injury, skor APACHE-II, dan hipoalbuminemia. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat regresi logistik.Hasil: Sebanyak 201 pasien diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan sebesar 57,2%. Kelompok usia, komorbiditas, renjatan sepsis, prokalsitonin, ketepatan antibiotik empiris, dan skor APACHE II merupakan variabel yang berpengaruh terhadap mortalitas pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah antibiotik empiris yang tidak tepat (OR 4,70; IK 95% 2,25 sampai 9,82; p < 0,001), prokalsitonin > 1,1 ng/mL (OR 4,09; IK 95% 1,45 sampai 11,54; p = 0,01), usia ≥ 60 tahun (OR 3,71; IK 95% 1,35 sampai 10,20; p = 0,011), dan adanya renjatan sepsis (OR 3,53; IK 95% 1,68 sampai 7,38; p = 0,001).Kesimpulan: Pemberian antibiotik empiris yang tidak tepat, prokalsitonin yang tinggi, usia 60 tahun atau lebih, dan adanya renjatan sepsis merupakan pediktor independen mortalitas pada pasien VAP.

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Background: Ventilator-associated pneumonia (VAP) is a frequent infection with high mortality rates in intensive care unit (ICU). The prediction of outcome is important in decision-making process. Studies exploring predictors of mortality in patients with VAP produced conflicting results and there are no comprehensive reports in Indonesia.

Objective: To determine predictors of mortality in patients with VAP in Cipto Mangunkusumo Hospital.

Methods: We performed a retrospective cohort study on patients admitted to the ICU who developed VAP between 2003?2012. Clinical and laboratory data along with outcome status (survive or non-survive) were obtained for analysis. We compared age, presence of high risk pathogens infection, presence of comorbidity, septic shock status, blood culture result, procalcitonin, appropriateness of initial antibiotics therapy, presence of acute lung injury, APACHE II score, and serum albumin between the two outcome group. Logistic regression analysis performed to identify independent predictors of mortality.

Results: A total of 201 patients were evaluated in this study. In-hospital mortality rate was 57.2%. Age, comorbidity, septic shock status, procalcitonin, appropriateness of initial antibiotics therapy, and APACHE II score were significantly different between outcome groups. The independent predictors of mortality in multivariate logistic regression analysis were inappropriate initial antibiotics therapy (OR: 4.70; 95% CI 2.25 to 9.82; p < 0.001), procalcitonin > 1.1 ng/mL (OR: 4.09; 95% CI 1.45 to 11.54; p = 0.01), age ≥ 60 years old (OR: 3.71; 95% CI 1.35 to 10.20; p = 0.011), and presence of septic shock (OR: 3.53; 95% CI 1.68 to 7.38; p = 0.001).

Conclusion: Inappropriate initial antibiotic therapy, high serum procalcitonin level, age 60 years or older, and presence of septic shock were independent predictors of mortality in patients with VAP."

"Jenis nosokomial di Pusat Jantung Nasional Harapan Kita (PJNHK) yang angkanya paling tinggi pada Januari - Juni 2003 adalah pneumonia, terutama di ruang perawatan intensif. Penelitian ini bertujuan untuk menganalisis faktor karakteristik pasien (umur, penyakit penyerta, jenis ruang perawatan intensif, lama inap, lama pemakaian ventilator mekanik), serta mengetahui gambaran bakteriologis tangan perawat, dan udara ruang perawatan intensif pada terjadinya infeksi pneumonia nosokomial pada pasien.Penelitian dilakukan di ruang Intensive Cure Unit (ICU) dan Cardio Vascular Care (CVC) PJNHK dengan desain Potong Lintang (Cross Sectional). Populasi dan sampel adalah pasien yang menggunakan ventilator mekanika 48 jam. Data mengenai karakteristik pasien dan kejadian infeksi nosokomial Maret 2003 - Februari 2004 dianalisis dengan Uji x2 atau Uji Fisher Exact pada a= 0,05. Odds Ratio dihitung untuk melihat kekuatan hubungan. Data gambaran bakteriologis tangan perawat dan udara ruang perawatan intensif dikumpulkan pada Januari - Februari 2004. Garnbaran bakteriologis tangan perawat diukur dengan swab tangan kanan terhadap 20 perawat setelah mencuci tangan, Sedangkan bakteriologis udara ruang perawatan intensif diukur dengan liquid impinger.Jumlah pasien yang memenuhi syarat sebagai sampel adalah 76 orang. Prevalensi pneumonia nosokomial di antara pasien yang menggunakan ventilator mekanik ? 48 jam adalah 78,9%. Karakteristik pasien yang berhubungan dengan pneumonia nosokomial adalah jenis ruang perawatan intensif (p-),000), umur (p=x,024), dan interaksi umur jenis ruang perawatan intensif (p=0,006). Pemeriksaan swab tangan dengan hasil positif ditemukan pada 20% perawat. Jutnlah koloni kuman di kedua ruangan pada semua titik melebihi standard. Jenis bakteri yang ditemukan pada tangan perawat yaitu Stapliilococcus epider nidis dan Enterobacter aerogenes. Jenis bakteri udara yang ditemukan adalah Enterobacter aerogenes dan Enterobacter agglomerans.Karakteristik pasien yang paling berhubungan dengan pneumonia nosokomial adalah jenis ruang perawatan intensif. Kemungkinan tangan perawat dan udara ruang perawatan intensif merupakan jalur transmisi pneumonia nosokomial sangat kecil. Disarankan kepada PJNHK untuk meningkatkan perhatian pada pasien pengguna ventilator mekanik > 2 hari. Perlu dilakukan studi prospektif untuk mendapatkan hasil yang lebih baik.Daftar Bacaan : 59 (1971 - 2003)

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Characteristics of Patients and Bacteriological Descriptions of Nurses's Hand and Air of Intensif Care Rooms in the Incidence of Nosocomial Pneumonia at National Cardiovascular Center Harapan Kita Jakarta 2003 - 2004Type of nosocomial whose rates was highest at National Cardio Vascular Centre (NCC) in January - June 2003 was pneumonia, especially in Intensive Care Room. This study was to analyze factors of patients' characteristics (age, other diseases, types of intensive care room, duration of hospitalization, duration of Mechanical Ventilator), and to obtain bacteriological descriptions of nurse?s hand, and air of intensive care room in the incidence of Nosocomial Pneumonia in the patients.

The study was conducted in Surgical and Medical Intensive Care Services of P.TNHK using A Cross Sectional Study. Population and sample are the patients who using mechanical ventilator a 48 hours Data of patients' characteristics and incidence of nosocomial pneumonia on March 2003 - February 2004 was analyzed using xz Test or Fisher Exact Test (a = 0,05). Odds Ratio was counted to see the power of the relationship, Data of bacteriological descriptions of nurse?s hands and air of intensive care room were collected on January- February 2004. Bacteriological descriptions of nurse?s hand was measured by swabbing of right side of 20 nurses' hands after hand washing. Bacteriological descriptions of air of intensive care room were measured using liquid impinger.

Number of patients who were eligible as samples were 76 patients. Prevalence of nosocomial pneumonia among patients using mechanical ventilator a 48 hours were 78,9%. Characteristics of patients which had significant association with nosocomial pneumonia were type of intensive care room (p-O,000), age (0,024), and interaction of age* type of intensive care room (p=0,006). Examination by hand swab with positive result were found in 20% of nurses. Number of colony of bacteria at two rooms on all of points were over standard. Species of bacteria which were found from nurses's hand were Staphilococcus epidermidis and Enterobacter aerogenes. Species of air bacteria were Enterobacter aerogenes and Enterobacter agglomerans.

Characteristics of patients which have significant strong association with nosocomial pneumonia are type of intensive care room. There is a little possibility that nurses' hand and air of intensive care room are path of transmission of nosocomial pneumonia. It is suggested that NCC improve their noticement for patients who used mechanical ventilator > 2 days. Prospective study is suggested to obtain a better result.

References : 59 (1971 - 2003)"

"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."