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Abstrak :
Latar belakang: Hiperglikemia dan AKI merupakan komorbiditas yang sering dijumpai pada anak sakit kritis. Keduanya berhubungan dengan peningkatan morbiditas dan mortalitas. Hubungan antara hiperglikemia dan AKI pada anak sakit kritis belum banyak diketahui. Tujuan: Diketahuinya perbedaan proporsi AKI pada kelompok anak sakit kritis dengan hiperglikemia dan nonhiperglikemia. Diketahuinya perbedaan rerata kadar gula darah admisi, kadar gula darah puncak, dan durasi hiperglikemia pada kelompok anak sakit kritis dengan AKI dan tanpa AKI. Metode: Penelitian kohort prospektif dilakukan pada anak sakit kritis usia 1 bulan-18 tahun di ruang resusitasi IGD dan perawatan intensif anak RSCM selama bulan Agustus-Desember 2016. Pemeriksaan kadar gula darah, kreatinin serum, dan kadar NGAL urine dilakukan pada saat admisi. Pemantauan kadar gula darah dilakukan dengan interval 2 jam pada kelompok hiperglikemia. Seluruh subyek diikuti sampai keluar ruang perawatan intensif. Hasil: Proporsi subyek anak sakit kritis yang mengalami hiperglikemia adalah 46,5 IK 95 36,8-56,2 . Proporsi subyek dengan hiperglikemia yang mengalami AKI menurut kriteria AKIN adalah 30,7 IK 95 21,8 ndash;39,6 , sedangkan proporsi subyek dengan hiperglikemia yang memiliki kadar NGAL urine >135 ng/mL adalah 21,8 IK 95 13,8 ndash;29,8 . Acute kidney injury menurut kriteria AKIN maupun kadar NGAL urine lebih banyak dijumpai pada subyek dengan hiperglikemia, namun perbedaan proporsi tersebut tidak bermakna secara statistik kriteria AKIN: RR 2,08; IK 95 0,93-4,67; P 0,072; NGAL urine >135 ng/mL: RR 1,34; IK 95 0,81-2,1; P 0,243 . Paparan hiperglikemia pada perawatan intensif dengan durasi ge;4 jam risiko AKI meningkat sebesar 2,38 kali IK 95 1,25 ndash;4,56. Simpulan: Acute kidney injury banyak dijumpai pada anak sakit kritis yang mengalami hiperglikemia. Paparan hiperglikemia ge;4 jam pada perawatan intensif berkaitan dengan peningkatan risiko AKI pada anak sakit kritis. ......Background Hyperglycemia and AKI are common in critically ill children. Both conditions are associated with increasing mortality and morbidity. The association of hyperglycemia and AKI in critically ill children is still not well understood. Objective To evaluate the difference in proportion of AKI between critically ill children with and without hyperglycemia. To evaluate the mean difference of initial blood glucose, peak blood glucose, and the duration of hyperglycemia between critically ill children with and without AKI. Method A prospective cohort study was conducted in critically ill children aged 1 month to 18 years at the emergency unit and the pediatric intensive care unit at Cipto Mangunkusumo Hospital between August December 2016. Blood glucose, creatinine serum, and urine NGAL was examined at admission. Blood glucose was monitored every 2 hours in hyperglycemic subjects. All of the subjects were followed until time of discharge from the intensive care unit. Result Hyperglycemia in critically ill children was found in 46.5 subject 95 CI 36.8 56.2. Acute kidney injury based on the AKIN criteria was found in 30.7 hyperglycemic subjects 95 CI 21,8 ndash 39,6, and hyperglycemia with an increased urine NGAL level 135 ng mL was found in 21.8 subjects 95 CI 13.8 ndash 29.8. Acute kidney injury and an increased urine NGAL were more frequently found in subjects with hyperglycemia, however, the difference in the proportion was statistically insignificant AKIN criteria RR 2,08 95 CI 0,93 4,67 P 0,072 urine NGAL level 135 ng mL RR 1,34 95 CI 0,81 2,1 P 0,243 . The duration of hyperglycemia ge 4 hours at the intensive care unit increases the risk of AKI up to 2.38 times CI 95 1.25 ndash 4.56. Conclusion Acute kidney injury are frequently seen in hyperglycemic critically ill children. A duration of hyperglycemia of ge 4 hours in intensive care unit is associated with an increased risk of AKI in critically ill children.

Abstrak :
Latar belakang : Anemia akut sering terjadi pada anak sakit kritis yang dirawat di PICU, memiliki konsekuensi hipoksia global yang dapat mengakibatkan disfungsi miokardium. Transfusi PRC masih menjadi salah satu pilihan dalam rangka memperbaiki oksigenasi dan kinerja jantung saat terjadi anemia. Bukti-bukti pengaruh transfusi pada perbaikan performa jantung masih terbatas. Tujuan : Mengevaluasi kadar NT-proBNP, pasokan oksigen, indeks inotropi dan rasio energi potensial:energi gerak pada jantung sebelum dan sesudah transfusi PRC pada anak sakit kritis yang mengalami anemia akut. Metode : Penelitian analitik observasional potong lintang sejak April sampai Agustus 2019 pada anak usia 1 bulan-18 tahun dengan sakit kritis yang dirawat di PICU RSUPN Dr. Cipto Mangunkusumo. Penilaian hemodinamik menggunakan USCOM. Hasil : Penelitian ini melibatkan 31 subyek dengan median umur 3,6 tahun (rentang 0,1-17,5 tahun). Kadar Hb naik sebesar 29,1±15,9% setelah mendapat transfusi PRC 9±3,3 mL/KgBB. Rerata kadar hemoglobin sebelum dan sesudah transfusi adalah 7,94±1,46 dan 10,17±1,92 g/dL (p<0,000 IK 95%: 1,80-2,64). Kadar NT-proBNP meningkat tak bermakna sebesar 12% (-77,0-199) setelah transfusi dari 4214±6678 menjadi 5182±8327 pg/mL (p=0,186 IK 95%: -493-2428). Tidak terdapat korelasi antara persen perubahan Hb dan NT-proBNP (Spearman correlation r=0,124; p=0,505). Terdapat kenaikan pasokan oksigen pasca transfusi sebesar 20,7±38,9% dan berkorelasi dengan kanaikan hemoglobin (Pearson correlation r=0,39; p=0,029). Uji Chi-square menunjukkan adanya hubungan bermakna antara kelompok yang mengalami kenaikan DO dengan perbaikan indeks inotropi (uji Chi square, p=0,031) dan perbaikan PKR (p=0,008), namun tak ada hubungan dengan perubahan NT-proBNP (p=0,511). Simpulan : Tidak terdapat perubahan bermakna kadar NT-proBNP sebelum dan sesudah transfusi PRC pada anak sakit kritis yang mengalami anemia akut. Peningkatan pasokan oksigen pasca transfusi PRC berkorelasi dengan peningkatan indeks inotropi (Smith-Madigan Inotropy Index) dan perbaikan potensial to kinetic ratio (PKR)

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Background: Acute anemia often occurs in critically ill children in PICU, which has global hypoxic consequences resulting myocardial dysfunction. Transfusion of PRC is still choosen in order to improve oxygenation and cardiac performance during anemia. Evidence of the effect of transfusion on improving cardiac performance is still limited. Objective: To evaluate NT-proBNP levels, delivery oxygen (DO2), inotropy index and the potential to kinetic energy ratio (PKR) of heart before and after PRC transfusion in critically ill children with acute anemia. Methods: A cross-sectional observational analytic study conducted from April to August 2019 in children aged 1 month-18 years cared in PICU Dr. Cipto Mangunkusumo Hospital. Hemodynamic assessment using USCOM. Results: This study involved 31 subjects with a median age of 3.6 years (range 0.1-17.5 years). Hb levels increased by 29.1±15.9% after receiving a 9±3.3 mL / KgBB transfusion PRC. The mean hemoglobin levels before and after the transfusion were 7.94±1.46 and 10.17±1.92 g / dL (p <0.000; CI 95%: 1.80-2.64). NT-proBNP levels slight increased but not statistically sgnificant by 12%(-77.0 - 199) after PRC transfusion from 4214±6678 to 5182±8327 pg/mL (p = 0.186; CI 95%: -493 - 2428). There was no correlation between percent change in Hb and NT-proBNP (Spearman correlation r=0.124; p=0.505). There was increasing in DO2 after transfusion by 20.7±38.9% and correlated with increased hemogolobin (Pearson correlation r=0.39; p=0.029). Chi-square test showed a significant relationship between groups that experienced an increase in DO2 with an improvement in the inotropy index (Chi square test, p=0.031) and improvement in PKR (p=0.008), but there was no relationship with NT-proBNP changes (p=0.511) . Conclusions: There was no significant change in NT-proBNP levels before and after PRC transfusion in critically ill children who had acute anemia. Increased DO2 after PRC transfusion correlates with an increase in the inotropy index (Smith-Madigan Inotropy Index) and improvement in potential to kinetic ratio (PKR).