ABSTRAK
Latar Belakang : Kebocoran plasma merupakan proses utama yang terjadi pada demam berdarah dengue (DBD) dimana mulai terjadi pada hari ke-3 demam danmencapai puncaknya pada hari ke-5 demam. Kebocoran plasma menyebabkanhipoksia jaringan yang berakibat asidosis. Variabel yang terkait denganmikrosirkulasi perfusi jaringan yaitu parameter asam-basa. Menurut Stewart,abnormalitas asam-basa metabolik ditentukan dengan menghitung Strong IonDifference (SID). Hingga saat ini belum diketahui nilai SID pada infeksi denguedewasa dengan kebocoran plasma.Tujuan Penelitian : Mengetahui peran nilai SID untuk memprediksi danmendiagnosis kebocoran plasma pada infeksi dengue pasien dewasa.Metode : Studi potong lintang dan kohort retrospektif, pada infeksi virus denguepasien dewasa yang dirawat di ruang penyakit dalam RSUPN CiptoMangunkusumo dan RSUP Persahabatan Jakarta. Dilakukan pemeriksaan nilaiSID untuk melihat perbedaan rerata nilai SID antara demam dengue (DD) danDBD dengan uji t tidak berpasangan, dan nilai titik potong SID pada keadaandengan atau tanpa kebocoran plasma dilakukan dengan menentukan sensitivitasdan spesifisitas terbaik dari kurva ROC.Hasil : Jumlah subjek sebanyak 57 orang. Jenis kelamin laki-laki sebanyak 31pasien (54,38%) dan perempuan 26 pasien (45,61%). Kasus DD 31 pasien(54,38%) dan kasus DBD 26 pasien. Nilai SID hari ke-3 pada DBD secarabermakna lebih rendah dibandingkan DD [36,577 (±2,08) dan 39,032 (±1,44);p<0,01]. Demikian pula pada hari ke-5, nilai SID pada DBD lebih rendahdibandingkan DD [34,423 (±2,36) dan 37,548 (±2,55); p<0,01]. Hasil analisisstatistik didapatkan perbedaan bermakna. Berdasarkan kurva ROC pada hari ke-3didapatkan nilai SID ≤37,5 sebagai titik potong yang memberikan sensitivitas65% dan spesifisitas 84% dengan Area Under Curve (AUC) 0,824 (IK 95% 0,71? 0,93; p<0,001). Pada hari ke-5, titik potong nilai SID ≤36,5 memberikansensitivitas 81% dan spesifisitas 68% dengan AUC 0,813 (IK 95% 0,7 ? 0,92;p<0,001).Kesimpulan : Nilai SID hari ke-3 dan hari ke-5 pada DBD lebih rendahdibandingkan DD. Nilai SID ≤37,5 pada hari ke-3 dan ≤36,5 pada hari ke-5 dapatdipakai sebagai petanda kebocoran plasma.
ABSTRACT
Background : Plasma leakage is the main process in dengue haemorrhagic fever (DHF) which starts at day 3 of fever and peaked at day 5 of fever. Plasma leakageis causing tissue hypoxia that resulting in acidosis. Tissue perfusionmicrocirculation-associated variable is acid-base parameters. According toStewart, abnormality of metabolic acid-base is determined by calculating StrongIon Difference (SID). Now, SID in adult dengue-infected patients with plasmaleakage is not known yet.Objectives : To detemine the role of SID in prediction and diagnosis of plasmaleakage in adult dengue-infected patients.Methods : These were cross-sectional and retrospective cohort study whichconducted in adult dengue-infected patients that hospitalized in internal medicineward of Cipto Mangunkusumo General Hospital and Persahabatan GeneralHospital in Jakarta. SID was examined to determine the mean difference betweendengue fever (DF) and DHF by t-test independent, and cut-off point of SID inplasma leakage was identified by sensitivity and specificity based on ROC curve. Results : There were 57 adult dengue-infected patients recruited; consist of 31male patients (54,38%) and 26 female patient (45,61%); 31 DF patients (54,38%)and 26 DHF patients (45,6%). SID on day 3 of fever in DHF was significantlylower than DF [36,577 (±2,08) vs 39,032 (±1,44); p<0,01]. Similarly on day 5,SID of DHF 36,577 (±2,08) vs DF 39,032 (±1,44); p<0,01. Based on ROC curveof day 3, the cut-off point of SID was ≤37,5 with sensitivity 65%, specificity 84%,Area Under Curve (AUC) 0,824 (95% CI 0,71 ? 0,93; p<0,001). On day 5, thecut-off points of SID was <36,5 with sensitivity 81%, specificity 68%, AUC 0,813(95% CI 0,7 ? 0,92; p<0,001).Conclusion : SID on day 3 and day 5 of fever in DHF was significantly lowerthan DF. SID ≤37,5 on day 3 and ≤36,5 on day 5 can be used as a marker ofplasma leakage. ;Background : Plasma leakage is the main process in dengue haemorrhagic fever (DHF) which starts at day 3 of fever and peaked at day 5 of fever. Plasma leakageis causing tissue hypoxia that resulting in acidosis. Tissue perfusionmicrocirculation-associated variable is acid-base parameters. According toStewart, abnormality of metabolic acid-base is determined by calculating StrongIon Difference (SID). Now, SID in adult dengue-infected patients with plasmaleakage is not known yet.Objectives : To detemine the role of SID in prediction and diagnosis of plasmaleakage in adult dengue-infected patients.Methods : These were cross-sectional and retrospective cohort study whichconducted in adult dengue-infected patients that hospitalized in internal medicineward of Cipto Mangunkusumo General Hospital and Persahabatan GeneralHospital in Jakarta. SID was examined to determine the mean difference betweendengue fever (DF) and DHF by t-test independent, and cut-off point of SID inplasma leakage was identified by sensitivity and specificity based on ROC curve. Results : There were 57 adult dengue-infected patients recruited; consist of 31male patients (54,38%) and 26 female patient (45,61%); 31 DF patients (54,38%)and 26 DHF patients (45,6%). SID on day 3 of fever in DHF was significantlylower than DF [36,577 (±2,08) vs 39,032 (±1,44); p<0,01]. Similarly on day 5,SID of DHF 36,577 (±2,08) vs DF 39,032 (±1,44); p<0,01. Based on ROC curveof day 3, the cut-off point of SID was ≤37,5 with sensitivity 65%, specificity 84%,Area Under Curve (AUC) 0,824 (95% CI 0,71 ? 0,93; p<0,001). On day 5, thecut-off points of SID was <36,5 with sensitivity 81%, specificity 68%, AUC 0,813(95% CI 0,7 ? 0,92; p<0,001).Conclusion : SID on day 3 and day 5 of fever in DHF was significantly lowerthan DF. SID ≤37,5 on day 3 and ≤36,5 on day 5 can be used as a marker ofplasma leakage. ;Background : Plasma leakage is the main process in dengue haemorrhagic fever (DHF) which starts at day 3 of fever and peaked at day 5 of fever. Plasma leakageis causing tissue hypoxia that resulting in acidosis. Tissue perfusionmicrocirculation-associated variable is acid-base parameters. According toStewart, abnormality of metabolic acid-base is determined by calculating StrongIon Difference (SID). Now, SID in adult dengue-infected patients with plasmaleakage is not known yet.Objectives : To detemine the role of SID in prediction and diagnosis of plasmaleakage in adult dengue-infected patients.Methods : These were cross-sectional and retrospective cohort study whichconducted in adult dengue-infected patients that hospitalized in internal medicineward of Cipto Mangunkusumo General Hospital and Persahabatan GeneralHospital in Jakarta. SID was examined to determine the mean difference betweendengue fever (DF) and DHF by t-test independent, and cut-off point of SID inplasma leakage was identified by sensitivity and specificity based on ROC curve. Results : There were 57 adult dengue-infected patients recruited; consist of 31male patients (54,38%) and 26 female patient (45,61%); 31 DF patients (54,38%)and 26 DHF patients (45,6%). SID on day 3 of fever in DHF was significantlylower than DF [36,577 (±2,08) vs 39,032 (±1,44); p<0,01]. Similarly on day 5,SID of DHF 36,577 (±2,08) vs DF 39,032 (±1,44); p<0,01. Based on ROC curveof day 3, the cut-off point of SID was ≤37,5 with sensitivity 65%, specificity 84%,Area Under Curve (AUC) 0,824 (95% CI 0,71 ? 0,93; p<0,001). On day 5, thecut-off points of SID was <36,5 with sensitivity 81%, specificity 68%, AUC 0,813(95% CI 0,7 ? 0,92; p<0,001).Conclusion : SID on day 3 and day 5 of fever in DHF was significantly lowerthan DF. SID ≤37,5 on day 3 and ≤36,5 on day 5 can be used as a marker ofplasma leakage. |
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