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Abstrak :
Latar Belakang: Pasien TB-HIV yang mengalami lost to follow-up dapat menjadi sumber penularan, resistensi obat, meningkatnya angka morbiditas dan mortalitas. Dibutuhkan data tentang proporsi lost to follow-up pasien TB-HIV, serta faktor-faktor yang memengaruhi. Tujuan : Mengetahui profil lost to follow-up pasien TB-HIV dan faktor-faktor yang memengaruhi. Metode: Desain penelitian menggunakan kohort retrospektif terhadap pasien TB-HIV rawat jalan di RSCM tahun 2015-2017. Analisis univariat untuk mendapatkan data profil pasien TB-HIV. Analisis bivariat dan multivariat untuk mengetahui besar pengaruh faktor-faktorr terkait lost to follow-up pasien TB-HIV. Analisis multivariat untuk mendapatkan Odds Ratio (OR) dari setiap faktor. Hasil: Hasil analisis univariat menunjukkan proporsi lost to follow-up pasien TB-HIV sebesar 39% dengan karakteristik sebagai berikut, laki-laki (74,4%), usia ≥30 tahun (76,9%), jumlah penghasilan dibawah upah minimum regional Jakarta (87,2%), status fungsional ambulatory-bedridden (51,3%), frekuensi ganti transportasi 2 kali (51,3%), lama menunggu pengobatan ≥ 2jam (87,2%), jumlah obat <12 (56,4%), tempat tinggal di Jakarta (92,3%), mengalami efek samping obat (56,4%) dan status imunodefisiensi berat (84,6%). Lost to follow-up TB-HIV paling banyak terjadi pada bulan ke-2 pengobatan TB. Hasil analisis multivariat menunjukkan jumlah penghasilan dibawah upah minimum regional Jakarta (OR 6,58; IK 95%(2,27-19,08); nilai p=0,001) paling berpengaruh terhadap lost to follow-up pasien TB-HIV. Kesimpulan : Proporsi lost to follow-up pasien TB-HIV sebesar 39%. Lost to follow-up TB-HIV paling banyak terjadi pada bulan ke-2 pengobatan TB. Jumlah penghasilan dibawah upah minimum regional Jakarta menjadi faktor paling memengaruhi lost to follow-up pasien TB-HIV ......Background. TB-HIV patients whose lost to follow-up can be followed up for transmission, drug resistance, patients and mortality. We required data for proportion of lost to follow up TB-HIV, factors associated within. Aim.To find out the profile of lost to follow-up in TB-HIV patients and influencing factors. Methods. The study design used a retrospective cohort of outpatient TB-HIV patients at the RSCM in 2015-2017. Univariate analysis to obtain profile data for TB-HIV patients. Bivariate and multivariate analysis to determine the effect of factors related to lost to follow-up of TB-HIV patients. Multivariate analysis to get Odds Ratio (OR) from each factor. Results. The results of univariate analysis were the proportion of lost to follow-up TB-HIV patients by 39%. The basic characteristics of each patient lost to follow-up TB-HIV were: Men (74.4%), age ≥30 years (76.9%), total income under the regional minimum wage of Jakarta (87.2%), functional status of ambulatory bedridden (51.3%), frequency of change transportation twice (51.3%), long waiting for treatment ≥2 hours (87.2%), number of drugs <12 (56.4%), place of residence in Jakarta (92.3%), experiencing drug side effects (56 , 4%), severe immune status (84.6%). Most lost during the second month of TB treatment. The results of multivariate analysis of income under the minimum regional of Jakarta (OR 6.58; IK 95%(2.27-19.08)) most influence the lost to follow-up of TB-HIV patients. Conclusion. The proportion of lost to follow-up for TB-HIV patients was 39%. Most were lost on the second month of TB treatment. Total income of under the minimum regional of Jakarta was the most influential factor in lost to follow-up of TB-HIV patients.

Abstrak :
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. ......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.

Abstrak :
Latar Belakang: Pneumonia berat adalah infeksi saluran napas yang masih memiliki angka mortalitas yang tinggi. Pasien pneumonia berat sering kali memerlukan intubasi untuk mencapai ventilasi yang adekuat. Terjadinya kegagalan ekstubasi dapat meningkatkan komplikasi dan mortalitas pada pasien, sehingga pasien dengan risiko gagal ekstubasi perlu dikenali sedini mungkin. Tujuan: Mengetahui faktor yang dapat memprediksi kegagalan ekstubasi pada pasien pneumonia berat Metode: Studi ini merupakan studi kohort retrospektif yang melibatkan pasien dengan pneumonia berat yang terintubasi dan dirawat di ICU/HCU RSCM pada tahun 2015-2019. Data pasien dan hasil pemeriksaan laboratorium diambil dari rekam medis. Analisis bivariat dilakukan dengan uji Chi-square atau uji Fischer, sementara analisis multivariat dilakukan dengan uji regresi cox. Hasil: Sebanyak 192 subjek pasien pneumonia berat dilibatkan dalam penelitian ini. Insidensi kegagalan ekstubasi pada pasien pneumonia berat di RSCM adalah 70,3%, dengan angka mortalitas pada pasien yang mengalami gagal ekstubasi adalah sebesar 85,2%. Dari analisis bivariat, didapatkan usia >60 tahun, merokok, Charlson Comorbidity Index sedang-berat, tidak adanya penyakit neuromuskular, terapi pengganti ginjal, prokalsitonin > 2 ng/mL, dan skor APACHE II ≥25 sebagai variabel yang berhubungan signifikan dengan kegagalan ekstubasi. Selanjutnya, analisis multivariat menemukan bahwa Charlson Comorbidity Index sedang-berat (p=0,002, HR 2,254, IK95% 1,353-3,755), dan prokalsitonin > 2 ng/mL (p<0,001, HR 1,859, IK95% 1,037-3,333) merupakan prediktor independen terhadap kegagalan ekstubasi pada pasien pneumonia berat. Kesimpulan: Faktor-faktor yang secara independen merupakan prediktor kegagalan ekstubasi pada pasien pneumonia berat adalah Charlson Comorbidity Index sedang-berat, dan kadar prokalsitonin > 2 ng/mL. ......Background: Severe pneumonia is a lower respiratory tract infection still presenting with a high a mortality rate. Patients with severe pneumonia often require intubation in order to achieve adequate ventilation. Extubation failure, however, is associated with increased complications and mortality. Therefore, it is crucial to recognize risk factors associated with extubation failure as soon as possible. Objective: To determine the predictors associated with extubation failure in patients with severe pneumonia Methods: A retrospective cohort study was conducted, which included patients with severe pneumonia who were intubated in ICU/HCU of Ciptomangunkusumo General Hospital over the period of 2015-2019. Patient characteristics and laboratory values were obtained from medical records. Bivariate analysis was performed with Chi-square or Fischer test, whereas multivariate analysis was performed with cox regression model. Results: A total of 192 subjects with severe pneumonia was included in this study. Incidence of extubation failure among patients with severe pneumonia was 70,3%, with a mortality rate of 85,2%. Bivariate analyses found that age of >60 years, smoking history, moderate-to-severe Charlson Comorbidity Index, procalcitonin > 2 ng/mL, not having neuromuscular disease, renal replacement therapy, and APACHE II score of ≥25 were significantly associated with extubation failure. In multivariate analysis, moderate-to-severe Charlson Comorbidity Index (p=0,002, HR 2,254, 95% CI 1,353-3,755) and procalcitonin > 2 ng/mL (p<0,001, HR 1,859, 95% CI 1,037-3,333) were found to be independent predictors of extubation failure in patients with severe pneumonia. Conclusion: Moderate-to-severe Charlson Comorbidity Index and procalcitonin level of > 2 ng/mL were independent predictors of extubation failure in patients with severe pneumonia.

Abstrak :
Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo. ...... Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia. Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo. Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test. Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86. Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital.

Abstrak :
Latar belakang: Insidens metastasis otak lebih tinggi dibanding tumor primer otak dan berisiko menimbulkan kematian dengan penyebab terbanyak berasal dari kanker paru (36,5%) di RSUPN Cipto Mangunkusumo (RSCM). Keterlambatan diagnosis berisiko menyebabkan herniasi otak, sehingga terjadi kecacatan dan kematian. Dibutuhkan data mengenai durasi penegakan diagnosis di RSCM. Metode penelitian: Penelitian ini merupakan studi deskriptif analitik dengan rancangan kohort retrospktif untuk mengetahui kesesuaian antara durasi penegakan diagnosis tumor otak metastasis akibat kanker paru dengan pedoman praktik klinis (durasi ≤2 minggu). Subjek merupakan pasien rawat inap di RSCM pada Januari 2019 s/d Desember 2021. Hasil: Terdapat 12 subjek (30%) dapat ditegakkan dalam waktu ≤2 minggu dengan  median durasi 18,5 hari (IQR (12-34 hari). Selain itu didapatkan durasi 7 hari (IQR 4-11 hari) untuk sampai didapatkannya massa di paru,  durasi 8 hari (IQR 4.5-13 hari) sampai dilakukannya biopsi, dan 6 hari (IQR 3.5-7 hari) sampai keluarnya hasil patologi anatomi. Tidak terdapat hubungan yang bermakna secara statistik antara variabel yang dinilai dengan durasi penegakan diagnosis ≤2 minggu (14 hari). Kesimpulan: Hanya 30% subjek dengan durasi yang sesuai dengan panduan praktik klinis di RSCM. Dibutuhkan diseminasi hasil dan kolaborasi antar bagian agar penegakan diagnosis lebih cepat. ......Background: Incidence of brain metastases is higher than primary brain tumors, with lung cancer as common etiology (36.5%) at Cipto Mangunkusumo General Hospital (RSCM). Delay in diagnosis can cause brain herniation, resulting in disability and death. Data is needed regarding the duration of diagnosis in RSCM. Method: This is a descriptive analytic study with a retrospective cohort design to determine the conformity between the duration of diagnosis of metastatic brain tumors due to lung cancer in daily clinical practice with clinical practice guidelines (duration 2 weeks). Subjects were inpatients at RSCM from January 2019 to December 2021 Results: There were 12 subjects (30%) who could be diagnosed within 2 weeks with a median duration of 18.5 days (IQR (12-34 days). Duration of 7 days (IQR 4-11 days) to obtain a lung mass, 8 days (IQR 4.5-13 days) until a biopsy was performed, and 6 days (IQR 3.5-7 days) until anatomic pathology results were released. There is no statistically significant relationship between the variables assessed and the duration of diagnosis 2 weeks. Conclusion: Only 30% of subjects with the duration matched the clinical practice guidelines at RSCM. Dissemination of results and collaboration between departments is needed to make diagnosis faster.

Abstrak :
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. ......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.

Abstrak :
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. ...... 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.

Abstrak :
Latar Belakang: Kegagalan ekstubasi akibat pneumonia berat meningkatkan morbiditas dan mortalitas. Imunitas adaptif sistemik berupa fraksi dan rasio sel T limfosit CD4/CD8 darah memiliki peranan penting sebagai prediktor lemah mortalitas. Dibutuhkan studi lanjutan untuk mengetahui imunitas adaptif lokal melalui Bronchoalveolar Lavage (BAL) pada kedua paru. Tujuan: Mengetahui perbedaan kadar dan rasio sel T limfosit CD4/CD8 Bronchoalveolar Lavage sesuai status ekstubasi dan status mortalitas pada pneumonia berat. Metode: Penelitian ini menggunakan desain kohort prospektif pada 40 pasien pneumonia berat. Data primer diambil dari pasien yang terintubasi dan menjalani tindakan bronkoskopi di perawatan IGD dan ruang intensif RSCM sejak November 2020 hingga Januari 2021. Analisa univariat dan bivariat dengan uji beda rerata digunakan pada data skala numerik dengan sebaran normal dan uji Mann Whitney dengan sebaran tidak normal. Hasil: Proporsi gagal ekstubasi sebesar 80% dan proporsi mortalitas sebesar 75%. Terdapat perbedaan bermakna pada fraksi sel T limfosit CD4 BAL pada paru cidera berat kelompok berhasil ekstubasi dan gagal ekstubasi (p=0,006); kelompok pasien hidup dan meninggal (p=0,002). Fraksi CD4 darah dan rasio CD4/CD8 darah ditemukan lebih tinggi secara bermakna pada kelompok berhasil ekstubasi dibandingkan dengan gagal ekstubasi; juga ditemukan lebih tinggi pada kelompok yang hidup dibandingkan yang meninggal. Kesimpulan: Fraksi CD4 BAL pada paru cidera berat berbeda secara statistik bermakna lebih tinggi pada kelompok pasien berhasil ekstubasi dibandingkan dengan kelompok pasien gagal ekstubasi dan kelompok pasien hidup dibandingkan dengan kelompok pasien meninggal. ......Background: Extubation failure due to severe pneumonia increases morbidity and mortality. Systemic adaptive immunity, T lymphocyte cells CD4/CD8 in blood, has special role as a mortality predictor in severe pneumonia. Further study still needed to evaluate local adaptive immunity through bronchoalveolar lavage celluler examination in both lung. Objective: The aim of this study was to find out the differences between T lymphocytes CD4/CD8 in both lung based on extubation status and mortality status. Methods: We performed a cohort prospective study of 40 patients with severe pneumonia whom underwent endotracheal intubation and bronchoscopy hospitalized in intensive care unit between November 2020 to January 2021 in Dr. Cipto Mangunkusumo National General Hospital. Primary data was taken and analyzed using univariat and bivariat to investigate mean or median differences with unpaired t-test for normal numeric distribution data and Mann-Whitney test for abnormal distribution numeric data. Result: The proportion of extubation failure was 80% and mortality rate was 75%. There were significantly different results of BALF CD4 T cells lymphocyte fraction in severe pneumonia group of patients based on extubation status (p=0,006) and mortality status (p=0,002). Blood CD4 T cells lymphocyte fraction and blood CD4/CD8 T cells lymphocyte ratio were found significantly higher in the successfully extubation group of patients compared to extubation failure group of patients; and also significantly higher in survived group of patients compared to mortality group of patients with pneumonia severe. Conclusion: Fraction of CD4 BALF in severely injured pneumonia lungs group of patients who had succesful intubation processes were statistically different compared to the group of patients with unsuccesful extubation. Fraction of CD4 BALF were also found statistically different in the group of patients who were survived compared to the group of patients who were passed away.

Abstrak :
Latar belakang : Dispnea sebagai sensasi subjektif yang dialami pasien merupakan penanda adanya penyakit dasar yang perlu didiagnosis dan ditatalaksana, khususnya pada pasien dengan penyakit progresif. Studi sebelumnya telah menunjukkan bahwa keluhan dispnea saat admisi berkaitan dengan peningkatan mortalitas pasien. Tujuan : Mengetahui pengaruh dispnea terhadap kesintasan 1 tahun pada pasien dengan penyakit progresif di RSCM Metode : Studi kohort retrospektif dilakukan dengan menelusuri rekam medik 155 pasien dengan penyakit progresif yang dirawat inap di RSCM selama bulan Agustus 2018 hingga Desember 2019. Sampel penelitian ada pasien dewasa usia 18 tahun ke atas yang didiagnosa PPOK, gagal jantung, keganasan atau CVD. Data identitas, keluhan dispnea dan kesintasan dikumpulkan melalui rekam medis kemudian dianalisis menggunakan analisis multivariat dan grafik Kaplan Meier menggunakan perangkat SPSS. Hasil : Pada penelitian ini didapatkan kesintasan subjek dengan penyakit progresif yang dirawat di RSCM pada bulan Agustus 2018 hingga Desember 2019 sebesar 34,8% dengan mean survival sebesar 163 hari dan median survival sebesar 72 hari. Sebanyak 49% subjek memiliki keluhan dispnea. Kesintasan subjek dengan dispnea sebesar 11%, dengan mean dan median survival sebesar 115 hari dan 29 hari. Dispnea berhubungan secara signifikan terhadap kesintasan dengan nilai p < 0,05 dan adjusted HR 1,928 (95% CI: 1,225 – 3,03). Pada subgroup analysis kelompok subjek gagal jantung, keganasan, dan CVD, didapatkan dispnea berhubungan dengan kesintasan dengan nilai p<0,05 dan nilai HR masing-masing 16,59 (95% CI: 2,20 – 124,73), 2,18 (95% CI: 1,33 – 3,58), dan 2,90 (95% CI: 1,34 – 6,28). ......Background: Dispnea as a subjective sensation is a sign of certain underlying disease which need to be diagnosed and treated to prevent the mortality, especially in patients with progressive disease. Previous study has shown that patients with dispnea at admission have higer mortality. Objective: To determine the association between dyspnea with 1 year survival in patients with progressive disease who were admitted to RSCM. Methods: A retrospective cohort study was conducted by tracing the medical records of 155 patients with progressive disease who were hospitalized at RSCM during August 2018 until December 2019. Recruited subjects were adults patients who 18 years above diagnosed with COPD, heart failure, malignancy or CVD. Identity, dispnea, and survival data were collected through medical records. Statistical analysis was conducted by using multivariate and Kaplan Meier analysis using SPSS software. Results: In this study, the survival rate of patients with progressive disease who were admitted to RSCM in August 2018-December 2019 was 34.8% with a mean survival of 163 days and a median survival of 72 days. Among the patients 49% had dispnea. The survival rate of patients with dispnea was 11% with a mean survival of 115 days and a median survival of 29 days.. Dyspnea was significantly associated with survival with p < 0,05 and adjusted HR 1.928 (95% CI: 1.225 - 3.03). In the subgroup analysis of heart failure, malignancy, and CVD, dispnea was associated with survival with p<0,05 and the HR value for every group 16,59 (95% CI: 2,20 – 124,73), 2,18 (95% CI: 1,33 – 3,58), and 2,90 (95% CI: 1,34 – 6,28).

Abstrak :
Prevalensi pasien TB yang mengalami vestibulotoksik akibat streptomisin sulfat menurut literatur tercatat sebesar 30-70%. Berbagai modalitas pemeriksaan dapat digunakan untuk mendiagnosis gangguan keseimbangan, di antaranya dizziness handicap inventory (DHI), dynamic visual acuity (DVA), dan video head impulse test (VHIT). Penelitian ini bertujuan untuk mengetahui kesesuaian hasil DHI, DVA, dan VHIT dalam menilai gangguan keseimbangan pada pasien TB yang mendapat terapi streptomisin. Metode penelitian ini merupakan pre and post study design untuk mengetahui kesesuaian hasil pemeriksaan fungsi keseimbangan pada ketiga modalitas pemeriksaan pada satu kelompok pasien TB pada hari ke-14 dan setelah selesai pemberian streptomisin atau bila timbul keluhan gangguan keseimbangan. Rancangan studi prospektif digunakan untuk melihat kesesuaian ketiga penilaian sebelum pemberian streptomisin, pada hari ke-14, dan hari ke-56 di mana pemberian streptomisin telah selesai. Pada akhir terapi didapatkan 5 dari 24 subjek memiliki handicap dalam melakukan aktivitas sehari-hari berdasarkan pemeriksaan DHI, 5 dari 24 subjek mengalami kelemahan vestibular perifer bilateral berdasarkan pemeriksaan DVA dan pada pemeriksaan VHIT didapatkan 9 dari 24 subjek menderita kelemahan vestibular perifer bilateral. Kesesuaian antara pemeriksaan DVA dengan VHIT dan DHI dengan VHIT sebesar 83,3%, sedangkan kesesuaian antara DHI dengan DVA sebesar 100% dalam menilai gangguan keseimbangan pada subjek dan tidak didapatkan perbedaan bermakna pada ketiga modalitas tersebut. Dari hasil tersebut mendukung DVA untuk digunakan sebagai pemeriksaan penapisan gangguan vestibular perifer bilateral pada pasien tuberkulosis yang mendapat terapi streptomisin. ......Balance disorders can be caused by several medications and one of those is streptomycin sulphate used as treatment of category II lung TB. Prevalence of streptomycin-induced vestibulotoxicity amongst patients with TB is recorded around 30-70%. Besides history taking and physical examination, other modalities can be used to diagnose balance disorders, including dizziness handicap inventory (DHI), dynamic visual acuity (DVA), and video head impulse test (VHIT). This pre and post study design aims to determine the conformity between DHI, DVA, and VHIT in assessing balance disorders in TB patients treated with streptomycin on the 14th day and the end of treatment or whenever the balance disorders symptoms arise. Prospective research design used to compare the three methods of measurement before streptomycin administration, on the 14th day, and on the 56th day when completion of treatment is declared. There are 5 subjects (20.8%) recorded experienced handicap during daily activities according to DHI examination, 5 subjects (20.8%) diagnosed with bilateral vestibular weakness dan from VHIT examination and 9 (37.5%) subject diagnosed with bilateral vestibular weakness. The concordance rate between DVA and VHIT, DHI and VHIT in assessing vestibular disorders was 83.3% meanwhile the concordance rate between DHI and DVA was 100% and there was no significant differences between this three modalities. Thus we can conclude that DVA can be used as a screening modality for bilateral peripher vestibular disorders in TB patients who receive streptomycin therapy.