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"Critically ill patients are increasing in number with mortality rates. Prediction model with a good performance is needed to predict their mortalities. Modified Sequntial Organ Failure Assessment (MSOFA) ..."

"Latar Belakang: Jumlah pasien penyakit kritis semakin meningkat dengan mortalitas yang cukup tinggi, sehingga diperlukan model prediksi yang memiliki performa yang baik untuk memprediksi mortalitas. MSOFA adalah salah satu sistem skor yang dapat memprediksi mortalitas 28 hari. Walaupun validasi MSOFA menunjukkan hasil yang baik di berbagai negara, masih diperlukan untuk melakukan validasi di Indonesia dan mencari parameter lain untuk meningkatkan ketepatan prediksi mortalitas. Kadar magnesium darah perlu diperhitungkan penggunaannya dalam memprediksi mortalitas terutama jika ditambahkan pada skor MSOFA. Tujuan: Menilai performa kalibrasi dan diskriminasi MSOFA serta nilai tambah kadar magnesium total dalam memprediksi mortalitas pasien penyakit kritis medis di Unit Perawatan Intensif Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo (UPI RSUPNCM). Metode: Penelitian ini merupakan studi kohort prospektif dengan subjek penelitian pasien penyakit kritis medis yang dirawat di UPI RSUPNCM pada periode April-Juli 2013. Hasil pemeriksaan fisik, Glasgow Coma Scale, saturasi oksigen perifer, serum kreatinin dan magnesium dinilai saat pasien masuk ke UPI. Outcome dinilai saat pasien mencapai hari ke 28 setelah hari perawatan pertama. Performa kalibrasi dinilai dengan plot kalibrasi dan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC). Kemampuan prediksi skor MSOFA bersama magnesium ditentukan dengan ROC dari nilai predicted probability terhadap mortalitas. Hasil: Sebanyak 150 pasien diikutsertakan dalam penelitian dengan angka mortalitas 33,3%. Plot kalibrasi MSOFA menunjukkan koefisien korelasi r = 0,7 dan uji Hosmer-Lemeshow menunjukkan p = 0,08. Performa diskriminasi ditunjukkan dengan nilai AUC 0,83 (IK 95% 0,76-0,90). Kadar magnesium darah tidak memiliki nilai tambah terhadap MSOFA dalam memprediksi mortalitas pasien penyakit kritis. Simpulan: MSOFA memiliki performa kalibrasi dan diskriminasi yang baik dan kadar magnesium darah tidak memiliki nilai tambah terhadap MSOFA dalam memprediksi mortalitas pasien penyakit kritis.

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Background: Critically ill patients are increasing in number with high mortality rate and good performance of prediction model is needed to predict mortality. MSOFA is one of the scoring systems which can predict 28 days mortality. MSOFA has showed a good validation in many patients abroad, yet still need to be tested in Indonesia and improving its performance. Total magnesium serum can be used as an added value to improve MSOFA performance.

Objective: To evaluate calibration and discrimination of MSOFA and magnesium as an added value to predict mortality in critically ill patients.

Methods: This is a prospective cohort study of medical critically ill patient who admitted to Intensive Care Cipto Mangunkusumo Hospital. Physical examination, Glasgow Coma Scale, peripheral oxygen saturation, creatinine and magnesium serum were obtained when the patient was admitted at ICU. Outcome was assessed when patients have reached 28 days after the first day of admission. Calibration was evaluated calibration plot and Hosmer-Lemeshow test. Discrimination was evaluated with area under the curve (AUC). Prediction performance of MSOFA and magnesium were evaluated with ROC curve.

Results: 150 patients was submitted to this study with mortality rate 33,3%. Calibration plot of MSOFA showed r = 0,7 and Hosmer-Lemeshow test showed p = 0,08. Discrimination was shown by ROC curve with AUC 0,83 (CI 95% 0,76-0,90). Magnesium total serum has no added value to MSOFA as a mortality predictor in critically ill patients.

Conclusion: MSOFA has good callibration and discrimination performance, and magnesium blood level has no added value to MSOFA for predicting mortality in critically ill patients."

"The nimber of visits and mortality rates of emergency patients at Emergency Department (ED) have been increaseing from time to time. Those patients have a wide spectrum of conditions. Appropriate identification of patients with high mortality risk is crucial ..."

"Latar belakang. Pasien sakit kritis berada dalam kondisi katabolik yang menyebabkan ketidakseimbangan sintesis dan pemecahan protein sehingga dibutuhkan asupan protein yang adekuat untuk mempertahankan massa otot, meningkatkan kadar prealbumin, dan imbang nitrogen. Ophiocephalus striatus (OS) mempunyai potensi sebagai sumber protein karena mengandung asam amino, asam lemak, mineral, dan vitamin. Penelitian ini bertujuan untuk menilai efek dari pemberian suplementasi ekstrak OS terhadap luas penampang otot rektus femoris, bisep brakii, kadar prealbumin, dan imbang nitrogen pasien sakit kritis dengan ventilator.Metodologi. Penelitian ini merupakan uji klinis dengan desain uji acak terkontrol yang dilakukan terhadap pasien usia 18-65 tahun yang menggunakan ventilator di intensive care unit (ICU) RSUPN Dr. Cipto Mangunkusumo sejak bulan Juli sampai dengan Oktober 2019 ICU. Sebanyak 42 subjek dirandomisasi menjadi dua kelompok. Kelompok ekstrak (n=19) mendapatkan suplementasi ekstrak OS 15 g/hari, yang diberikan sejak hari kedua sampai dengan hari keenam. Kelompok kontrol (n=23) tidak mendapatkan suplementasi tersebut. Pengukuran luas penampang otot, pemeriksaan kadar prealbumin, dan imbang nitrogen dilakukan pada hari pertama dan hari ketujuh.Hasil. Terjadi peningkatan luas penampang otot rektus femoris pada kelompok ekstrak (p=0,038) dan penurunan pada kelompok kontrol (p=0,006) disertai perbedaan bermakna antara dua kelompok (p=0,001). Terjadi peningkatan luas penampang otot bisep brakii pada kelompok ekstrak (p=0,033) dan penurunan pada kelompok kontrol (p=0,001) disertai perbedaan bermakna antara kedua kelompok (p<0,001). Terjadi peningkatan kadar prealbumin pada kelompok ekstrak (p<0,001) maupun kelompok kontrol (p=0,023) disertai perbedaan peningkatan yang bermakna antara kedua kelompok (p<0,001). Terjadi peningkatan kadar imbang nitrogen pada kelompok ekstrak (p<0,001) maupun kelompok kontrol (p=0,001) disertai perbedaan peningkatan yang tidak bermakna antara kedua kelompok (p=0,685).Kesimpulan. Pemberian suplementasi ekstrak Ophiocephalus striatus secara signifikan dapat meningkatkan luas penampang otot rektus femoris, otot bisep brakii, dan kadar prealbumin pada pasien sakit kritis.

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Background. Critically ill patients are in catabolic conditions that have imbalances in protein synthesis and breakdown. Thus, they require adequate protein intake to maintain the muscle mass and to increase the prealbumin levels and nitrogen balance. Ophiocephalus striatus (OS) is a potential source of proteins since it contains high amount of amino acids, fatty acids, minerals, and vitamins. This study was aimed to measure the effect of OS extract supplementation on cross-sectional area (CSA) of rectus femoris and biceps brachii, prealbumin levels, and nitrogen balance in critically ill patients with ventilator.

Methods. This was a randomized controlled clinical trial study involving patients aged 18-65 years old with ventilator in intensive care unit (ICU) Dr. Cipto Mangunkusumo Hospital between July until October 2019. In total, 42 subjects were randomized into two groups. Extract group (n=19) recieved 15 g of OS extract supplementation daily, administered from the second day to the sixth day. Control group (n=23) did not receive the extract. Measurement of CSA of rectus femoris and biceps brachii, prealbumin levels, and nitrogen balance were done in the first and the seventh day.

Results. There was an increase of cross sectional area of rectus femoris in extract group (p=0.038) and a decrease in control group (p=0.006) with significant difference between the two groups (p=0.001). There was an increase of cross sectional area of biceps brachii in extract group (p=0.033) and a decrase in control group (p=0.001) with significant difference between the two groups (p<0.001). There was an increase of prealbumin levels in both groups, extract group (p<0.001) and control group (p=0.023), with a significant difference of increase between the two groups (p<0.001). There was an increase of nitrogen balance in both groups, extract group (p<0.001) and control group (p<0.001), with an insignificant difference of increase between the two groups (p<0.685)

Conclusion. Administration of Ophiocephalus striatus extract supplementation can significantly increase the cross-sectional area of rectus femoris and biceps brachii, and the prealbumin levels in critically ill patients."

"Latar belakang: Model prediksi risiko operasi memiliki peranan penting pada tindakan operasi katup jantung. Perubahan karakter pasien dan fasilitas pembedahan dalam waktu tertentu dapat mempengaruhi nilai prediksi skor risiko operasi.Tujuan: Mengetahui perbandingan validasi EuroSCORE II, skor Ambler dan skor Harapan Kita dalam memprediksi mortalitas di rumah sakit pasca operasi katup jantung.Metode: Dilakukan studi kohort retrospektif terhadap 416 pasien yang menjalani operasi katup jantung pada periode November 2018 hingga Desember 2019. Data berasal dari rekam medis dengan metode sampling konsekutif. Didapatkan nilai kalibrasi dan diskriminasi EuroSCORE II, skor Ambler dan skor Harapan Kita.Hasil: Angka kematian yang diobservasi sebesar 6,7%. EuroSCORE II, skor Ambler and skor Harapan Kita memiliki kalibrasi yang baik (uji Hosmer-Lemeshow p=0,065, p=0,233 and p=0,314). Kemampuan diskriminasi skor dalam memprediksi kematian di rumah sakit EuroSCORE II (AUC 0,763; 95% IK;0.660-0.867), diikuti skor Ambler (AUC 0.748; 95% IK; 0.655-0.841) dan skor Harapan Kita (AUC 0,694; 95% IK; 0.584-0.804)Kesimpulan: EuroSCORE II, skor Ambler dan skor Harapan Kita memiliki validasi yang cukup baik. Kalibrasi ketiga skor baik dengan kalibrasi skor Harapan Kita relatif lebih baik dari dua skor lainnya, sedangkan nilai diskriminasi skor Harapan Kita di bawah EuroSCORE II dan skor Ambler.

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Background: Preoperative risk prediction models have important role in cardiac valve surgical management. Changing in patient characteristics and surgical facilities over time, might affect the predicting value of those scoring system.

Objective: This study aimed to compare the validation of EuroSCORE II, Ambler score and Harapan Kita score in predicting in-hospital mortality at patients underwent heart valve surgery

Methods: Cohort restrospective study was performed at 416 patients who underwent heart valve surgery from November 2018 to December 2019. Data was taken from the medical records by consecutive sampling method. The calibration and discrimination value of EuroSCORE II, Ambler score and Harapan Kita score were obtained.

Results: Observed in-hospital mortality was 6,7%. EuroSCORE II, Ambler score and Harapan Kita score have good calibration (Hosmer-Lemeshow test p=0,065, p=0,233 and p=0,314). The discriminative value of these three scores in predicting in-hospital mortality for EuroScore II AUC 0,763 (95% CI; 0.660-0.867), Ambler score AUC 0.748 (95% CI; 0.655-0.841) and Harapan Kita score AUC 0,694 (95% CI; 0.584-0.804)

Conclusion: EuroSCORE II, Ambler score and Harapan Kita score have fairly good validation. Those scoring system have good calibration with Harapan Kita score calibration relatively better than EuroSCORE and Ambler score, meanwhile Harapan Kita score has less discrimination value than EuroScore II and Ambler score."

"Penggunaan ventilasi mekanis pada pasien kritis tidak dapat dihindarkan namun dapat menyebabkan ventilator-induced lung injury (VILI) dan ventilator-induced diaphragm dysfunction (VIDD). Penelitian ini bertujuan untuk menilai hubungan antara volume tidal rendah (6 ml/kgBB) dan tinggi (10 ml/kgBB) terhadap disfungsi diafragma. Penelitian ini merupakan sebuah randomized controlled trial yang dilakukan di ruang perawatan intensif, RS Cipto Mangunkusumo. Pasien secara random masuk ke kelompok volume tidal 6 ml/kgBB dan 10 ml/kgBB, dan diikuti selama 72 jam (3 hari) untuk dinilai adanya disfungsi diafragma. Disfungsi diafragma dinilai menggunakan alat ultrasonografi, menggunakan kriteria ekskursi dan fraksi ketebalan diafragma. Variabel lain yang dinilai dalam penelitian ini ialah kadar interleukin-6.Sebanyak 52 pasien dilakukan randomisasi. Sebanyak total 45 pasien menyelesaikan studi. Tidak terdapat perbedaan karakteristik dasar sampel pasien pada kedua kelompok volume tidal. Sebanyak 37.8% pasien mengalami disfungsi diafragma pada hari ketiga. Tidak terdapat perbedaan proporsi disfungsi diafragma pada kedua kelompok volume tidal baik menggunakan kriteria ekskursi, fraksi ketebalan, maupun salah satunya. Terdapat perbedaan rerata interleukin-6 hari nol antara kelompok dengan dan tanpa disfungsi diafragma hari ketiga sebesar 332.29 pg/mL (p=0.024). Sebagai kesimpulan, volume tidal 6 ml/kgbb dan 10 ml/kgbb tidak berbeda dalam mencegah disfungsi diafragma pada pasien kritis. Interleukin-6 memiliki pengaruh terhadap disfungsi diafragma.

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The use of mechanical ventilation is inevitable for critically ill patients yet it causes tremendous side effect of ventilator-induced lung injury (VILI) and ventilator-induced diaphragm dysfunction (VIDD). This study is aimed to examine the effect of low tidal volume (6 ml/kgBW) and high tidal volume (10 ml/kgBW) to diaphragm dysfunction. This is a randomized controlled trial conducted at intensive care unit (ICU) of Cipto Mangunkusumo Hospital. Patients were randomly allocated to tidal volume of 6 ml/kgBW or 10 ml/kgBW and were followed for 72 hours (3 days). At the end of the 72 hours, patients were assessed for diaphragm dysfunction. Diaphragm dysfunction is assessed by ultrasonography with excursion and thickness fraction criteria. Interleukin-6 was also examined. Of 52 patients who were randomized, 25 were on 6 ml/kgBW group and 27 were on the other. There were 45 patients finishing the study. The baseline characteristics of the sample was not different among the two groups. We found 37.8% patients with diaphragm dysfunction on day-3 but no significant proportion difference among the two groups. Diaphragm dysfunction was assessed with excursion, fraction of thickness criteria. We found 332.29 pg/mL mean difference between interleukin-6 on patients with and without diaphragm dysfunction on day-3 (p=0.024). In conclusion, tidal volume of 6 ml/kgBW and 10 ml/kgBW is not different in preventing diaphragm dysfunction on critically ill."

"Latar belakang : Skor PELOD-2 digunakan untuk mengetahui prognosis disfungsi organ pada anak sakit kritis. Hasil skor PELOD-2 terkadang tidak berbanding lurus dengan luaran perawatan sehingga tidak selalu dapat digunakan sebagai prediktor luaran pasien yang dirawat di PICU. Tujuan : Mengetahui profil dan luaran pasien sakit kritis yang dirawat di PICU RSCM berdasar skor PELOD-2. Metode : Penelitian retrospektif dengan mengambil data rekam medis pasien rawat di PICU RSCM, periode Januari-Desember 2018 secara total sampling. Penilaian skor PELOD-2 pada 24 jam pertama perawatan, komorbid dan luaran subjek dicatat dalam rekam medis. Hasil : Diperoleh 477 subjek yang memenuhi kriteria. Pasien sakit kritis yang dirawat di PICU RSCM sebagian besar berjenis kelamin laki (56,4%) dan berusia <1 tahun (27,9%), dengan bedah sebagai diagnosis terbanyak (65%). Sebagian besar pasien memiliki penyakit kronik (70,4%). Nilai median skor PELOD-2 2 untuk pasien hidup dan median skor 8 untuk pasien meninggal. Angka mortalitas adalah 10,7%. Sebagian besar subjek memiliki lama rawat <7 hari (75,5%). Subjek dengan lama rawat >14 hari memiliki median skor PELOD-2 tiga kali lipat dari subjek dengan lama rawat <7 hari. Subjek meninggal memiliki median skor PELOD-2 empat kali lipat lebih tinggi dari subjek hidup. Adanya luaran mortalitas dan lama rawat subjek yang tidak sesuai dengan skor PELOD-2 kemungkinan dipengaruhi oleh status nutrisi dan status imun. Titik potong mortalitas skor PELOD-2 pada penelitian ini adalah >5, dan titik potong mortalitas skor PELOD-2 pasien sepsis >7. Simpulan : Skor PELOD-2 dapat digunakan untuk memprediksi prognosis disfungsi organ yang mengancam kehidupan pada anak tanpa imunosupresi, semakin tinggi skor PELOD-2 akan diikuti peningkatan lama rawat dan mortalitas.

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Background: PELOD-2 score is stated can be used to discover prognosis of organ dysfunction in critically ill child. Sometimes PELOD-2 score does not always directly proportional to critically ill child s outcome, therefore sometimes can not be used as outcome and mortality predictor. Objective: To describe critically ill patient s profile and outcome of based on PELOD-2 score. Methods: This descriptive study was retrospective, conducted from January to December 2018 in PICU RSCM by total sampling. Evaluation of PELOD-2 score were performed in the first 24 hours. Subjects comorbid and outcome were stated in medical record. Results: There were 477 subjects that fulfilled the criteria. Most of the subjects were boys (56,4%) and under 1 year of age (27,9%) with surgical were the most common diagnosis (65%). Most of the subject have chronic illness as comorbid (70,4%). Median of PELOD-2 score were 2 for subjects that lived and 8 for subjects that died. Mortality rate is 10,7%. Most of the subjects were stayed in PICU for < 7 days (75,5%). Subjects with length of stay >14 days had median PELOD-2 score 3 times higher than the subjects with length of stay <7 days. Died subjects had median PELOD-2 score 4 times higher than the subjects that lived. The subjects mortality and length of stay that not in accordance with the PELOD-2 score may be influenced by subjects nutritional and immunity status. Mortality cut off point for PELOD-2 score in this study is >5. Mortality cut off point for PELOD-2 for subjects with sepsis is >7 Conclusion: PELOD-2 score is feasible to be used to predict life threatening organ dysfunction in critically ill children without immunosuppression, the higher the PELOD-2 score is equal to higher mortality and longer length of stay."

"Latar belakang: Penentuan kebutuhan nutrisi secara tepat pada anak sakit kritis perludilakukan untuk menghindari underfeeding dan overfeeding. Rumus estimasi menjadidasar perkiraan kebutuhan energi jika kalorimetri indirek sebagai baku emas tidaktersedia. Akurasi rumus pada studi terdahulu sangat bervariasi dan dipengaruhi olehkarakteristik populasi setempat, sehingga akurasinya perlu diuji pada populasi Indonesia.Tujuan: Mengevaluasi akurasi rumus Schofield WH, Schofield W, dan WHOdibandingkan kalorimetri indirek, serta mengevaluasi dampak penambahan faktor stresterhadap akurasi.Metode: Penelitian deskriptif analitik potong lintang ini mengikutsertakan pasien anakyang menggunakan ventilasi mekanik Mei sampai Juli 2019. Analisis kesesuaiandilakukan dengan membandingkan perhitungan rumus Schofield WH, Schofield W, danWHO, dengan dan tanpa faktor stres terhadap pengukuran kalorimetri indirek.Hasil: Penelitian mengikutsertakan 52 subjek pada hari perawatan 1-5 di PICU denganmedian usia 5 tahun (1 bulan 10 hari hingga 17 tahun 9 bulan). Kebutuhan energi yangdiukur kalorimetri indirek adalah 60,7 ± 23,5 Kkal/kg/hari. Estimasi rumus SchofieldWH, Schofield W, dan WHO lebih rendah dari hasil pengukuran tersebut dengan %biasberturut-turut -13 ± 19, -15 ± 20, dan -16 ± 21. Nilai estimasi dan hasil pengukurankalorimetri indirek berkorelasi kuat (intraclass correlation coefficient r > 0,9) namuninterval kesesuaian (limit of agreement) dari %bias sangat lebar. Hanya 12 (23%) subjekyang memiliki nilai estimasi akurat sesuai dengan kalorimetri indirek. Pada populasipenelitian ini faktor stres meningkatkan akurasi rumus estimasi.Simpulan: Rumus Schofield WH, Schofield W, dan WHO tidak akurat sebagai estimasikebutuhan energi anak sakit kritis. Hasil prediksi rumus tersebut lebih rendah darikebutuhan aktual jika faktor stres tidak digunakan.

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Background: Accurate estimation of energy expenditure in critically ill children isimportant to avoid underfeeding and overfeeding. Prediction formula helps to estimateenergy expenditure when the gold standard indirect calorimetry is not available. Previousstudy on estimation accuracy yielded variable result in different populationcharacteristics, therefore the accuracy of prediction formula in Indonesian populationneeds to be evaluated.Objective: To assess the accuracy of Schofield WH, Schofield W, and WHO formulacompared to indirect calorimetry. To evaluate the impact of additional stress factor on theaccuracy of prediction formula.Methods: This is a descriptive analytic cross-sectional study on mechanically ventilatedcritically ill children held in May-July 2019. We analyze the agreement of measuredenergy expenditure using indirect calorimetry and estimated energy expenditurecalculated by Schofield WH, Schofield W, and WHO formula, with and withoutadditional stress factor.Results: This study included 52 subjects with median age 5 years old (1 month 10 days -17 years 9 months) on day 0-5 after they were admitted to PICU. Mean measuredenergy expenditure was 60,7 ± 23,5 Kcal/kg/day. All estimated energy expenditure bySchofield WH, Schofield W, and WHO were lower than measured energy expenditurewith % bias of -13 ± 19, -15 ± 20, and -16 ± 21, respectively. Estimated and measuredvalue have strong correlation (intraclass correlation coefficient r > 0.9) but the limit ofagreement interval is too wide. Only 12 (23%) subjects have accurate estimation ofenergy expenditure. In this population stress factor improves the accuracy of predictionformulas.Conclusion: Schofield WH, Schofield W, and WHO formula have poor accuracy inestimating energy expenditure in critically ill children. Without additional stress factor,the estimated value were lower than actual/measured energy expenditure"

"Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat.

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Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration."

"ABSTRAKLatar Belakang: Pneumonia menimbulkan mortalitas yang cukup tinggi, karenanya diperlukan model prediksi yang akurat untuk membantu prediksi kematian pasien pneumonia. Sistem skor CURB-65 mudah digunakan namun beberapa penelitian mengindikasikan performa skor CURB-65 kurang baik sehingga diperlukan penambahan faktor prognostik baru. Faktor prognostik yang diperkirakan dapat meningkatkan performa skor CURB-65 adalah kadar albumin darah. Tujuan: Menilai kemampuan kadar albumin serta nilai tambahnya pada skor CURB-65 dalam memprediksi mortalitas pasien penumonia dengan komorbid yang masuk rawat inap. Metode: Penelitian ini merupakan studi kohort prospektif dengan subjek penelitian pasien pneumonia dengan komorbid yang masuk rawat inap melalui IGD di RSCM. Outcome penelitian ini yaitu mortalitas selama perawatan. Performa skor CURB-65 dinilai sebelum dan sesudah ditambahkan albumin. Performa kalibrasi dinilai dengan uji Hosmer-Lemeshow sedangkan performa diskriminasi dinilai dengan area under the curve AUC . Hasil: 250 pasien diikutsertakan dalam penelitian ini dengan angka mortalitas 42,6 . Performa kalibrasi skor CURB-65 dengan uji Hosmer-Lemeshow menunjukkan p = 0,990 . Performa diskriminasi skor CURB-65 ditunjukkan dengan nilai AUC0,677 IK 95 0,61-0,74 . Setelah ditambahkan kadar albumin dengan titik potong 3,125, didapatkan peningkatan nilai AUC skor CURB-65 menjadi 0,727 IK95 0,66-0,79 . Simpulan: Kadar albumin darah memiliki nilai tambah pada skor CURB-65 sebagai prediktor mortalitas pada pasien pneumonia yang masuk rawat inap. Kata Kunci: pasien pneumonia, mortalitas, CURB-65, kadar albumin darah

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ABSTRACTBackground Pneumonia is an infection disease with high mortality. An accurate prediction rule is needed to help clinician in predicting mortality of pneumonia patients. CURB 65 score is a simple and well known scoring system to asses the severity of community pneumonia, but several research indicated that the performance is not really good. Added value of albumin serum in CURB 65 score should be evaluated. Aim To evaluate added value of albumin serum in CURB 65 score as mortality predictor in pneumonia patients. Methode This is a prospective cohort study of pneumonia with commorbidity patients who admitted to emergency instalation of Cipto Mangunkusumo Hospital. Mortality is the outcome that assessed during hospitalization. Performance of CURB 65 score was evaluated before and after addition of albumin in scoring system. Calibration was evaluated with Hosmer Lemeshow test. Discrimination was evaluated with area under the curve AUC . Prediction performance of CURB 65 score and albumin were evaluated with ROC curve. Results 250 patients was submitted to this study with mortality rate 42,6 . Calibration plot of CURB 65 score of Hosmer Lemeshow test showed p 0,990. Discrimination was shown by ROC curve with AUC 0,677 IK 95 0,61 0,74 . AUC of CURB 65 score added by albumin improved to 0,727 IK95 0,66 0,79 . Conclusion Serum albumin has added value to CURB 65 score in predicting mortality of pneumonia patients. Key Words pneumonia patients, mortality, CURB 65 score, serum albumin"