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"Penelitian ini bertujuan untuk mengetahui implementasi dan pengembangan clinical pathway pneumonia ringan. Jenis penelitian yang digunakan adalah kuantitatif dan kualitatif dengan metode telaah data, telaah dokumen dan wawancara mendalam. Analisis data kuantitatif menggunakan Tools Pengembangan Pra Clinical Pathway dan Evaluasi Clinical Pathway versi beta 2.3. Hasil penelitian menunjukkan bahwa pada variabel input tidak memiliki kendala, staf sudah siap untuk melakukan implementasi clinical pathway. Tim pengembangan clinical pathway masih terbatas pada satu golongan tenaga medis saja. Masih terdapatnya variasi yang tinggi pada pemakaian obat-obatan. Rata-rata lama hari rawat sudah sesuai yaitu 4,19 hari dengan pasien terbanyak pulang pada hari rawat keempat. Sebanyak 14 pasien dari total 67 pasien dirujuk ke Rumah Sakit lain pada hari rawat pertama. Beberapa hal yang dapat Rumah Sakit lakukan yaitu libatkan lebih banyak staf dari berbagai disiplin ilmu dalam proses pengembangan clinical pathway, lakukan berbagai cara untuk sosialisasi clinical pathway, lakukan evaluasi rutin terkait kepatuhan terhadap clinical pathway dan evaluasi formulir clinical pathway berdasarkan dengan variasi pada penelitian ini.

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This study aims to determine the implementation and development of clinical pathway of simple pneumonia. The type of research used quantitative and qualitative study withdata analysis, document review and in depth interviews methods. Quantitative data analysis using Pre Clinical Pathway Development Tools and Clinical Pathway Evaluation beta 2.3. The results showed that in the input variables have no constraints, the staff is ready to implement the clinical pathway. Clinical pathway development team is still limited to one class of medical personnel only. There is still a high variation in the use of drugs. The average length of stay was 4,19 days with most patients discharge from the hospital on the fourth day of treatment, 14 patients from 67 patients were referred to another hospital on the first day of treatment. Some things the Hospital can do include involving more staff from various disciplines in the clinical pathway development process, doing various ways to socialize clinical pathways, conducting routine evaluations about clinical pathway compliance and clinical pathway form evaluation based on variations in this study."

"Latar Belakang: Pneumonia merupakan infeksi paru yang serius dan seringkalimenyebabkan pasien dirawat di ICU. Skor Clinical Pulmonary Infection Score (CPIS) dan Lung Ultrasound Score (LUS) telah digunakan untuk memprediksi keparahan pneumonia. Namun, modifikasi skor ini dan hubungannya dengan luaran klinis seperti lama perawatan, penggunaan ventilator, dan mortalitas pada pasien pneumonia di ICU belum banyak diteliti. Penelitian ini dilakukan bertujuan untuk mengetahui hubungan antara modifikasi skor CPIS dan LUS dapat memprediksi luaran pada pasien pneumonia yang dirawat di ICU RS Dr. Kariadi Semarang.Metode: Penelitian ini merupakan studi retrospektif kohort yang menganalisis data pasien pneumonia yang dirawat di ICU RS Dr. Kariadi Semarang. Skor CPIS dan LUS dimodifikasi sesuai dengan karakteristik pasien dan kondisi lokal. Analisis statistik digunakan untuk mengidentifikasi prediktor luaran klinis.Hasil: Hasil penelitian menunjukkan modifikasi skor CPIS dan LUS secara signifikan terkait dengan lama perawatan, penggunaan ventilator, dan mortalitas. AUC, ROC cut off point skor CPIS modifikasi dengan nilai 10,5. Variabel lain seperti usia, komorbiditas, dan jenis patogen juga ditemukan memiliki pengaruh terhadap luaran klinis.Kesimpulan: Dari penelitian ini terbukti modifikasi skor CPIS dan LUS secara signifikan dapat membantu lama perawatan, penggunaan ventilator, dan mortalitas. Oleh sebab itu layak digunakan dalam memprediksi luaran klinis pada pasien pneumonia di ICU dan dapat membantu dalam pengambilan keputusan klinis dan perencanaan perawatan pasien.

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Background: Pneumonia is a serious lung infection and often leads to ICU admissions. The Clinical Pulmonary Infection Score (CPIS) and Lung Ultrasound Score (LUS) have been used to predict the severity of pneumonia. However, the modification of these scores and their relationship with clinical outcomes such as length of stay, ventilator use, and mortality in pneumonia patients in the ICU have not been widely studied. This study was conducted to determine the relationship between modified CPIS and LUS scores to predict outcomes in pneumonia patients admitted to the ICU of Dr. Kariadi Hospital Semarang.

Methods: This study was a retrospective cohort study that analyzed data of pneumonia patients admitted to the ICU of Dr. Kariadi Hospital Semarang. CPIS and LUS scores were modified according to patient characteristics and local conditions. Statistical analysis was used to identify predictors of clinical outcomes.

Results: The results showed the modified CPIS and LUS scores were significantly associated with length of stay, ventilator use, and mortality. AUC, ROC cut off point of modified CPIS score with a value of 10.5. Other variables such as age, comorbidities, and pathogen type were also found to have an influence on clinical outcomes.

Conclusion: From this study, it was proven that modification of CPIS and LUS scores can significantly help with length of stay, ventilator use, and mortality. Therefore, it is feasible to use in predicting clinical outcomes in pneumonia patients in the ICU and can help in clinical decision making and patient care planning."

"Pendahuluan. Skor CURB-65 merupakan suatu sistem skor untuk menilai derajat penyakit pneumonia, namun beberapa penelitian menilai performanya kurang baik, sehingga diperlukan faktor prognostik lain sebagai penambah variabel. C-Reactive Protein dinilai mempunyai peran sebagai faktor independen dalam memprediksi mortalitas pasien pneumonia. Penelitian ini dilakukan untuk menilai peran C-Reactive Protein pada skor CURB-65 dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas rawat inap. Metode. Penelitian ini merupakan studi prospektif berbasis riset prognostik dengan subjek penelitian yaitu pasien pneumonia komunitas yang dirawat di IGD dan gedung A Rumah Sakit dr. Cipto Mangunkusumo RSCM, Jakarta bulan Oktober-November 2017. Keluaran yang dinilai pada penelitian ini yaitu mortalitas pasien dalam 30 hari. Pada subjek dilakukan penilaian performa skor CURB-65 sebelum dan setelah ditambah dengan nilai C-Reactive Protein. Performa diskriminasi dinilai dengan area under the curve AUC. Hasil. Sebanyak 200 pasien ikut serta dalam penelitian ini dengan angka mortalitas 37. Performa diskriminasi skor CURB-65 menunjukkan nilai AUC 70,1 IK 95 0,62-0,77. Setelah ditambahkan dengan nilai C-Reactive Protein berdasarkan cut off ge;48,5 mg/L, didapatkan peningkatan nilai AUC skor CURB-65 menjadi 88,0 IK 95 0,83-0,92. Simpulan. C-Reactive Protein memiliki peran pada skor CURB 65 sebagai prediktor mortalitas 30 hari pasien pneumonia komunitas rawat inap.

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Introduction. CURB 65 is a scoring system to evaluate the degree of pneumonia, but some research identified that its performance to predict mortality was below expectations. Therefore, we need other prognostic factor as an added value. C Reactive Protein has a role as an independent factor to predict mortality in community acquired pneumonia. This study aims to evaluate role of C Reactive Protein in CURB 65 score to predict 30 days mortality in hospitalized community acquired pneumonia patient.

Method. A prospective cohort study was conducted to hospitalized community acquired pneumonia patients in Cipto Mangunkusumo Hospital, Jakarta from October to November 2017. Outcome of the study was mortality in 30 days. Performance of CURB 65 score was evaluated before and after addition of C Reactive Protein. Discrimination was evaluated with area under curved AUC.

Results. Total of 200 patients were included in this study with number of mortality was 37. Performance discrimination CURB 65 score was shown by ROC curve, the AUC is 70,1 CI 95 0,62 ndash 0,77. After addition of C Reactive Protein based of cut off ge 48,5 mg L, the AUC score improved to 88,0 CI 95 0,83 ndash 0,92.

Conclusion. C Reactive Protein has a role to CURB 65 score to predict 30 days mortality in hospitalized community acquired pneumonia patient."

"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: COVID-19 telah menyebabkan pandemi dengan angka mortalitas yang signifikan. Indonesia merupakan salah satu negara dengan angka kematian tertinggi akibat COVID-19. Beberapa faktor risiko yang menyebabkan kematian pada pasien COVID-19 memiliki kesamaan dengan faktor risiko pada infeksi SARS-CoV dan MERS- CoV, seperti usia, komorbiditas, kadar neutrofil dan limfosit, d-dimer, serta jumlah lobus paru yang terlibat berdasarkan temuan rontgen toraks.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi proporsi kematian dan faktor- faktor yang memengaruhi mortalitas pasien COVID-19 dalam perawatan ≤ 14 hari, dengan pendekatan komprehensif yang mencakup anamnesis, pemeriksaan fisik dasar, dan pemeriksaan penunjang sederhana yaitu pemeriksaan laboratorium darah dan rontgen toraks.Metode: Penelitian ini menggunakan desain retrospektif observasional dengan menganalisis rekam medis pasien COVID-19 yang dirawat di RSUPN Cipto Mangunkusumo dari Januari 2021 hingga Januari 2024. Data dianalisis menggunakan program STATA versi 17.0 melalui metode analisis univariat, bivariat, dan regresi logistik.Hasil: Sebanyak 142 subjek direkrut dan dianalisis, dengan angka mortalitas selama perawatan mencapai 29,57%. Mayoritas pasien berjenis kelamin laki-laki (58,5%) dan berusia >60 tahun (52,8%), serta sebagian besar mengalami ketergantungan total (85,7%). Sebagian besar subjek memiliki status nutrisi obesitas (43%). Komorbiditas terbanyak adalah diabetes melitus (42,3%), hipertensi (39,4%), dan gangguan ginjal kronis (37,3%), sedangkan mortalitas tertinggi ditemukan pada pasien dengan gangguan ginjal kronis (34%), penyakit jantung koroner (33,3%), dan stroke (29,2%). Faktor signifikan yang memengaruhi mortalitas dalam ≤14 hari meliputi usia (OR 3,17, p = 0,016), D-dimer (OR 3,07, p = 0,015), CRP (OR 5,16, p < 0,001), dan SpO2 (OR 8,64, p < 0,001).Kesimpulan: Proporsi mortalitas pasien COVID-19 dalam perawatan ≤ 14 hari adalah 29,57%. Mortalitas sebagian besar terjadi pada pasien berusia ≥60 tahun dengan ketergantungan total. Faktor usia, D-dimer, CRP, dan SpO2 terbukti sebagai faktor yang memengaruhi mortalitas pasien COVID-19 selama perawatan.

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Background: COVID-19 has caused a pandemic with a significant mortality rate. Indonesia is among the countries with the highest death toll from COVID-19. Several risk factors contributing to mortality in COVID-19 patients are similar to those observed in SARS-CoV and MERS-CoV infections, such as age, comorbidities, neutrophil-to- lymphocyte ratio, D-dimer levels, and the number of lung lobes affected as identified through chest X-ray findings.

Aim: This study aims to identify the proportion of mortality and the factors influencing the mortality of COVID-19 patients within ≤ 14 days of care, using a comprehensive approach that includes medical history, basic physical examination, and simple supporting tests, namely blood laboratory tests and chest X-rays

Methods: This study employs a retrospective observational design by analyzing the medical records of COVID-19 patients treated at RSUPN Cipto Mangunkusumo from January 2021 to January 2024. The data were analyzed using STATA version 17.0 software through univariate, bivariate, and logistic regression analysis methods.

Results: A total of 142 subjects were recruited and analyzed, with a mortality rate of 29.57% during ≤14 days of treatment. Most patients were male (58.5%) and aged over 60 years (52.8%), with the majority experiencing total dependence (85.7%). Obesity was the predominant nutritional status among the subjects (43%). The most prevalent comorbidities included diabetes mellitus (42.3%), hypertension (39.4%), and chronic kidney disease (37.3%). The highest mortality rates were found in patients with chronic kidney disease (34%), coronary artery disease (33.3%), and stroke (29.2%). Significant factors affecting mortality within ≤14 days included age (OR 3.17, p = 0.016), D-dimer (OR 3.07, p = 0.015), CRP (OR 5.16, p < 0.001), and SpO2 (OR 8.64, p < 0.001).

Conclusion: The mortality proportion of COVID-19 patients during ≤14 days of treatment is 29.57%. The majority of mortality occurred in patients over 60 years old with total dependence. Age, D-dimer, CRP, and SpO2 were found to be significant factors influencing mortality in COVID-19 patients during treatment."