[ABSTRAK Latar Belakang : Perbedaan antara demam dengue ( DD ) dan demam berdarahdengue ( DBD ) adalah terjadinya kebocoran plasma pada DBD. Kebocoranplasma pada ruang interstitial ditandai dengan adanya efusi cairan di pleura danperitoneal, hemokonsentrasi, serta hipovolemia intravaskular. Keadaan inimenyebabkan gangguan perfusi ke jaringan, sehingga menyebabkan metabolismanaerob. yang menimbulkan peningkatan kadar laktat dalam darah.Tujuan Penelitian: Mengetahui peran laktat sebagai prediktor prognosis dandiagnosis kebocoran plasma pada infeksi dengue pasien dewasa.Metode: Studi potong lintang, pada infeksi virus dengue pasien dewasa yangdirawat di bangsal penyakit dalam RS Cipto Mangunkusumo dan RS PersahabatanJakarta. Jumlah subjek sebanyak 57 orang. Dilakukan pemeriksaan kadar laktatuntuk melihat perbedaan rerata kadar laktat antara DD dan DBD dengan uji t-testidak berpasangan, dan nilai titik potong kadar laktat pada keadaan tanpa ataudengan kebocoran plasma dilakukan dengan menentukan sensitifitas danspesifisitas terbaik dari kurva ROC yang sudah dibuat.Hasil: Rerata kadar laktat pada DBD secara bermakna lebih tinggi daripada DD.Nilai titik potong untuk prediktor prognostik pada hari ke-3 yang ditentukandengan kurva ROC mendapatkan nilai kadar laktat ≥ 2,65 mmol/ L dengan AUC0,626 ; IK 95% 0,480-0,772. Dan nilai titik potong untuk diagnostik pada hari ke-5 mendapatkan nilai kadar laktat ≥ 2,55 mmol/L memberikan sensitivitas 66,6%%dan spesifisitas 54,2%.Kesimpulan: Terdapat perbedaan bermakna kadar laktat antara DD dan DBD.Nilai kadar laktat ≥ 2,65 mmol/L belum dapat digunakan sebagai prediktorprognostik adanya kebocoran plasma pada fase kritis. Nilai kadar laktat ≥ 2,55mmol/L pada saat fase kritis dipakai sebagai petanda adanya kebocoran plasmadengan akurasi yang rendah. ABSTRACT Background : The difference between dengue fever (DF) and denguehemorrhagic fever (DHF) is plasma leakage which occurs in DHF. The leakage ofplasma into interstitial space is shown by pleura and peritoneal effusion,hemoconcentration, and intravascular hypovolemia. Anaerob metabolism willoccur due to perfusion dysfunction which will cause increased serum lactate.Objectives : To determine the role of lactate as a prognostic predictor anddiagnostic in plasma leakage which occurs in adult dengue-infected patients.Methods : This is cross-sectional study which is conducted in adult dengueinfectedpatients hospitalized in internal medicine ward of Cipto MangunkusumoHospital and Persahabatan Hospital in Jakarta. There are 57 adult dengue-infectedpatients recruited. Serum lactate is examined to determine the mean differencebetween DF and DHF. The data is analyzed by t-test independent and cut-off pointis identified in presence as well as absence of plasma leakage which is todetermine the sensitivity and specificity based on ROC curve.Results : The mean of serum lactate in DHF is significantly higher compared toDF. The cut-off point of prognostic predictor in day three of fever which isdetermined based on ROC curve shows lactate serum ≥ 2.65 mmol/L with AUC0.626; 95% CI 0.480-0.772. Moreover, the cut-off point of diagnostic factor inday five of fever is shown by serum lactate ≥ 2.55 mmol/L with sensitivity 66.6%and specificity 54.2%.Conclusion : There is difference of serum lactate in DF and DHF. Serum lactate ≥2.65 mmol/L could not be used as a prognostic predictor of plasma leakage incritical phase. Serum lactate ≥ 2.55 mmol/L during critical phase could be used asa marker of plasma leakage but low of accuracy, Background : The difference between dengue fever (DF) and denguehemorrhagic fever (DHF) is plasma leakage which occurs in DHF. The leakage ofplasma into interstitial space is shown by pleura and peritoneal effusion,hemoconcentration, and intravascular hypovolemia. Anaerob metabolism willoccur due to perfusion dysfunction which will cause increased serum lactate.Objectives : To determine the role of lactate as a prognostic predictor anddiagnostic in plasma leakage which occurs in adult dengue-infected patients.Methods : This is cross-sectional study which is conducted in adult dengueinfectedpatients hospitalized in internal medicine ward of Cipto MangunkusumoHospital and Persahabatan Hospital in Jakarta. There are 57 adult dengue-infectedpatients recruited. Serum lactate is examined to determine the mean differencebetween DF and DHF. The data is analyzed by t-test independent and cut-off pointis identified in presence as well as absence of plasma leakage which is todetermine the sensitivity and specificity based on ROC curve.Results : The mean of serum lactate in DHF is significantly higher compared toDF. The cut-off point of prognostic predictor in day three of fever which isdetermined based on ROC curve shows lactate serum ≥ 2.65 mmol/L with AUC0.626; 95% CI 0.480-0.772. Moreover, the cut-off point of diagnostic factor inday five of fever is shown by serum lactate ≥ 2.55 mmol/L with sensitivity 66.6%and specificity 54.2%.Conclusion : There is difference of serum lactate in DF and DHF. Serum lactate ≥2.65 mmol/L could not be used as a prognostic predictor of plasma leakage incritical phase. Serum lactate ≥ 2.55 mmol/L during critical phase could be used asa marker of plasma leakage but low of accuracy] |