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Abstrak :
Latar Belakang: Disebutkan pada beberapa literatur bahwa faktor prognostik menentukan laju kejadian rekurensi pada pasien pasca operasi kanker serviks. Faktor- faktor prognostik tersebut diantaranya adalah invasi ruang pembuluh limfa, tipe sel kanker, ukuran tumor primer, kedalaman invasi stroma, bebas/tidak bebasnya tepi vagina hasil reseksi, keterlibatan parametrium, dan status limfonodi. Sampai saat ini belum ada data yang dapat menggambarkan faktor-faktor prognostik pada kanker serviks serta kaitannya dengan kejadian rekurensi di Indonesia.  Metode: Penelitian ini memiliki desain deskriptif dan analitik yang menampilkan sebaran faktor-faktor prognostik pada pasien kanker serviks pasca operasi beserta tingkat rekurensinya. Peneliti menggunakan data rekam medik sebagai sumber data.  Hasil: Hasil dari studi deskriptif adalah sebagai berikut: invasi ruang pembuluh limfa (81,4%), tipe sel kanker tipe skuamosa (62,2%), ukuran tumor primer <4cm (66%), invasi stroma >10mm (59,2%), invasi limfonodi positif (57,3%), hasil reseksi vagina tidak bebas sel kanker (79.7%), dan pasien rekurens (9%). Adapun hasil studi analitik yang mempertemukan antara faktor-faktor prognostik kanker serviks menghasilkan bahwa ukuran tumor primer berhubungan secara signifikan terhadap kejadian rekurensi (nilai p 0.05).  Kesimpulan: Berdasarkan analisis deskriptif, didapatkan bahwa terdapat dominasi pada beberapa sub-komponen pada faktor prognostik seperti yang telah tertera pada bagian Hasil. Pada studi analitik, didapatkan bahwa terdapat hubungan yang bermakna secara statistik antara ukuran tumor primer dengan kejadian rekurensi (nilai p 0.05). ......Background: Multiple prognostic factors affect the recurrence rate in post-operative cervical cancer patients. These factors are lymphovascular space invasion (LVSI), types of cancer cells, primary tumor size, the depth of the stromal invasion, cleanliness of vaginal resection, parametrial involvement, and lymph nodular status. Despite the importance of prognostic factors, there are no data available in the Indonesian population yet. Hence, the writer proposed a study depicting the prognostic factors of cervical cancer.  Method: This research is aimed to acquire a descriptive picture of the prognostic factors in cervical cancer patients, particularly from the Indonesian population data. Moreover, a sub-analytical study of comparative-analytical hypothetical test was added to examine the statistical relation between the prognostic factors and recurrence in post-operative cervical cancer patients. The data is taken from the medical record from Cipto Mangunkusumo Hospital, Jakarta.  Results: The descriptive result of the prognostic factors shows LVSI (81.4%), Squamous Cell Carcinoma type of cervical cancer (62.2%), primary tumor size <4cm (66%), stromal invasion with depth >10mm (59.2%), positive lymph node invasion (57.3%), non-clear vaginal resection (79.7%), and recurrent patients (9%). The analytical study shows a statistical significance between the size of the primary tumor and the recurrence in post-operative cervical cancer patients (p-value 0.05).  Conclusion: From the descriptive study, there are several dominances seen in the prognostic factors of the cervical cancer patient. Also, the analytical study shows a significant statistical relationship between primary tumor size and recurrence.

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Tujuan: Menilai kesintasan hidup (OS) dan kesintasan bebas progresivitas (PFS) pasien meningioma intrakranial yang menjalani radioterapi di RSCM dan mengetahui faktor klinis yang dapat dijadikan faktor prognostik. Metode: Dilakukan studi kohort retrospektif yang menyertakan 61 subjek meningioma intrakranial yang terdiagnosis secara radiologis maupun histopatologis yang menjalani radioterapi di IPTOR RSCM pada Januari 2014 – Desember 2019. Hasil: OS 1, 2, dan 3 tahun adalah 98,1%, 87,8%, dan 77,1%. PFS 1, 2, dan 3 tahun adalah 84%; 72,4%; dan 58,2%. Faktor yang memperburuk OS adalah jenis kelamin laki-laki (p <0,001), KPS <70 (p <0,001), lokasi tumor di konveksitas/falx/parasagittal (p <0,016), tumor derajat II dan III (p <0,001) dan BED ≥85,74 Gy3,7. Faktor yang memperburuk PFS adalah jenis kelamin laki-laki (p = 0,027), KPS <70 (p <0,001), lokasi tumor konveksitas/falx/parasagittal (p = 0,002), tumor derajat III (p <0,001), volume GTV ≥46,35 cm3 (p = 0,026), dan BED ≥85,74 Gy3,7 (p = 0,02). Pada analisis multivariat, faktor independen yang mempengaruhi OS adalah jenis kelamin, dan faktor yang mempengaruhi PFS adalah jenis kelamin dan KPS. Kesimpulan: Jenis kelamin merupakan faktor prognostik independen terhadap OS pasien meningioma yang menjalani radioterapi. ......Aims: To assess overall survival (OS) and progression-free survival (PFS) of patient with intracranial meningioma who underwent radiotherapy in RSCM and to find clinical factors that contribute as prognostic factors. Methods: Patient with radiologically or pathologically-confirmed intracranial meningioma who underwent radiotherapy in our department from January 2014 to Decemer 2019 were retrospectively analyzed. Results: OS in 1, 2, and 3 year were 98,1%; 87,8%; dan 77,1%; and PFS in 1, 2, dan 3 year were 84%; 72,4%; dan 58,2%. Male (p <0,001), KPS <70 (p <0,001), convexity/falx/parasagittal tumor (p <0,016), WHO grade II dan III tumor (p <0,001) and BED ≥85,74 Gy3,7 were associated with poor OS. Male (0,027), KPS <70 (p <0,001), lokasi tumor convexity/falx/parasagittal (p = 0,002), WHO grade III (p <0,001), GTV volume ≥46,35 cm3 (p = 0,026), and BED ≥85,74 Gy3,7 (p = 0,02) were associated with poor PFS. Male is independent factor associated with poor OS in multivariate analysis, wherase male and KPS <70 were associated with poor PFS. Conclusions: Male is an independent prognostic factor affecting OS and PFS in meningioma patients underwent radiotherapy.

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Demam neutropenia pasca kemoterapi adalah morbiditas yang masih tinggi pada anak dengan keganasan. Sejumlah faktor prognostik, pola kuman, penggunaan antibiotik dan antijamur dapat memengaruhi luaran namun penelitian di Indonesia masih terbatas. Penelitian ini bertujuan mengetahui pola kuman, sensitvitas antibiotik serta faktor yang berpengaruh terhadap mortalitas infeksi anak DN. Penelitian ini dilakukan secara kohort retrospektif serta studi desktriptif terhadap 180 pasien (252 episode demam) di RSCM periode 2015-2017. Riwayat medis, pola kuman, sensitivitas antibiotik didata serta faktor prognostik dianalisis menggunakan uji multivariat regresi logistik. Bakteri terbanyak adalah gram negatif 51,5% diikuti gram positif 47,1%%. Golongan jamur terbanyak adalah Candida sp.(82,5%) Sensitivitas antibiotik Klebsiella sp. terutama amikasin (85,71%), Pseudomonas aeruginosa terhadap seftazidim (75%), amikasin dan gentamisin (100%). Staphylococcus sp. terutama amoksiklav dan ampicsulbactam (76.92%). Hampir semua golongan jamur sensitif flukonoazole, ketokonazole, vorikonazole (80-100%). Faktir prognostik yang meningkatkan mortalitas adalah pemasangan vena sentral (RR 1,947; IK95% 1,114-3,402), gizi kurang (RR 1,176;IK95% 1,044-1,325), gizi buruk (RR 1,241;IK95% 0,975-1,579), serta keganasan hematologi (RR 0,87;IK95% 0,788-0,976).

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Fever post-chemotherapy neutropenia is still a high morbidity in children with malignancy. A number of prognostic factors, microorganisms, antibiotic and antifungal use can affect outcomes but research in Indonesia is still limited. This study aims to determine the pattern of germs, antibiotic sensitivity and factors that influence the mortality of FN child infections. This study was a retrospective cohort as well as a descriptive study of 180 patients (252 episodes of fever) in RSCM 2015-2017 period. Medical history, microorganisms, antibiotic sensitivity was recorded as well as prognostic factors were analyzed using multivariate logistic regression tests. The most common bacteria was gram negative 51.5% and gram positive 47.1 %%. In the fungus group, Candida sp. was most common (82.5%). Antibiotic sensitivity of Klebsiella sp. mainly amikasin (85.71%), Pseudomonas aeruginosa against seftazidim (75%), amikasin and gentamisin (100%). Staphylococcus sp. mainly amoksiklav and ampicsulbactam (76.92%). Almost all fungi groups was sensitive flukonoazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increase mortality was central venous insertion (RR 1,947; 95%CI 1,114-3,402), wasted (RR 1,176; 95%CI 1,044-1,325), severe malnutrition (RR 1,241; 95%CI 0.975-1,579), and hematological malignancies (RR 0.87; 95%CI 0.788-0.976).

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ABSTRACT
Purpose: Whether or not gastrectomy is feasible for very elderly gastric cancer patients is unclear. This study aimed to clarify the feasibility and safety of surgical treatment for patients in this age group. Method: The study included 55 very elderly patients with resectable gastric cancer who underwent gastrectomy (≥ 85 years of age; very-E group). The surgical outcomes were compared with those of 611 elderly patients (75-84 years old; E group). Results: Female sex, a poor physical and performance status, and a low serum albumin level patients were more frequent in the very-E group than in the E group. Lymphadenectomy was less aggressive in the very-E group than in the E group (P < 0.001). The overall postoperative complication rate was not significantly different between the groups (46 vs 33%; P = 0.073). A multivariate analysis to predict the overall survival identified male sex (hazard ratio 1.75, 95% confidence interval 1.30-2.36), low body mass index (2.19, 1.52-3.16), poor performance status (2.14, 1.60-2.86), low serum albumin level (1.84, 1.37-2.48), and advanced tumor stage (1.71, 1.29-2.27) but not age (1.31, 0.84-2.03) as independent prognostic factors. Conclusion: Chronological age alone is not a contraindicative factor for gastrectomy in very elderly patients.

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Leukemia limfoblastik akut (LLA) adalah jenis kanker yang disebabkan oleh akumulasi limfoblas di sumsum tulang yang mempengaruhi banyak anak. Keberhasilan pengobatan pada pasien leukemia dapat dinilai berdasarkan tingkat kelangsungan hidup pasien LLA. Tujuan dari penelitian ini adalah untuk mengidentifikasi kelangsungan hidup 5 tahun, faktor-faktor yang mempengaruhinya, dan nilai skor prediktor kelangsungan hidup pada anak usia 1-18 tahun yang didiagnosis dengan leukemia limfoblastik akut (LLA) di RSAB Harapan Kita. Penelitian ini adalah penelitian observasional analitik yang menggunakan desain penelitian kohort retrospektif. Sampel adalah 130 pasien LLA yang didiagnosis pada tahun 2013-2014 yang diperoleh dari teknik pengambilan sampel non-probabilitas jenis consecutive sampling. Data dikumpulkan dengan melacak rekam medis pasien. Data dianalisis menggunakan analisis Kaplan-Meier dan Regresi Cox. Hasil penelitian menunjukkan bahwa probabilitas tingkat kelangsungan hidup pasien LLA tahun 2013-2014 adalah 92,25% dengan tingkat kelangsungan hidup rata-rata 60 bulan. Berdasarkan analisis multivariat menggunakan model interaksi regresi Cox, faktor yang paling berpengaruh pada tingkat kelangsungan hidup pasien LLA adalah komorbiditas (p = 0,002; HR = 10,76 CI; 2,38-48,55), remisi (p = 0,001; HR = 13,28 CI2,98- 59,73) dan kambuh (p = 0,014; HR = 7,92 CI; 1,53-41,12). ......Acute lymphoblastic leukemia (LLA) is a type of cancer caused by the accumulation of lymphoblasts in the bone marrow that affects many children. The success of treatment in leukemia patients can be assessed based on the survival rate of LLA patients. The aims of this study were to identify 5-year survival, the factors that influence it, and the scoring value of predictors of survival in children aged 1-18 years diagnosed with acute lymphoblastic leukemia (LLA) in RSAB Harapan Kita. This study is an analytic observational study that used retrospective cohort study design. The sample was 130 LLA patients diagnosed in 2013-2014 who were obtained from a non-probability sampling technique consecutive sampling. Data were collected by tracking the patient's medical records. Data were analyzed using Kaplan- Meier analysis and Cox Regression. The results show that the LLA patient's survival rate probability from 2013-2014 was 92.25% with a median survival rate of 60 months. Based on multivariate analysis using Cox regression interaction models, the most influential factors on survival rate of LLA patients were comorbidity (p = 0.002; HR = 10.76 CI; 2.38-48.55), remission (p = 0.001; HR = 13.28 CI2.98-59.73) and relapse (p = 0.014; HR = 7.92 CI; 1.53- 41.12)

Abstrak :
Tujuan: mendapatkan kesintasan dan faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna. Metode: penelitian kohort retrospektif dan prospektif dilakukan dengan data sekunder pasien ikterus obstruktif yang dirawat di RS. Cipto Mangunkusumo, Jakarta antara Januari 2010-Desember 2013. Faktor-faktor yang dinilai meliputi umur, jenis kelamin, sepsis, hipoalbumin, tingkat bilirubin serum, tingkat CA 19-9 serum, drainase bilier, keganasan non ca ampula Vater, dan komorbid dengan hasil keluaran berupa mortalitas pasien. Hasil: sebanyak 181 dari 402 pasien ikterus obstruktif dengan etiologi maligna memenuhi kriteria penelitian dengan proporsi laki-laki sebesar 58,6 % dengan pasien berumur ≥50 tahun sebesar 57,5%. Analisis multivariat menunjukkan bahwa sepsis, riwayat drainase bilier sebelumnya dan skor komorbid Charlson ≥4 merupakan prediktor independen terhadap mortalitas. Median kesintasan pasien dengan faktor prognosis bermakna adalah 14 hari sedangkan median kesintasan keseluruhan 26 hari. Ambang skor prognostik terbaik didapatkan pada skor ≥2 dengan sensitivitas 68% dan spesifisitas 75%. AUC pada kurva ROC 0.769. Kesimpulan: kesintasan pasien dengan faktor prognosis sepsis, drainase bilier tidak berhasil/tidak ada, dan skor indeks komorbid Charlson ≥4 lebih pendek dibandingkan kesintasan keseluruhan pasien. Skor prognostik ≥2 termasuk dalam risiko tinggi kematian dan kemampuan prediksi mortalitas dari faktor prognosis bermakna adalah 76.9%.

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Aim: to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. Methods: all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. Results: total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. Conclusion: sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%.

Abstrak :
LATAR BELAKANG: Banyak faktor mempengaruhi prognosis luka bakar, data di Indonesia belum ada yang rinci. Dengan mengetahui faktor prognostik terpenting, akan dimungkinkan menetapkan penatalaksanaan yang tepat_ Perbaikan standar penatalaksana an membawa perbaikan nyata untuk menekan mortalitas. METODE: Penelitian kohort historikal menggunakan subyek penderita luka bakar rawat inap di RSCM Januari I998-Mei 2001. Semua yang memenuhi kriteria inklusi diambil. Analisis data dengan survival analysis menggunakan Cox proportional hazard untuk mencari perhitungan ketahanan hidup. HASIL: Dari 156 penderita didapat angka mortalitas 27,6%. Penderita terbanyak berusia 19 tahun, laki-laki lebih banyak 1,6 x dari perempuan. Penyebab tersering api (55,1%) dan terjadi dirurnah (72,4%). Ditemukan luka bakar terbanyak derajat 2° (76,9%) dengan Iuas terbanyak 27%, interquartile range 19-43%. Faktor prognostik terpenting dengan nilai hazard ratio (HR) dan 95% confidence interval (CI) masing-masing adalah syok-SIRS 12,05 (2,36;60,95), trombositopeni 10,78 (2,23;52,05), trauma inhalasi 5,20 (2,77;9,77), syok 4,87 (1,25;18,98) dan luas>50% 4,35 (1,22;15,59) KESIMPULAN: Penatalaksanaan resusitasi cairan yang tepat dan resusitasi jalan napas dapat menekan angka mortalitas penderita luka bakar. Trombositopeni merupakan salah satu petanda awal kemungkinan sepsis/SIRS.

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Prognostic factors in moderate and severe burn patients at Dr. Cipto Mangunkusumo National General Hospital Jakarta 1998-May 2001. BACKGROUND: Several factors influence the outcome of burn injuries. Knowing the most important factors influencing the outcome of burn might be helpfull in developing new strategies for patient care. Improvement of burn patients management can reduce mortality rate. METHODS: Data from historical cohort were analyzed using Cox proportional hazard. One hundred fifty six burn patients hospitalized at Dr. Cipto Mangunkusumo National General Hospital from January 1998-May 2001 were selected consecutively according to inclusion criteria. RESULTS: From the 156 patients studied, mortality rate was 27,6%. Median patient age was 19 years , male : female ratio 1,6:1. The most common cause of thermal injury was flame (55,1%) and the majority occured at home (72,4%). Second degree burns were dominant (76,9%) with median burn size 27% Total Body Surface Area ( interquartile 19-43). The most important prognostic factors, hazard ratios and 95% confidence interval were shock with SIRS 12,05 (2,36;60,95), thrombocytopenia 10,78 (2,23;52,05), inhalation injury 5,20 (2,77;9,77), shock 4,87 (1,25;18,98) and burn size >50% 4,35 (1,22;15,59). CONCLUSIONS: Adequate fluid rescusitation and respiratory rescusitation can overcome important factors influencing burn patients outcome in order to reduce mortality rate. Thrombocytopenia can be use as an early sign of impending sepsis/SIRS.

Abstrak :
Ruang lingkup dan Cara penelitian : Dilakukan penelitian terhadap 114 penderita kanker payudara stadium I dan II di Bagian Bedah Onkologi/HNB FKUI/RSUPNCM Jakarta dalam kurun waktu 1989-1996. Setelah dibuktikan secara histopatologi suatu keganasan, penderita selanjutnya dilakukan mastektomi radikal. Bila kelenjar getah bening terdapat penyebaran sel kanker maka diberikan terapi ajuvan berupa radiasi dan atau kemoterapi. Selanjutnya penderita diikuti sampai terjadi suatu kekambuhan, hilang dari pengamatan atau sampai penelitian berakhir. Hasil dan kesimpulan : Rerata umur penderita 45 tahun dengan rentang 22-64 dan terdapat 15% kekambuhan yang terjadi balk lokal maupun metastasis jauh. Kekambuhan terbanyak mengenai paru sebesar 32% kemudian hati dan tulang masing-masing 25%. Rerata lama pengamatan 519 hari (median 191 dan modus 39 ). Probabilitas babas penyakit sebesar 51% pada 1500 hari. Kelompok umur kurang 35 tahun dan kelompok 35-50 tahun mempunyai risiko untuk kambuh masing-masing 4 dan 6.3 kali dibanding kelompok lebih 50 tahun. Adanya penyebaran ke kelenjar getah bening meningkatkan risiko kekambuhan sebesar 6.9 kali. Ukuran tumor 2-5 cm dibanding kurang 2 cm mempunyai risiko kekambuhan 2.8 kali. Dan tipe Ca ductal Invasif mempunyai risiko yang sangat tinggi untuk kambuh dibanding tipe lainnya. Tetapi yang berrnakna secara statistik hanya penyebaran ke kelenjar getah bening dan tipe histopatologi.

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The Role of Clinical Prognostic Factors for Stage I and II Breast Cancer Recurrence in Cipto Mangunkusumo Hospital JakartaScope and Method of study : The objective of this study is to find out the role of several prognostic factors in breast cancer recurrence for patients underwent radical mastectomy on stage I and II in Cipto Mangunkusumo Hospital Jakarta. 114 patients entered this study during the period of 1989 to 1996. The patients with positive axillary node received adjuvant therapy i.e external radiation or chemotherapy. Survival analysis were used to analyze data. Results and conclusions : The mean age was 45 years(range 22-64 yrs). Cumulative incidence of recurrence was 15% with disease free survival 51 % at 1500 days. The most frequent site of metastasis was lung 32% then liver and bone 25% each. The mean follow up time was 519 days (median 191, mode 30). Age group below 35 years and between 35-50 years had higher risk for a relapse, 4 and 6.3 times than group above 50 years. Positive axillary node and tumor size above 2 cm increased risk 6.9 and 2.8 times respectively. Ductal invasive type had a very high risk to recur. But only axillary node involvement and ductal invasive type were statistically significant.

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ABSTRAK
Latar Belakang. Terdapat gangguan sistem imun pada sepsis. Fase awal ditandai dengan hiperinflamasi, sedangkan fase lanjut ditandai dengan imunosupresi. Kematian kumulatif lebih banyak pada fase lanjut. Saat ini belum terdapat penelitian yang secara khusus meneliti faktor prognostik mortalitas sepsis fase lanjut dan mengembangkan model prediksi mortalitasnya. Tujuan. Mengetahui faktor prognostik mortalitas sepsis berat fase lanjut di ICU dan mengembangkan sistem skor untuk memprediksi mortalitas. Metode. Penelitian kohort retrospektif dilakukan pada pasien dewasa yang mengalami sepsis berat di ICU RSCM pada periode Oktober 2011 – November 2012 dan masih bertahan setelah > 72 jam diagnosis sepsis ditegakkan di ICU. Tujuh faktor prognostik diidentifikasi saat diagnosis sepsis berat ditegakkan di ICU. Prediktor independen diidentifikasi dengan analisis Cox’s proportional hazard. Prediktor yang bermakna secara statistik dikuantifikasi dalam model prediksi. Kalibrasi model dinilai dengan uji Hosmer-Lemeshow dan kemampuan diskriminasi dinilai dari area under curve (AUC) dari receiver operating curve. Hasil. Subjek penelitian terdiri atas 220 pasien. Mortalitas 28 hari sepsis berat fase lanjut adalah 40%. Faktor prognostik yang bermakna adalah alasan masuk ICU (medis (HR 2,75; IK95%:1,56-4,84), pembedahan emergensi (HR 1,96; IK95%:0,99 – 3,90), indeks komorbiditas Charlson > 2 (HR 2,07; IK95%:1,32- 3,23), dan skor MSOFA > 4 (HR 2,84; IK95%:1,54-5,24). Model prediksi memiliki kemampuan diskriminasi yang baik (AUC 0,844) dan kalibrasi yang baik (uji Hosmer-Lemeshow p 0,674). Berdasarkan model tersebut risiko mortalitas dapat dibagi menjadi rendah (skor 0, mortalitas 5,4%), sedang (skor 1 – 2,5, mortalitas 20,6%), dan tinggi (skor > 2,5, mortalitas 73,6%). Simpulan. Alasan masuk medis dan pembedahan emergensi, indeks komorbiditas Charlson > 2, dan skor MSOFA > 4 merupakan faktor prognostik mortalitas sepsis berat fase lanjut di ICU RSCM. Sebuah model telah dikembangkan untuk memprediksi dan mengklasifikasikan risiko mortalitas.

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ABSTRACT
Background. Immune system derrangement occurs during the course of sepsis, characterized by hyperinflamation in early phase and hypoinflamation and immunosupression in late phase. The number of patient die during late phase is larger than early phase. Until now, there is no study specifically addressing prognostic factors of mortality from late sepsis and developing a mortality prediction model. Aim. To determine prognostic factors of mortality from late phase of severe sepsis in ICU and to develop scoring system to predict mortality. Method. A retrospective cohort study was conducted to identify prognostic factors associated with mortality. Adult patients admitted to ICU during November 2011 until October 2012 who developed severe sepsis and still alive for minimum 72 hours were included in this study. Seven predefined prognostic factors were indentified at the onset of severe sepsis in ICU. Cox’s proportional hazard ratio was used to identify independent prognostic factors. Each independent factors was quantified to develop a prediction model. Calibration of the model was tested by Hosmer-Lemeshow, and its discrimination ability was calculated from area under receiver operating curve. Result. Subjects consist of 220 patients. Twenty eight-day mortality was 40%. Significant prognostic factors indentified were admission source (medical (HR 2.75; CI95%: 1.56 – 4.84), emergency surgery (HR 1.96; CI95%:0.99 – 3.90), Charlson comorbidity index > 2(HR 2.07; CI95%:1.32 – 3.23), and MSOFA score > 4 (HR 2.84; CI95% : 1.54 – 5.24). Prediction model developed has good discrimination ability (AUC 0.844) and good calibration (Hosmer-Lemeshow test p 0.674). Based on the model mortality risk can be classified as low (score 0, mortality 5.4%), moderate (score 1 – 2.5, mortality 20.6%), and high (score > 2.5, mortality 73.6%). Conclusion. Medical and emergency surgery admission, Charlson comorbidity index > 2, and MSOFA score > 4 were prognostic factors of mortality from late phase of severe sepsis in ICU at Dr.Cipto Mangunkusumo general hospital. A model has been developed to predict and classify mortality risk.

Abstrak :
ABSTRAK Latar belakang: Mengetahui faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna merupakan hal penting untuk membantu membuat perencanaan optimal dalam melakukan pendekatan terapi yang tepat untuk masing-masing etiologi dan faktor terkait guna membantu meningkatkan kesintasan dan kualitas hidup pasien. Tujuan: Mendapatkan kesintasan dan faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna di RSCM. Metode: Penelitian kohort retrospektif dan prospektif dilakukan dengan data sekunder pasien ikterus obstruktif yang dirawat di ruang perawatan RSCM antara Januari 2010 ? Desember 2013. Faktor-faktor yang dinilai meliputi umur, jenis kelamin, sepsis, hipoalbumin, tingkat bilirubin serum, tingkat CA 19-9 serum, drainase bilier, keganasan non ca ampula Vater, dan komorbid dengan hasil keluaran berupa mortalitas pasien. Kesintasan kumulatif terjadinya mortalitas dalam 3 bulan setelah diagnosis dinyatakan dengan kurva Kaplan Meier. Analisis bivariat dan multivariat dilakukan dengan Cox Proportional Hazards Regression Model untuk mendapatkan Hazard Ratio (HR) dari setiap faktor prognosis. Skor prognosis dari setiap faktor bermakna ditentukan berdasarkan model akhir regresi. Hasil: Sebanyak 181 dari 402 pasien ikterus obstruktif dengan etiologi maligna memenuhi kriteria penelitian dengan proporsi laki-laki sebesar 58,6 % dengan pasien berumur ≥ 50 tahun sebesar 57,5 %. Sepsis (HR 2.462 ; IK 95% 1.552 ? 3.906), drainase bilier tidak berhasil/tidak ada (HR 1.604 ; IK 95% 0.988 ? 2.603), serta skor indeks komorbid Charlson ≥ 4 (HR 2.476 ; IK 95% 1.562 ? 3.923) merupakan faktor prognosis yang bermakna terhadap mortalitas pasien. Median kesintasan pasien dengan faktor prognosis bermakna 14 hari; IK 95% 9.66 ? 18.34 sedangkan median kesintasan keseluruhan 26 hari; IK 95% 20.82 ? 31.19 (p < 0.01). Ambang skor prognostik terbaik didapatkan pada skor ≥ 2 dengan sensitifitas 68% dan spesifisitas 75%. AUC pada kurva ROC 0.769. Kesimpulan: Kesintasan pasien dengan faktor prognosis sepsis, drainase bilier tidak berhasil/tidak ada, dan skor indeks komorbid Charlson ≥ 4 lebih pendek dibandingkan kesintasan keseluruhan pasien. Skor prognostik ≥ 2 termasuk dalam risiko tinggi kematian dan kemampuan prediksi mortalitas dari faktor prognosis bermakna sebesar 76.9%.

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ABSTRACT Background: Understanding any related factors affecting mortality in patients with malignant obstructive jaundice will better guide to an approriate and optimal planning in making theurapetic approach for each etiological and relating factors thus improving survival and patients? quality of life. Aim: To obtain survival rate and mortality-related factors of malignant obsructive jaundice patients in Cipto Mangunkusumo Hospital. Methods: Retrospective-prospective cohort study was conducted with medical records of obstructive jaundice inpatient from January 2010 to December 2013 were reviewed. Suggested mortality-related factors include age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid were analyzed. Three-month cumulative overall survival was calculated by Kaplan-Meier curve. Bivariat and multivariat analysis was done with Cox Proportional Hazards Regression Model to obtain Hazard Ration (HR) of each prognostic factor. Prognosis score from each mortality-related factor was calculated based on the last regression model. Results: 181 from 402 patients were enrolled in this study with male proportion was 58.6% and patients aged 50 years or above was 57.5%. Sepsis (HR 2.462 ; CI 95% 1.552 ? 3.906), unsuccessful / no prior billiary drainage (HR 1.604 ; CI 95% 0.988 ? 2.603), and Charlson comorbid score ≥ 4 (HR 2.476 ; CI 95% 1.562 ? 3.923) were mortality-related factors with significant difference. Patients with significant prognostic factors had median survival 14 days; 95% CI: 9.66 ? 18.34 compared with overall median survival 26 days; 95% CI: 20.82 ? 31.19 (p < 0.01). Score ≥ 2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. Conclusion: Patients with significant prognostic factors which were sepsis, unsuccessful / no prior billiary drainage, and Charlson comorbid score ≥ 4 had shorter survival than overall survival. Prognostic threshold ≥ 2 quite good to classify malignant obstructive jaundice inpatient into high risk mortality population. Mortality of patients with those significant prognostic factors can be predicted in 76,9%.