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"Endokarditis Infektif (EI) merupakan masalah kesehatan serius dengan angka insidensi, morbiditas dan mortalitas yang tinggi. Perburukan fungsi ginjal terkait antibiotik intraperawatan terjadi cukup sering dan dikaitkan dengan luaran klinis yang lebih buruk. Tujuan penelitian ini adalah mengetahui hubungan antara perburukan fungsi ginjal terkait antibiotik dengan mortalitas intraperawatan pada pasien EI sisi jantung kiri. Dilakukan studi kohort retrospektif terhadap 315 pasien dengan EI aktif sisi jantung kiri pada periode 1 Januari 2013–31 Mei 2023. Dilakukan analisis bivariat dan multivariat untuk mengetahui prediktor mortalitas intraperawatan, mortalitas jangka panjang, lama rawat dan kebutuhan terapi pengganti ginjal. Terdapat 315 pasien dengan EI aktif sisi jantung kiri dimana 169 pasien dengan perburukan fungsi ginjal terkait antibiotik dan 146 pasien tanpa perburukan fungsi ginjal. Angka mortalitas intraperawatan sebesar 20,3% sedangkan pada pasien dengan perburukan fungsi ginjal terkait antibiotik mortalitas intraperawatan sebesar 34,9%. Dari analisis multivariat didapatkan faktor yang berhubungan dengan mortalitas intraperawatan adalah perburukan fungsi ginjal terkait antibiotik (OR 8,6), kejadian sepsis (OR 11,16), penggunaan antibiotik inkomplit (OR 10,49), lama perawatan <21 hari (OR 5,16), ukuran vegetasi >10 mm (OR 5,04) dan penggunaan terapi pengganti ginjal (OR4,74). Dilakukan perhitungan untuk skoring prediktor mortalitas intraperawatan. Hasil analisis kurva ROC untuk perhitungan skor prediktor mortalitas intraperawatan didapatkan AUC 0,927; IK 95% 0,886 – 0,968; p < 0,001; H-L 0,610) dengan sensitivitas 89,1%, spesifisitas 84,5%. Kejadian perburukan fungsi ginjal terkait antibiotik berhubungan dengan mortalitas intraperawatan dengan OR 8,6.

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Infective endocarditis (IE) is a serious health problem with high incidence, morbidity, and mortality rates. Intrahospital antibiotic-related worsening of renal function occurs quite frequently and is associated with worse clinical outcomes. The objective of this study was to determine the relationship between antibiotic-related worsening of kidney function and intrahospital mortality in left-sided IE patients. A retrospective cohort study was conducted on 315 patients with active IE on the left side of the heart from January 1, 2013 to May 31, 2023. Bivariate and multivariate analyses were conducted to determine predictors of intrahospital mortality, long-term mortality, length of stay, and the need for renal replacement therapy. There were 315 patients with active IE on the left side of the heart, of whom 169 had antibiotic-related worsening of kidney function, and 146 did not. The intrahospital mortality rate was 20.3%, whereas the intrahospital mortality rate was 34.9% in patients with worsening kidney function due to antibiotics. According to multivariate analysis, factors associated with intra-treatment mortality were antibiotic-related worsening of kidney function (OR 8.6, p=0.001), incidence of sepsis (OR 11.16, p=<0.001), incomplete use of antibiotics (OR 10.49, p=<0.001), length of stay <21 days (OR 5.16, p=0.003), vegetation size >10 mm (OR 5.04, p=0.006), and use of renal replacement therapy (OR 4.74, p=0.008). We obtained the predictor score for intrahospital mortality. The results of the ROC curve analysis for calculating intrahospital mortality predictor scores showed an AUC of 0.927 (95% CI 0.886–0.968; p < 0.001; H-L 0.610) with a sensitivity of 89.1% and a specificity of 84.5%. Worsening kidney function related to antibiotics was associated with intrahospital mortality."

"Latar belakang: Endokarditis infektif (EI) merupakan salah satu penyebab kesakitan dan kematian pada anak baik yang dengan penyakit jantung bawaan (PJB) maupun tanpa PJB. Insidens EI pada anak jarang dibandingkan orang dewasa, tetapi diprediksikan akan meningkat seiring meningkatnya kesintasan anak dengan PJB dan meningkatnya penggunaan kateter vena sentral. Saat ini belum ada data epidemiologi, karakteristik klinis dan mikrobiologis, serta luaran EI pada anak di Indonesia.Tujuan: Mengetahui karakteristik, profil mikrobiologis serta luaran penyakit EI pada anak serta faktor-faktor yang memengaruhinya sehingga dapat menilai efektivitas terapi empiris yang digunakan saat ini.Metode: Menggunakan desain potong lintang pada anak dengan EI usia 0-18 tahun yang dirawat di RSCM tahun 2014-2018. Data mengenai karakteristik klinis, pola kuman dan uji sensitivitasnya, serta luaran EI diperoleh melalui rekam medis pasien.Hasil: Insidens EI di RSCM pada tahun 2014-2018 adalah 3,08 kasus per 10000 rawat inap anak. Insidens per tahun meningkat seiring dengan peningkatan jumlah rawat inap anak. Karakteristik klinis anak dengan EI di RSCM umumnya laki-laki berusia 5-18 tahun, dengan penyakit dasar PJB terutama ventricular septal defect  (VSD) dan tetralogy of fallot (TOF). Faktor risiko utama yang ditemukan adalah prosedur invasif dan pemasangan kateter vena sentral.  Sebagian besar biakan steril dengan bakteri terbanyak yang tumbuh adalah S. aureus yang resisten terhadap penisilin G dan ampisilin. Angka komplikasi pada EI di RSCM cukup tinggi yaitu 40,2% dengan angka mortalitas 5,9%. Tidak ditemukan perbedaan usia, jenis kelamin, penyakit dasar, dan ukuran vegetasi pada kelompok dengan dan tanpa komplikasi di RSCM. Kesimpulan: Terdapat peningkatan insidens EI pada anak dalam kurun waktu 5 tahun dengan etiologi utama S.aureus. Uji kepekaan antibiotik menunjukkan resistensi kuman terhadap antibiotik empirik yang digunakan. Angka komplikasi dan kematian pada anak masih cukup tinggi sehingga perlu dilakukan tindakan pencegahan yang tepat pada anak berisiko tinggi EI.

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Background: Infective endocarditis (IE) is one of the cause of morbidity and mortality in children both with or without congenital heart disease (CHD). The incidence is much lower than adults but tends to increase along with improved survival rates of children with CHD and increased usage of central venous catheter in critically ill children. Nowadays, there is still no epidemiological data, clinical characteristics, microbiological profile, and outcomes of IE in children in Indonesia.

Objectives: To assess the recent trends in incidence, characterictics, microbiological profile and outcomeof infective endocarditis in children during the period  of 2014–2018.

Methods: Using cross sectional study design involving patients with IE aged 0-18 years old admitted in Cipto Mangunkusumo Hospital (CMH) in 2014-2018. Clinical data, microbiological profile, and outcomes of subjects with IE was obtained from electronic and printed medical record.

Results: Total incidence of IE in CMH in 5 years was 3.08 cases per 10000 pediatric admission with increasing trends along with increased total pediatric admission. Clinical characteristics was predominantly male, aged 5-18 years old, with CHD as underlying disease, especially ventricular septal defect  (VSD) and tetralogy of fallot (TOF). The most common predisposing factors were history of invasive procedure and indwelling central catheter. Most of cases were the blood culture negative IE with the majority of positive blood cultures isolated S.aureus resistant to penisilin G and ampisilin. There were high rates of complications (40.2%) leading to mortality (5.9%) in CMH. There was no significant difference in age, genders, underlying disease, and size of vegetation in both cases with or withot complication in CMH.

Conclusions: There were increasing trends of IE incidence in children during last five years with S.aureus as the most common causative agent. Antibiotic sensitivity test showed antibiotic resistant to the most common empirical antibiotics in the health care setting. Complication and mortality rates were still high, thus proper prophylactic procedure was needed to be considered in high risked population."

"Latar Belakang: Endokarditis Infektif (EI) dalam 3 dekade terakhir masih memiliki insidensi, beban morbiditas, dan mortalitas yang tinggi, mencapai 30% dalam 1 tahun. Beragam predisposisi insiden EI menunjukkan perubahan seiring dengan perkembangan tatalaksana dan tindakan medis yang seringkali menjadi pemicu baru EI itu sendiri.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor prediktor mortalitas dan luaran klinis pasien EI aktif sisi jantung kiri dalam jangka pendek dan jangka panjang. Penelitian ini juga menjadi penelitian awal untuk mengetahui model prediktor stratifikasi risiko pasien EI aktif sisi jantung kiri di Indonesia.Metode: Dilakukan studi kohort retrospektif terhadap 376 pasien yang mengalami EI aktif sisi jantung kiri pada periode 1 Januari 2013 – 31 Desember 2022. Analisis bivariat dan multivariat dilakukan untuk mengidentifikasi prediktor luaran klinis jangka pendek dan jangka panjang. Dilakukan juga pembuatan sistem skor prediktor mortalitas awal untuk pasien EI aktif.Hasil: Terdapat 376 pasien EI aktif sisi jantung kiri yang kemudian mendapatkan tatalaksana antibiotik serta menjalani operasi sebanyak 56,6% pasien. Studi ini menunjukkan angka mortalitas jangka pendek sebesar 18,6% dan mortalitas jangka panjang 13,2%. Selain itu, didapatkan pula profil morbiditas selama perawatan fase aktif dengan kejadian sepsis 27,1%, perawatan ruang intensif >10 hari 18,6%, penggunaan ventilator mekanik >7 hari 11,4%, kejadian stroke sebanyak 28,5%, dan gagal ginjal akut 57,7%. Studi ini juga menunjukkan model awal skor prediktor mortalitas jangka pendek dan jangka panjang pada studi ini didapatkan berturut-turut dengan AUC 0,935 (IK95% 0,902 – 0,969; p <0,001; uji H-L 0,386) dan AUC 0,733 (IK95% 0,614 – 0,852; p <,001; uji H-L 0,530).Kesimpulan: Faktor-faktor prediktor luaran mortalitas jangka pendek pasien EI aktif sisi jantung kiri meliputi kapasitas fungsional NYHA kelas III-IV, keterlibatan vegetasi katup aorta, ukuran vegetasi >10mm, penggunaan antibiotik inkomplit, sepsis, dan penggunaan terapi pengganti ginjal. Sementara itu, prediktor luaran mortalitas jangka panjang meliputi tidak dilakukannya prosedur operasi, komplikasi paravalvular, serta infeksi Streptoccocus non-viridans.

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Background: Infective endocarditis (IE) in the last 3 decades still has a high incidence, burden of morbidity, and mortality reaching 30% in 1 year. Various predispositions for IE incidents show changes along with developments in medical management and actions which often become new triggers for IE itself.

Objective: This study aims to identify predictors for mortality and clinical outcomes in patients with active left-sided IE in short-term and long term. This study is also initial research to determine the risk stratification predictor model for patients with active IE on the left side of the heart in Indonesia.

Methods: A retrospective cohort study was conducted on 376 patients who experienced active left- sided IE in the period 1 January 2013 – 31 December 2022. Bivariate and multivariate analyzes were performed to identify predictors of short-term and long-term clinical outcomes. Mortality risk predictor score model was also created for active IE patients.

Results: There were 376 active left-sided IE patients who then received antibiotic treatment and 56.6% of the patients underwent surgery. This study showed a short-term mortality rate of 18.6% and a long-term mortality rate of 13.2%. Apart from that, the morbidity profile during the active phase of treatment was also obtained with the incidence of sepsis in 27.1% cases, intensive care > 10 days in 18.6% cases, use of mechanical ventilators > 7 days in 11.4% cases, stroke incidence in 28.5% cases, and acute renal failure in 57.7% cases. This study also shows initial model of short- term and long-term mortality predictor score respectively with AUC 0,935 (95%CI 0,902 – 0,969; p <0,001; H-L test 0,386) and AUC 0,733 (95%CI 0,614 – 0,852; p <,001; H-L test 0,530).

Conclusion: Predictors for short-term mortality outcomes in patients with active left-sided IE include NYHA class III-IV functional capacity, involvement of aortic valve vegetation, vegetation size >10mm, incomplete use of antibiotics, sepsis, and use of renal replacement therapy. Meanwhile, predictors of long-term mortality outcomes include not having a surgical procedure, paravalvular complications, and Streptoccocus non-viridans infection."

"[ABSTRAKLatar Belakang. Malnutrisi merupakan salah satu masalah kesehatan utama yang banyak dijumpai terutama di negara berkembang. Malnutrisi pada pasien gagal jantung diketahui berhubungan dengan luaran klinis yang lebih buruk, meliputi peningkatan lama perawatan, readmisi dan mortalitas. Pada pasien gagal jantung dekompensasi akut (GJDA), perburukan fungsi ginjal (PFG) selama perawatan diduga merupakan komorbid yang memberikan dampak luaran klinis yang lebih buruk tersebut. Namun sampai saat ini belum diketahui bagaimana hubungan antara status malnutrisi dengan terjadinya PFG pada pasien GJDA. Oleh karena itu, penelitian ini bertujuan untuk mengetahui hubungan antara status malnutrisi dengan terjadinya PFG pada pasien GJDA, sekaligus untuk menilai besarnya pengaruh malnutrisi terhadap luaran klinis tersebut.Metode. Studi kohort prospektif dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Kejadian PFG didefinisikan sebagai peningkatan nilai kreatinin > 0,3 mg/dL atau > 25% dibandingkan kreatinin saat masuk rawat. Karakteristik dasar, pemeriksaan klinis awal, status antropometri dan data laboratorium diambil pada saat admisi. Pasien dibagi berdasarkan nilai NRI menjadi kelompok malnutrisi (NRI < 97,5) dan tidak malnutrisi (NRI > 97,5). Kemudian pemeriksaan serial kreatinin dilakukan dengan interval setiap 3 hari selama pasien menjalani perawatan di RS. Data kemudian diolah dengan analisis bivariat dan multivariat untuk mengetahui hubungan antara malnutrisi dengan PFG, lama perawatan, dan mortalitas.Hasil Penelitian. Sebanyak 265 pasien GJDA diikutsertakan dalam penelitian ini, dengan proporsi kelompok malnutrisi sebesar 50,2%. Pada kelompok malnutrisi PFG terjadi pada 31,6% pasien, sedangkan pada kelompok tidak malnutrisi sebesar 26,5% pasien. Tidak didapatkan hubungan yang bermakna antara malnutrisi dengan kejadian PFG, namun terdapat kecenderungan peningkatan risiko PFG pada pasien GJDA yang disertai malnutrisi (OR 1,279; 95%IK 0,751-2,178; p=0,364). Malnutrisi ditemukan memiliki pengaruh yang signifikan terhadap tingginya lama rawat (HR 6,254; 95%IK 4,614-8,477; p<0,001) serta kematian pada pasien GJDA.Kesimpulan. Penelitian prospektif ini tidak menemukan hubungan yang bermakna antara malnutrisi dengan PFG, namun didapatkan kecenderungan bahwa malnutrisi akan semakin meningkatkan risiko terjadinya PFG pada pasien GJDA. Pada pasien GJDA di RSJPDHK ditemukan proporsi malnutrisi yang sangat besar, dan malnutrisi pada kelompok ini memberikan kontribusi yang signifikan terhadap tingginya lama perawatan serta kematian.

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ABSTRACTBackground. Malnutrition is the leading cause of disease burden especially in developing countries. Malnutrition in heart failure patients is associated with longer length of stay (LOS), higher readmission and mortality rates. Worsening renal function (WRF) has also been shown to contribute to the worsened outcomes in patients with acute decompensated heart failure (ADHF) patients. It is not known, however, whether malnutrition contributed to the worse outcomes in ADHF patient through the WRF. Accordingly, this study sought to investigate the association between malnutrition and WRF in ADHF patients.Methods. A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita (NCCHK) to all patients admitted with ADHF. WRF was defined as the occurrence, at any time during the hospitalization, of > 0,3 mg/dL or > 25% increase in serum creatinine from admission. Baseline and clinical characteristics, anthropometry status, and laboratory data were collected during hospital admission. Subjects were divided based on NRI into malnutrition (NRI < 97,5) and no malnutrition group (NRI > 97,5). Serial serum creatinine was evaluated within 3 days interval during hospitalization. Statistical analysis was done using bivariate and multivariate analysis to determine the association between malnutrition with WRF, LOS and mortality rates.Results. Two hundred and sixty-five ADHF patients were included in this cohort study. Of those subjects, 50,2% were on malnutrition group. WRF occured in 31,6% patients of malnutrition group and 26,5% patients of no malnutrition group. Although there was an increased probability of WRF occurence in ADHF patients with malnutrition (OR 1,279; 95%CI 0,751-2,178; p=0,364), but this increased probability was not statistically significant. Malnutrition was found significantly prolonged the LOS (HR 6,254; 95%CI 4,614-8,477; p<0,001) and increased mortality rates in ADHF patients.Conclusion. This prospective study demonstrated there was no significant association between malnutrition and WRF, but there was an increased probability of WRF occurrences in ADHF patients with malnutrition. Nevertheless, we found high burden of malnutrition in ADHF patients in NCCHK, and this burden contributed significantly to longer LOS and higher mortality rates in this population., Background. Malnutrition is the leading cause of disease burden especially in developing countries. Malnutrition in heart failure patients is associated with longer length of stay (LOS), higher readmission and mortality rates. Worsening renal function (WRF) has also been shown to contribute to the worsened outcomes in patients with acute decompensated heart failure (ADHF) patients. It is not known, however, whether malnutrition contributed to the worse outcomes in ADHF patient through the WRF. Accordingly, this study sought to investigate the association between malnutrition and WRF in ADHF patients.Methods. A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita (NCCHK) to all patients admitted with ADHF. WRF was defined as the occurrence, at any time during the hospitalization, of > 0,3 mg/dL or > 25% increase in serum creatinine from admission. Baseline and clinical characteristics, anthropometry status, and laboratory data were collected during hospital admission. Subjects were divided based on NRI into malnutrition (NRI < 97,5) and no malnutrition group (NRI > 97,5). Serial serum creatinine was evaluated within 3 days interval during hospitalization. Statistical analysis was done using bivariate and multivariate analysis to determine the association between malnutrition with WRF, LOS and mortality rates.Results. Two hundred and sixty-five ADHF patients were included in this cohort study. Of those subjects, 50,2% were on malnutrition group. WRF occured in 31,6% patients of malnutrition group and 26,5% patients of no malnutrition group. Although there was an increased probability of WRF occurence in ADHF patients with malnutrition (OR 1,279; 95%CI 0,751-2,178; p=0,364), but this increased probability was not statistically significant. Malnutrition was found significantly prolonged the LOS (HR 6,254; 95%CI 4,614-8,477; p<0,001) and increased mortality rates in ADHF patients.Conclusion. This prospective study demonstrated there was no significant association between malnutrition and WRF, but there was an increased probability of WRF occurrences in ADHF patients with malnutrition. Nevertheless, we found high burden of malnutrition in ADHF patients in NCCHK, and this burden contributed significantly to longer LOS and higher mortality rates in this population.]"

"Covid-19 (Coronavirus Disease-2019) adalah penyakit yang disebabkan oleh virus SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2). Usia tua (≥65 tahun), jenis kelamin laki-laki, hipertensi, penyakit kardiovaskular, diabetes, PPOK dan kanker dapat meningkatkan risiko kematian akibat Covid-19. Desain penelitian ini adalah studi analitik kasus kontrol dari data penelusuran epidemiologi (PE) Dinas Kesehatan Kota Tangerang Selatan sejak bulan Maret 2020-Juli 2021. Jumlah sampel kelompok kasus dan kontrol masing-masing sebanyak 344 sehingga total sampel adalah 688 sampel. Proporsi pasien Covid-19 yang memiliki diabetes mellitus (DM) pada kelompok kasus adalah 35% dan pada kelompok kontrol sebanyak 4%. Analisis bivariat hubungan diabetes mellitus dengan mortalitas pasien Covid-19 di Tangerang Selatan menunjukkan OR=12.47 (p-value=0.0000; 95% CI 6.9-24). Analisis multivariat dengan regresi logistik dihasilkan OR=15.87 (p-value=0.000; 95% CI 7.09-35.5) setelah dikontrol dengan usia, hipertensi, interaksi DM dengan hipertensi, dan interaksi DM dengan gangguan imunologi.

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Covid-19 (Coronavirus Disease-2019) is a new disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2). Old age (≥65 years old), male, hypertension, cardiovascular disease, diabetes, COPD, and cancer are associated with higher mortality risk. The design of this study is case control using secondary data penelusuran epidemiologi (PE) of Dinas Kesehatan Kota Tangerang Selatan since March 2020-July 2021. The sample size from each case and control was 344 so the total sample was 688 sample. Proportion of Covid-19 patients with diabetes mellitus (DM) is 44.77% in case group and 8.14% in control group. Bivariate analysis of the association of diabetes mellitus with mortality among Covid-19 patients in South Tangerang showed OR=12.47 (p-value=0.0000; 95% CI 6.9-24). Multivariate analysis using logistic regression showed OR=15.87 (p-value=0.000; 95% CI 7.09-35.5) after age, hypertension, interaction between DM and hypertension, and interaction between DM and autoimmune disease were controlled."

"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."

"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."

"[ABSTRAKLatar Belakang. Perburukan fungsi ginjal berkaitan dengan luaran klinis yang lebih buruk pada pasien gagal jantung dekompensasi akut. Karakteristik klinis pada saat pasien masuk ke unit gawat darurat (UGD) dapat menolong untuk identifikasi pasien yang berisiko terhadap kejadian perburukan fungsi ginjal. Tujuan penelitian ini adalah membuat sistem skor untuk mempermudah identifikasi pasien yang berisiko terhadap perburukan fungsi ginjal pada gagal jantung dekompensasi akut.Metode. Studi kohort retrospektif dilakukan terhadap 614 pasien yang menjalani perawatan karenan gagal jantung dekompensasi akut. Perburukan fungsi ginjal didefinisikan sebagai peningkatan nilai kreatinin serum ≥ 0.3 mg/dL kapanpun selama perawatan atau ≥ 25% dari awal masuk perawatan.Hasil. Perburukan fungsi ginjal terjadi pada hampir 26% pasien. Prediktor independen terhadap kejadian perburukan fungsi ginjal yang didapat melalui analisis dengan logistik regresi backward selection adalah usia > 75 tahun (p < 0.0001); perempuan (p = 0.034); riwayat hipertensi (p = 0.001); anemia (p = 0.005); dan serum Creatinin saat masuk di UGD > 2.5 mg/dL (p = 0.013). Sistem skor dibuat dari model akhir tersebut. Dilakukan validasi internal dengan metode bootstrap didapatkan hasil optimisme yang baik (0.01088808).Kesimpulan. Sistem skor baru dapat memprediksi kejadian perburukan fungsi ginjal pada pasien gagal jantung dekompensasi akut yang menjalani rawat inap.

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ABSTRACTBackground. Worsening renal function (WRF) is associated with worse outcomes among patients who are hospitalized with acute decompensated heart failure (ADHF). Clinical characteristics at admission may help identify patients at increased risk of WRF. The aim of this study was to create in admission scoring system to simplify identification patients at risk of WRF in ADHF setting.Methods. A retrospective data of 614 patients admitted with ADHF was analyzed. By the definition WRF occurred when serum Creatinin increased at anytime during hospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission.Results. Worsening renal function developed in near 26% patients. The independent predictors of WRF analyzed with backward selection logistic regression were: age > 75 years old (p < 0.0001), female (p = 0.034); history of hypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p = 0.013). A scoring system was generated from this final model. An internal validation with bootstrap method showed good optimism (0.01088808).Conclusion. A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure., Background. Worsening renal function (WRF) is associated with worse outcomesamong patients who are hospitalized with acute decompensated heart failure(ADHF). Clinical characteristics at admission may help identify patients at incresedrisk of WRF. The aim of this study was to create in admission scoring system tosimplify identification patients at risk of WRF in ADHF setting.Methods. A retrospective data of 614 patients admitted with ADHF was analyzed.By the definition WRF occurred when serum Creatinin increased at anytime duringhospitalization by ≥ 0.3 mg/dL or by ≥ 25% from admission.Results. Worsening renal function developed in near 26% patients. Theindependent predictors of WRF analyzed with backward selection logisticregression were: age > 75 years old (p < 0.0001), female (p = 0.034); history ofhypertension (p = 0.001); anemia (p = 0.005); and in admission serum Creatinin (p= 0.013). A scoring system was generated from this final model. An internalvalidation with bootstrap method showed good optimism (0.01088808).Conclusion. A new scoring system could predict in-hospital worsening renal function among patients hospitalized with acute decompensated heart failure.]"

"Latar belakang: Corona Virus Disease 19 (COVID-19) merupakan sebuah kumpulan gejala permasalahan saluran napas atas yang disebabkan olehh virus SARS-CoV-2. Penyakit ini telah menjadi permasalahan global, dan diketahui bahwa populasi lanjut usia memiliki risiko jangkitan dan mortalitas yang tinggi. Prevalensi mortalitas pasien COVID-19 lanjut usia adalah 49,9%. Angka ini sangatlah tinggi karena pasien lanjut usia memiliki faktor risiko yang lebih banyak dibandingkan populasi dewasa, faktor risiko tersebut adalah usia, komorbiditas, dan adanya perubahan fungsi tubuh. Salah satu faktor risiko yang penting untuk dipertimbangkan dalam menilai prognosis adalah status nutrisi pasien. Disebutkan bahwa pasien lanjut usia memiliki prevalensi risiko malnutrisi yang tinggi yaitu berkisar antara 18-78%. Oleh karena itulah penelitian memiliki tujuan untuk melihat hubungan status nutrisi dengan mortalitas pasien COVID-19 berusia lanjut.Metode: Penelitian ini menggunakan desain studi kohort retrospektif dengan menggunakan data sekunder berupa rekam medis pasien Rumah Sakit Cipto Mangungkusumo.Hasil: Total subjek penelitian berjumlah 459 orang dengan pasien berusia 60-69 tahun sebanyak 302 orang (65,7%) dan pasien berusia ≥70 tahun sebanyak 157 orang (34,2%). Rata-rata usia subjek penelitian adalah 67,78 ± 6,9 tahun dengan median 66 tahun. Jenis kelamin subjek yang paling mendominasi adalah laki-laki dengan jumlah 279 orang (60,8%). Sebanyak 177 orang (38,6%) dinyatakan berisiko malnutrisi menggunakan asesmen malnutrition screening tool (MST). Angka mortalitas dalam perawatan pasien COVID-19 berusia lanjut adalah 28,3%. Pada analisis bivariat, didapatkan bahwa malnutrisi memiliki hubungan yang signifikan pada mortalitas pasien COVID-19 berusia lanjut dengan relative risk 2,63 (95% CI: 2,603-6,273; p = 0,000).Kesimpulan: Malnutrisi meningkatkan risiko mortalitas pasien COVID-19 berusia lanjut.

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Introduction: Corona Virus Disease 19 (COVID-19) is a disease that is caused by SARS-CoV-2 and can be identified by several respiratory symptoms. This disease has been a global threat in every country, and it is known that elderly population have the greatest risk of infection and mortality. The mortality prevalence of eldery patients infected by COVID-19 in Indonesia is 49,9%. The prevalence is so high because elderly patient carries a lot of risk factors, such as age itself, comorbidities, and functional body change. One of the risk factors that we need to consider to be prognostic factors is nutrition status. Malnutrition prevalence in elderly patients is estimated to be 18-78%. With that in mind, this research is intended to look at the effect of nutrition status on mortality in COVID-19 elderly patients.     

Method: This research is using retrospective cohort as its study design. We used secondary data from the Rumah Sakit Cipto Mangunkusumo patient’s medical records.

Result: There are 459 research subjects with 302 people (65,7%) in the 60-69 years old age population and 157 remaining people (34,2%) in ≥ 70 years old age population. The mean age in this study was 67,78 ± 6,9 years old with the median of 66 years old. This study population was dominated by males group of 279 people (60,8%). A total of 177 people was diagnosed with risk of malnutrition by malnutrition screening tool (MST) assessment. In-hospital mortality occurred for 28,3% from total sample population.  Bivariat analysis showed that malnutrition has a significant relationship with mortality in COVID-19 elderly patients with a relative risk of 2,63 (95% CI: 2,603-6,273; p = 0,000).

Conclusion: Malnutrition increased the mortality risk for COVID-19 elderly patients."

"Latar Belakang. Sepsis merupakan masalah besar yang menyumbang tingkat mortalitas tinggi. Hal ini diperparah dengan adanya komorbid keganasan. Dalam salah satu penelitian menyebutkan pasien sepsis dengan komorbid keganasan mempunyai resiko 2,32 kali lebih tinggi dibandingkan dengan pasien tanpa komorbid keganasan. Untuk itu diperlukan data faktor-faktor yang memengaruhi mortalitas pasien sepsis dengan komorbid keganasan agar dapat memberikan terapi yang efektif dan efisien dan menurunkan angka mortalitas.Tujuan Penelitian. Mengetahui faktor-faktor yang memengaruhi mortalitas pada pasien sepsis dengan komorbid keganasan.Metode. Penelitian dilaksanakan dengan desain kohort retrospektif . Data diambil dari rekam medis pasien sepsis dengan komorbid keganasan yang dirawat di RS Ciptomangunkusumo dan memenuhi kriteria inklusi dari tahun 2020 sampai 2022. Dilakukan uji kategorik dan dilanjutkan dengan Uji regresi log pada variabel-variabel yang memenuhi syarat.Hasil. Dari 350 subjek sepsis dengan komorbid keganasan yang memenuhi kriteria inklusi didapatkan mortalitas sebanyak 287 (82%) subjek. Pada ujia kategorik bivariat didapatkan 2 variabel yang mempunyai kemaknaan secara statistik yaitu skor SOFA dan performa status dengan nilai P masing-masing <0,001 dan <0,001. Setelah dilakukan uji log regresi didapatkan Odds Ratio 5.833 IK (3,214-10,587) untuk variabel skor SOFA dan Odds Ratio3,490 IK (1,690-7,208) untuk variabel performa status.Kesimpulan. Variabel skor SOFA dan performa status mempunyai hubungan yang bermakna terhadap mortalitas pasien sepsis dengan komorbid keganasan

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Background. Sepsis is a major problem that contributes to a high mortality rate. This is exacerbated by the presence of malignancy. In one study, sepsis patients with malignancy had a 2.32 times higher risk compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patients with malignancy are needed in order to provide effective and efficient therapy and reduce mortality.

Research purposes. Knowing the factors that influence mortality in sepsis patients with  malignancy.

Method. The study was conducted with a retrospective cohort design. Data were taken from the medical records of sepsis patients with comorbid malignancy who were treated at Ciptomangunkusumo Hospital and met the inclusion criteria from year 2020 to 2022. A categorical test was carried out and followed by a log regression test on eligible variables.

Results.  Of the 350 sepsis subjects with comorbid malignancy who met the inclusion criteria, 287 (82%) subjects had a mortality. In the bivariate categorical test, there were 2 variables that had statistical significance, namely the SOFA score and status performance with P values ​​of <0.001 and <0.001respectively. After doing the log regression test is obtained Odds Ratio 5.833 CI (3.214-1.587) for SOFA score variables and Odds Ratio 3.490 CI (1.690-7.208) for status performance variables.

Conclusion. SOFA score and performance status variables have a significant relationship to the mortality of sepsis patients with comorbid malignancy."