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"Latar Belakang : Lima belas persen (15%) pasien yang terinfeksi COVID- 19 jatuh ke dalam kondisi penyakit yang berat dan memerlukan suplementasi oksigen (O2). Lima persen (5%) lainnya mengalami perburukan lebih lanjut dan jatuh ke dalam penyakit kritis dengan komplikasi. Pemberian terapi O2 dilakukan segera kepada pasien dengan atau tanpa tanda-tanda kegawatdaruratan dengan saturasi oksigen (SpO2) < 90%. Penelitian ini bertujuan untuk mengetahui hubungan antara Skor Acute Physiology and Chronic Health Evaluation (APACHE) II dengan kejadian desaturasi pada pasien Pneumonia COVID-19.Metode : Penelitian ini merupakan penelitian analitik observasionalkohort prospektif yang dilakukan di Instalasi Gawat Darurat (IGD) dan ruang rawat inap RSUP Persahabatan periode 31 Juli 2021 – 30 September 2021. Subjek penelitian didapatkan dari pasien yang datang ke IGD RSUP Persahabatan sejak 30 Juli 2021 – 30 September 2021 dan terdiagnosis COVID-19 dari hasil pemeriksaan PCR usap tenggorok positif. Dilakukan pengumpulan data klinis, tanda vital, pemeriksaan penunjang dan Skor APACHE II sejak subjek tiba di IGD hingga masuk ruang rawat dalam 24 jam pertama. Hasil : Pada penelitian ini didapatkan 100 subjek penelitian. Hasil penelitian ini menyatakan bahwa tidak terdapat hubungan yang bermakna antara Skor APACHE II dengan kejadian desaturasi pada pasien Pneumonia COVID-19 (p 0,257). Selain itu, tidak ditemukan perbedaan bermakna skor APACHE II pada kelompok pasien dengan derajat keparahan COVID-19 yang berbeda pada PaO2 sesuai hasil pemeriksaan AGD (p 0,073) namun didapatkan hubungan yang bermakna pada penggunaan PaO2 seusai kurva disosiasi O2 (p <0,001).Kesimpulan : Tidak terdapat hubungan yang bermakna antara SkorAPACHE II dengan kejadian desaturasi pada pasien Pneumonia COVID-19.

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Background : Fiftheen percents (15%) patients infected with COVID-19

falls to severe disease and require oxygen (O2) therapy and the other 5% suffered

progressive worsening to critical disease with complications. Oxygen therapy

conducted in patients with or without emergency condition with low O2 saturation

(SpO2 < 90%). This study aim to determine the correlation between Acute

Physiology and Chronic Health Evaluation (APACHE) II score with desaturation

in Pnuemonia COVID-19 patients.

Methods : A prospective cohort observational analytic study

conducted at National Respiratory Ceter Persahabatan Hospital Emergency Unit

from July 2021-September 2021. The study subjects were patients admitted to

Emergency Unit and diagnosed with COVID-19 from positive result of

nasopharing PCR swab. Clinical data, vital signs, supportive examination and

APACHE II score are collected since Emergency Unit admission to inward unit in

first 24 hours.

Results : There were 100 subjects participating in this study. The

result stated there were no significant correlation between APACHE II Score with

desaturation in Pneumonia COVID-19 patients (p-value 0,257). There was also no

significant correlation between APACHE II score with disease severity of COVID-

19 based on O2 partial pressure collected from blood gas analysis examination (pvalue

0,073) but there was a significant correlation between APACHE II score with

disease severity of COVID-19 based on O2 partial pressure referred to O2

dissociation curve (p-value <0,001).

Conclusion : There was no significant correlation between APACHE II

Score with desaturation in Pneumonia COVID-19 patients"

"Pneumonia merupakan salah satu penyakit menular yang sering terlihat pada pasien penyakit ginjal kronis (PGK). Antibiotik yang digunakan dalam terapi farmakologis pneumonia sering kali memerlukan pengaturan dosis akibat penurunan fungsi ginjal. Studi cross-sectional ini dilakukan untuk mengetahui ketepatan dosis antibiotik dan pengaruhnya pada luaran terapi dan durasi rawat pada pasien pneumonia dengan PGK di RSUP Persahabatan Jakarta. Data pasien diambil secara retrospektif pada periode 2021-2023 menggunakan metode total sampling. Analisis statistik dilakukan dengan metode Chi-squared untuk kesesuaian dosis dan hubungan kesesuaian dosis dengan luaran terapi dan Mann-Whitney untuk kesesuaian dosis dengan durasi rawat. Diperoleh 111 sampel penelitian yang mayoritias merupakan laki-laki dengan median usia 59 tahun dengan penyakit ginjal stadium akhir. Sefoperazon merupakan antibiotik yang paling banyak digunakan, diikuti oleh levofloksasin dan sefotaksim. Mayoritas pasien (51,4%) menerima peresepan antibiotik dengan pengaturan dosis yang tidak tepat. Ditemukan bahwa nilai laju filtrasi glomerulus (LFG) (p < 0,001; RR = 1,048) dan hemodialisis (p = 0,003; RR = 0,571) memengaruhi kesesuaian dosis. Tidak ditemukan hubungan yang signifikan antara kesesuaian dosis dengan luaran terapi; faktor lain yang memengaruhi luaran terapi meliputi nilai Charlson comorbidity index (CCI) (p = 0,007; RR = 1,829), jenis terapi (p = 0,023; RR = 1,183) dan sepsis (p < 0,001; RR = 0,368). Kesesuaian dosis memengaruhi durasi rawat secara signifikan (p < 0,001) dan faktor lain yang memengaruhi durasi rawat adalah hemodialisis (p = 0,019). Temuan ini menunjukkan masih adanya ketidaksesuaian pengaturan dosis yang perlu diperbaiki dengan melibatkan apoteker dan tenaga kesehatan lain dalam pengaturan dosis antibiotik.

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Pneumonia is one of the most prevalent infectious diseases in patients with chronic kidney disease (CKD). Antibiotics used in pneumonia often require dose adjustments. A cross-sectional study was conducted to determine antibiotic dose appropriateness and its impact on patients’ outcomes and length of stay (LOS) at the Persahabatan National Respiratory Hospital Jakarta. Patients’ data were retrospectively reviewed between 2021 and 2023 using the total sampling method. Statistical analyses were performed with the Chi-squared analyses for dose appropriateness and outcomes and the Mann-Whitney test for LOS. A total of 111 samples were included in the study, with the majority being males with a median age of 59 and end-stage renal disease. Cefoperazone was prescribed more than any other antibiotics, followed by levofloxacin and cefotaxime. Most patients (51,4%) received antibiotics with inappropriate dose adjustment. Low estimated glomerular filtration rate (eGFR) (p < 0,001; RR = 1,048) and haemodialysis (p = 0,003; RR = 0,571) were independently associated with inappropriate dose adjustment. No statistically significant association was found between dose appropriateness and clinical outcome; other associated factors include a high Charlson comorbidity index (CCI) score (p = 0,007; RR = 1,829), type of therapy (p = 0,023; RR = 1,183), and sepsis (p < 0,001; RR = 0,368). Inappropriate dose adjustments were associated with a longer LOS (p < 0,001). Other associated factors include haemodialysis (p = 0,019). These findings indicate substantial dose adjustment inappropriateness that requires immediate attention and collaboration by pharmacists and other healthcare professionals to ensure appropriate adjustment."

"Polisi lalu lintas menjadi salah satu kelompok pekerja yang rentan mengalami masalah kesehatan jika ditinjau berdasarkan lingkungan kerja dan penerapan proteksi dirinya. Masalah kesehatan yang mungkin terjadi akibat lingkungan kerja yang berisiko dan ketidakpatuhan dalam penerapan proteksi diri salah satunya adalah Infeksi Saluran Pernapasan Akut (ISPA). Desain penelitian cross sectional dengan uji chi squaredigunakan untuk mengidentifikasi hubungan lingkungan kerja dan penerapan proteksi diri dengan kejadian ISPA pada polisi lalu lintas. Penelitian kuantitatif dengan teknik simple random samplingini melibatkan sebanyak 71 responden terpilih. Kuesioner yang digunakan berupa kuesioner lingkungan kerja, kepatuhan menggunakan Alat Pelindung Diri (APD) dan kejadian ISPA untuk menilai tingkat kejadian ISPA. Hasil penelitian menunjukkan bahwa 52,1% polisi lalu lintas memiliki lingkungan kerja yang berisiko, 53,5% polisi lalu lintas tidak patuh dalam penerapan proteksi diri dan 50,7% polisi lalu lintas mengalami ISPA. Hasil analisis penelitian dengan menggunakan uji chi square menunjukkan bahwa terdapat hubungan antara lingkungan kerja dengan kejadian ISPA (p value=0,024)dan terdapat hubungan antara penerapan proteksi diri dengan kejadian ISPA (p value=0,001). Polisi lalu lintas yang memiliki lingkungan kerja yang berisiko akan berpeluang 3,385 kali lebih besar untuk terjangkit ISPA (OR: 3,385) dan polisi lalu lintas yang patuh dalam penerapan proteksi diri akan berpeluang 6,545 lebih besar untuk tidak terjangkit ISPA (OR: 6,545). Implikasi penelitian ini diharapkan pelayanan keperawatan dapat berkoordinasi dengan institusi terkait untuk melakukan pendidikan kesehatan terkait masalah kesehatan yang mungkin timbul jika ditinjau dari segi lingkungan kerja dan penerapan proteksi diri pekerja.

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Traffic police officers are group of workers prone to develop health problem due to their work environment and their personal protective equipment application. The main health problem that may occur due to their risky working environment and non-compliance personal protective equipment application is Acute Respiratory Tract Infection. Cross-sectional research method using Chi-squared test are used to identify the relationship between work environment and self-protection application to the occurrence of URTI.This quantitative research using simple random sampling method involved 71 participants. The instruments used in this research are work environment questionnaire, self-protection application compliance, and the occurrence of Acute Respiratory Tract Infection questionnaire. The result showed that 52,1% of the police have a risky working environment, 53,5% of them didn't have a compliance behavior on using personal protective equipment, and 50,7% of them reported the Acute Respiratory Tract Infection occurrence. The analysis result using chi-squared showed that there was a significant relationship between working environment and the occurrence of Acute Respiratory Tract Infection (p=0,024) and there is a significant relationship between the application of self-protection equipment and the occurrence of Acute Respiratory Tract Infection (p=0,001). Traffic police officer working on a risky working environment have 3,385 times bigger chance to develop Acute Respiratory Tract Infection and the police who are obedient on using the personal protective equipment have 6,545 times bigger chance to not to develop Acute Respiratory Tract Infection. The implication of this research is that nursing service institutions are able to coordinate with related institution have health education program related to their health problem that may occur due to their working environment dan the application of personal protective application."

"Latar belakang dan tujuan: Dari berbagai literatur, salah satu penyebab kegagalan respons klinis pasien pneumonia komunitas adalah akibat pemberian terapi antibiotik yang tidak tepat. Pemberian terapi antibiotik yang tidak tepat dapat meningkatkan risiko kematian dan resistensi antibiotik di kemudian hari. Tujuan penelitian ini adalah untuk mengevaluasi ketepatan penggunaan antibiotik dengan menggunakan metode Gyssens yang merupakan alat penilaian kualitatif yang dipakai oleh PPRA di Indonesia serta membandingkannya dengan luaran pasien pneumonia komunitas.Metode: Penelitian ini merupakan penelitian kohort retrospektif di Rumah Sakit Umum Pusat Persahabatan. Data diambil dari rekam medis pasien berusia di atas 18 tahun yang didiagnosis pneumonia komunitas dan dirawat inap selama periode Januari- Desember 2019. Penelitian ini menganalisis pemberian antibiotik empiris pada saat pasien pertama kali didiagnosis pneumonia komunitas.Hasil: Jumlah sampel pada penelitian ini adalah 108 subjek. Proporsi pasien yang diberikan antibiotik empiris tidak tepat berdasarkan metode Gyssens adalah 58,3% dan yang diberikan antibiotik empiris telah tepat adalah 41,7%. Pasien yang mendapatkan terapi antibiotik empiris tidak sesuai dengan pedoman PDPI memiliki risiko meninggal sebesar 2,875 kali lipat (IK 95% 1,440 – 5,739, p=0,004). Pasien yang diberikan antibiotik empiris dalam waktu setelah 8 jam didiagnosis pnemunia komunitas memiliki risiko meninggal sebesar 3,018 kali lipat (IK 95% 1,612 – 5,650, p=0,002). Dari analisis multivariat, faktor prediktor independen yang berhubungan dengan kejadian mortalitas pasien pneumonia komunitas dalam 30 hari adalah kejadian pneumonia berat dengan risiko sebesar 7,3 kali lipat (IK 95% 2,24-23,88, p=0,001), penyakit CVD dengan risiko sebesar 5,8 kali lipat (IK 95% 1,28-26,46, p=0,023), dan ketidaktepatan pemberian antibiotik empiris dengan risiko sebesar 4,2 kali lipat (IK 95% 1,02-17,74, p=0,048).Kesimpulan: Pada penelitian ini terdapat hubungan yang bermakna antara penggunaan antibiotik empiris tidak tepat berdasarkan metode Gyssens dengan luaran pasien yaitu kejadian mortalitas 30 hari (p=0,001).

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Background and Purpose: From many literatures, one of the causes of clinical response failure in community-acquired pneumonia patients is due to the inappropriate empirical antibiotics use. Improper administration of empirical antibiotics can increase the risk of death and antibiotic resistance later in life. The purpose of this study is to evaluate the appropriateness of the empirical antibiotics use using the Gyssens method which is a qualitative assessment tool used by the antibiotic stewardship program in Indonesia and to compare it with the outcome of community-acquired pneumonia patients.

Method: This study is a retrospective cohort study at the Persahabatan General Hospital. Data is taken from the medical records of patients over the age of 18 who are diagnosed with community-acquired pneumonia and hospitalized during the January- December 2019 period. This study analyzes the administration of empirical antibiotics when the patient is first diagnosed with community-acquired pneumonia.

Results: The number of samples in this study were 108 subjects. The proportion of patients who were given empirical antibiotics incorrectly based on the Gyssens method was 58.3% and those given empirical antibiotics were appropriate was 41.7%. Patients who received empirical antibiotic therapy not in accordance with PDPI guidelines had a 2.875-fold risk of death (95% CI 1.440 - 5.739, p = 0.004). Patients who were given empirical antibiotics after 8 hours of being diagnosed by the community-acquired pneumonia had a risk of death of 3,018-fold (95% CI 1.612 – 5.650, p = 0,002). From a multivariate analysis, independent predictors related to the mortality of community- acquired pneumonia patients within 30 days were the incidence of severe pneumonia with a risk of 7.3-fold (95% CI 2.24-23.88, p = 0.001), CVD with a risk of 5.8-fold (95% CI 1.28-26.46, p = 0.023), and inappropriate empirical antibiotics use with a risk of 4.2 fold (95% CI 1.02-17.74, p = 0.048).

Conclusion: In this study there was a significant relationship between the use of inappropriate empirical antibiotics use based on the Gyssens method and the outcome of community-acquired patients, which was the 30-days mortality (p = 0.001)."

"Latar belakang: Skor SAPS 3 (Simplified Acute Physiology Score 3) merupakan sistem skor mutakhir yang dikembangkan untuk memprediksi mortalitas pasien di unit perawatan intensif (UPI). Sebelum suatu sistem skor dapat diterapkan pada populasi yang berbeda maka harus dilakukan penilaian kesahihannya terlebih dahulu. tujuan dari penelitian ini adalah untuk menilai kesahihan skor SAPS 3 dan persamaan baru SAPS 3 pada pasien UPI RSCM. Metode: Studi kohort retrospektif menggunakan data rekam medis pasien yang dirawat di UPI RSCM Januari-Juli 2012 dengan metode pengambilan sampel konsekutif. Dilakukan analisis bivariat dilanjutkan dengan analisis multivariat dengan persamaan regresi logistik metode stepwise backward. Kemampuan kalibrasi skor SAPS 3 dinilai dengan uji Hosmer-Lemeshow sedangkan kemampuan diskriminasi dianalisis dengan nilai AUC. Hasil: Selama penelitian terkumpul 550 pasien yang dirawat di UPI RSCM. Persamaan baru SAPS 3 didapatkan y = -4,765 + (0,319 x total skor) dengan 7 variabel sebagai prediktor kuat. Skor SAPS 3 baru dan Australasia memiliki kemampuan kalibrasi dan diskriminasi yang baik dengan uji Hosmer-Lemeshow p = 0,383 dan p = 0,123 dengan nilai AUC 0,901 dan 0,945. Kesimpulan: Skor SAPS 3 memiliki kemampuan yang baik (sahih) dalam memprediksi mortalitas pasien di UPI RSCM.

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Background: Simplified Acute Physiology Score 3 (SAPS 3) has been developed to estimate mortality in intensive care unit. However, this model need to be validated before it use in different populations. The aim of this study was to validate the performance of SAPS 3 score in the intensive care unit (ICU) Cipto Mangunkusumo Hospital population and to find new equation of SAPS 3 for ICU Cipto Mangunkusumo Hospital population.

Methods: A retrospective cohort study with consecutive sampling was done to patients hospitalized in the ICU Cipto Mangunkusumo Hospital from January to July 2012. Bivariate analysis was performed, continued with multivariate analysis with stepwise backward method of logistic regression equation. Calibration was assessed by Hosmer-Lemeshow test while discrimination was analyzed using the area under the receiver operator curve (AUC).

Results: A total of 550 patients were included in this study. New equation of SAPS 3 score is y = -4,765 + (0,319 x total score) with 7 variable found as strong predictor. Both new and Australasia SAPS 3 equation have a good calibration and discrimination performance with Hosmer-Lemeshow test p = 0,383 and p= 0,123 with AUC = 0,901 and 0,945.

Conclusion: SAPS 3 score has a good performance in predicting mortality of intensive care unit patients in Cipto Mangunkusumo Hospital."

"Penyakit ginjal kronis (PGK) berkaitan dengan perburukan dan kematian akibat COVID-19. Pasien COVID-19 dengan PGK yang menjalani rawat inap banyak diberikan antivirus dan/atau antibiotik yang memerlukan penyesuaian dosis. Penyesuaian dosis dianalisis berdasarkan laju filtrasi glomerulus (LFG) pasien yang diestimasi dengan metode CKD-EPI. Studi cross-sectional ini bertujuan untuk mengevaluasi penyesuaian dosis antivirus dan/atau antibiotik pada pasien COVID-19 dengan PGK terhadap luaran terapi dan durasi rawat inap di RSUD Pasar Minggu Jakarta periode Januari hingga Desember 2021. Penelitian ini menggunakan teknik total sampling.  Hasil menemukan 70 pasien (51,1%) dari 137 pasien menerima dosis antivirus dan/atau antibiotik yang tidak sesuai anjuran pedoman. Hasil uji Chi-square menunjukkan bahwa pasien dengan dosis sesuai memiliki kecenderungan sebesar 2,236 kali lebih tinggi untuk mencapai luaran terapi perbaikan dibandingkan pasien dengan dosis tidak sesuai (p = 0,032). Faktor lain yang memengaruhi luaran terapi adalah usia (p = 0,000) dan derajat keparahan COVID-19 (p = 0,000). Hasil uji Mann-Whitney U menunjukkan tidak ada hubungan antara kesesuaian dosis dan durasi rawat inap (p = 0,303). Faktor lain yang memengaruhi durasi rawat inap pasien COVID-19 dengan PGK adalah derajat keparahan COVID (p = 0,020), stage PGK (p = 0,020), komorbid selain PGK (p = 0,062), dan luaran terapi (p = 0,001).

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Chronic kidney disease (CKD) is associated with worsening and death from COVID-19. COVID-19 patients with CKD who are hospitalized are often given antivirals and/or antibiotics that require dose adjustments. Dose adjustment can be analyzed based on the patient's glomerular filtration rate (GFR) estimated by the CKD-EPI method. This cross-sectional study aims to evaluate the dose adjustment of antiviral and/or antibiotic and analyze its relation with therapeutic outcomes and length of stay of COVID-19 patients with CKD at Pasar Minggu Hospital, Jakarta from January to December 2021. This study used a total sampling technique. Results found that 70 patients (51.1%) of 137 patients received inappropriate doses. Results of Chi-square test showed that patients with appropriate doses had a tendency of 2,236 times higher to achieve improved therapeutic outcomes than patients with inappropriate doses (p = 0.032). Other factors that influenced therapeutic outcomes were age (p = 0.000) and severity of COVID-19 (p = 0.000). Results of Mann-Whitney U test showed no relationship between dose adjustments and length of stay (p = 0.303). Other factors that influenced length of stay were the severity of COVID (p = 0.020), CKD stage (p = 0.020), comorbidities other than CKD (p = 0.062), and therapeutic outcomes (p = 0.001)."

"Pasien sindrom koroner akut (SKA) dengan penyakit ginjal kronik (PGK) diketahui memiliki risiko mortalitas lebih tinggi dibandingkan dengan pasien SKA tanpa disertai PGK. Setiap tahunnya, dilaporkan 9% kematian akibat penyakit jantung koroner (PJK) yang disertai PGK, yaitu hampir 10 – 20 kali lebih tinggi dibanding populasi umum. Pada pasien SKA dengan PGK terjadi proses inflamasi kronik yang memainkan peranan penting dalam perubahan morfologi dan fungsional sel endotel yang mengakibatkan akselerasi proses aterosklerosis yang berkaitan dengan keparahan koroner pasien SKA dan berujung meningkatkan kejadian major adverse cardiac event (MACE). Penelitian ini bertujuan untuk mengetahui peran rasio neutrofil limfosit (RNL) sebagai prediktor MACE dan korelasinya dengan derajat keparahan koroner pada pasien SKA dengan PGK. Digunakan 2 desain pada penelitian ini, yaitu studi nested case control dengan 31 subjek yang mengalami MACE sebagai kelompok kasus dan 28 subjek yang tidak mengalami MACE sebagai kelompok kontrol dari total 59 pasien SKA dengan PGK, serta studi korelatif dengan pendekatan potong lintang. Pada penelitian ini didapatkan area under curve (AUC) sebesar 60,8% dengan nilai titik potong RNL terhadap kejadian MACE adalah 3,62 dengan sensitivitas 74,2% dan spesifisitas 42,9%. Tidak terdapat perbedaan dan hubungan yang bermakna antara nilai RNL dengan kejadian MACE (p>0,05; OR=2,16 [95%CI=0,63 – 7,51]) dan tidak terdapat korelasi antara nilai RNL dengan derajat keparahan koroner yang dinilai menggunakan skor Gensini (r=0,10; p=0,474).

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Acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) are known to have a higher risk of mortality compared to ACS patients without CKD. Every year, 9% of deaths due to coronary heart disease (CHD) accompanied by CKD reported, which is almost 10 – 20 times higher than the general population. In ACS patients with CKD, chronic inflammation play an important role in morphological and functional changes in endothelial cells that resulted in atherosclerosis acceleration associated with coronary severity in SKA patients, thus lead the increase in major adverse cardiac events (MACE). This study aims to determine the role of neutrophil lymphocyte ratio (NLR) as a predictor of MACE and its correlation with the degree of coronary severity in ACS patients with CKD. Two designs were used in this study, first using nested case control study with 31 subjects who experienced MACE as a case group and 28 subjects who did not experience MACE as a control group of a total of 59 ACS patients with CKD. Second using correlative study with a cross-sectional approach. Area under curve (AUC) of 60.8% was obtained with an NLR cutoff value for MACE is 3.62 with 74.2% sensitivity and 42.9% specificity. There is no significant difference and relationship between NLR and MACE (p>0.05; OR= 2.16 [95%CI=0.63 – 7.51]), also no correlation between NLR and coronary severity degree assessed using Gensini score (r = 0.10; p = 0.474)."

"ABSTRAK Latar Belakang: Kematian pada Penyakit Jantung Koroner (PJK) terutama akibat tindakan revaskularisasi yang tertunda atau lesi koroner kompleks yang biasanyalebih buruk pada populasi pasien PGK. Skor Modified ACEF merupakan sebuahperangkat yang memiliki peran penting dalam prognosis mortalitas PJK. SkormACEF belum pernah digunakan untuk mengevaluasi kompleksitas lesi koroner.Informasi tersebut berguna dalam menentukan prioritas tindakan angiografikoroner. Tujuan: Mendapatkan nilai diagnostik dan titik potong skor mACEF sebagaiprediktor kompleksitas lesi koroner pada pasien PGK stadium 3 dan 4 yangmengalami sindrom koroner akut (SKA). Metode: Penelitian ini merupakan uji diagnostik secara retrospektif terhadap 179subjek PGK stadium 3 dan 4 yang mengalami SKA yang dirawat di ICCU RSCMtahun 2012 hingga 2014. Analisis titik potong skor mACEF dilakukan denganmenggunakan Receiver Operating Characteristic (ROC) curves dengan intervalkepercayaan (IK) sebesar 95%. Akurasi diagnostik skor mACEF dinilai dengancara menghitung sensitivitas, spesifisitas, RKP, dan RKN. Hasil: Titik potong skor mACEF yang optimal adalah 2,288 dengan sensitivitas90,9%, spesifisitas 63,7%, RKP 2,5, RKN 0,14 dan prevalens 55,3%. Kesimpulan: Titik potong yang optimal skor mACEF pada populasi pasien PGKstadium 3 dan 4 yang mengalami SKA adalah 2,288. Akurasi diagnostik skor mACEF dinilai baik.ABSTRACT Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively.;Background: Cardiovascular disease is one of the main causes of death mainlydue to delayed revascularization or complex coronary lesions which are usuallyworse in CKD patients. Modified ACEF (mACEF) score is well established indetermining cardiovascular mortality of patients undergoing revascularizationtherapy and has never been used to evaluate the complexity of coronary lesionsbefore. mACEF score?s potential as a diagnostic tool needs to be evaluated to helpstratify patients eligible for coronary angiography. Aim: To evaluate mACEF score?s diagnostic value and cut-off point as apredictor of coronary lesion complexity in patients with CKD stages 3 and 4 withACS. Methods: This study is a diagnostic test conducted retrospectively involving 179subjects with CKD stages 3 and 4 with ACS admitted to ICCU RSCM from 2012to 2014. Cut-off analysis was performed using ROC curve with confidenceintervals (CI) of 95% and diagnostic accuracy of mACEF was analyzed togenerate sensitivity, specificity, LR+, and LR-. Result: The optimal cut-off point for mACEF score was 2,288 with sensitivity of90,9%, specificity 63,7%, LR+ 2,5, LR- 0,14, and prevalence of 55,3%. Conclusion: mACEF score has a good diagnostic accuracy in subjects with CKD stage 3 and 4 with ACS with optimal cut-off point of 2,288, respectively."