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Reza Nugraha Yulisar
Kadar Procalcitonin sebagai Biomarker Sepsis pada Pasien Tumor Padat dengan Demam dan Leukositosis = Cut-off Level of Serum Procalcitonin for Sepsis Diagnosis in Advanced Solid Tumor Patients with Fever and Leucocytosis
"Latar Belakang: Diagnosis sepsis pada pasien tumor padat metastasis sulit karena adanya gejala, seperti demam dan leukositosis, dapat timbul tanpa adanya infeksi. Procalcitonin (PCT) merupakan salah satu parameter untuk mendiagnosis sepsis. Titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosis masih belum diketahui. Studi sebelumnya belum ada yang menilai titik potong PCT pada pasien tumor padat metastasis dengan demam dan leukositosis.
Tujuan: Mengetahui titik potong PCT dalam diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosis.
Metode: Studi potong lintang terhadap pasien tumor padat metastasis dengan demam dan leukositosis yang berobat di RSCM Juni 2016 - April 2018. Pada pasien ditentukan ada tidaknya sepsis menggunakan kriteria sepsis sesuai The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), yaitu menggunakan mSOFA. Dilakukan pemeriksaan darah perifer dan PCT. Dilakukan pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosios menggunakan ROC.
Hasil: Didapatkan 86 pasien tumor padat metastasis dengan demam dan lekositosis, dengan wanita sebanyak 61,6%, rerata usia 49,48 ±11,44 tahun. Sebanyak  43 pasien (50%) mengalami sepsis. Dari kurva ROC kadar PCT pada tumor padat metastasis dengan demam dan leukositosis yang mengalami sepsis, didapatkan AUC [0,873 ,IK 0,799 - 0,946, p <0,001]. Nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan demam dan leukositosis adalah 1,755 ng/mL dengan sensitivitas 76,7% dan spesifisitas 81,4%, NDP 80,5%, NDN 77,8%.
Kesimpulan: Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis dengan demam dan leukositosis adalah 1,755 ng/mL.
Background: Diagnosis of infection in advanced solid tumor patients can be difficult since fever and leucocytosis is a non-specific clinical marker and can occur without infections. Untreated infections can lead to sepsis, increasing mortality in those patients. Procalcitonin has been used to support the diagnosis of sepsis. Procalcitonin cut off in advanced stage solid tumor patients with fever as a sepsis biomarker is still unclear. No study has seen procalcitonin cut-off in advanced solid tumor patients with fever.
Objective: To discover the cut-off point for sepsis in advanced solid tumor patients with fever.
Method: A cross-sectional study was conducted in the advanced solid tumor patients with fever patients who were admitted to Cipto Mangunkusumo Hospitals, Indonesia during June 2016 to April 2018. Demographic characteristics, physical examinations, laboratory examinations were recorded. Sepsis was defined using 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference criteria.
Results: A total of 86 subjects were enrolled in this study, 61,6% were female with mean age 49,5 years old. Among them, 43 patients (50%) were diagnosed with sepsis. The ROC curve showed that the levels of procalcitonin for sepsis in advanced solid tumor patients with fever was in the area under curve (AUC) 0,891 (CI 826 - 956). Cut-off procalcitonin for diagnosing sepsis in advanced solid tumor patients with fever was 1,755 ng/mL, sensitivity 76,7%, specificity 81,4%, PPV 80,5%, NPV 77,8%.
Conclusions: The cut-off point of procalcitonin level to support sepsis diagnosis in advanced solid tumor patients with fever was higher than normal populations."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
T58575
UI - Tesis Membership  Universitas Indonesia Library
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Segal Abdul Aziz
Kadar procalcitonin dan perannya sebagai biomarker sepsis pada pasien tumor padat dengan metastasis jauh = Level of procalcitonin and its role as a sepsis biomarker in patient with metastatic solid tumor
"ABSTRAK
Latar Belakang: Pengaruh metastasis sebagai penyebab peningkatan procalcitonin
(PCT) pada pasien tumor padat nonsepsis masih belum jelas. Studi-studi
sebelumnya memberikan hasil yang tidak konklusif. Nilai titik potong PCT untuk
diagnosis sepsis pada tumor padat metastasis juga belum diketahui.
Tujuan: Mengetahui peran PCT dalam diagnosis sepsis pada pasien tumor padat
dengan metastasis.
Metode: Studi potong lintang terhadap pasien tumor padat yang berobat di RSCM
September-Desember 2015. Pada pasien ditentukan ada tidaknya sepsis
menggunakan kriteria sepsis ACCP/SCCM 2001, dilakukan pemeriksaan darah
perifer, serta PCT. Dilakukan analisis untuk mengetahui perbedaan kadar PCT
pasien tumor padat metastasis dan tanpa metastasis yang tidak sepsis. Selain itu,
dilakukan pula pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasien
tumor padat metastasis dengan menggunakan ROC.
Hasil dan Pembahasan: Didapatkan 112 pasien tumor padat, pria sebanyak 51%,
dengan rerata usia 47,9 ±12,47 tahun. Sebanyak 71 (63,4%) pasien sudah
didapatkan metastasis, 36 (32,1%) diantaranya sepsis, dan 6 (5,3%) mengalami
SIRS. Dari 41 (36,6%) pasien tanpa metastasis, 9 (8%) mengalami sepsis, dan 5
(4,4%) SIRS. Terdapat perbedaan bermakna kadar PCT pada pasien tumor padat
metastasis dibandingkan tanpa metastasis pada kondisi nonsepsis [0,25 ng/mL
(0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Pasien tumor padat metastasis
yang mengalami sepsis memiliki kadar PCT lebih tinggi dibandingkan nonsepsis
[3,5 ng/mL (0,66-189,4) vs. 0,25 ng/mL (0,07-1,76); p<0,001]. Dari kurva ROC
kadar PCT pada tumor padat metastasis, didapatkan AUC [0,956, IK 0,916-0,996]
untuk mendiagnosis sepsis. Nilai titik potong PCT untuk diagnosis sepsis pada
pasien tumor padat metastasis adalah 1,14 ng/mL dengan sensitivitas 86% dan
spesifisitas 88%.
Kesimpulan: Pada kondisi nonsepsis, kadar PCT pasien tumor padat metastasis
lebih tinggi dibandingkan pasien tanpa metastasis. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis adalah 1,14 ng/mL. ABSTRACT
Background: The effect of metastasis as a cause of increased procalcitonin (PCT)
in patients with solid tumors without sepsis remains unclear. Previous studies did
not provide conclusive results. Cut off point of PCT for sepsis diagnosis in
metastatic solid tumors is also unknown.
Objective: To determine the role of PCT in the diagnosis of sepsis toward
metastatic solid tumors patients.
Methods: A cross sectional study was conducted in solid tumor patients who were
admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December
2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in
patients. Procalcitonin level, as well as routine blood examination, was performed
to determine the differences of PCT level among solid tumor patients with and
without metastasis. Cut off point of PCT for diagnosing sepsis in patients with
metastatic solid tumors was determined using ROC curve.
Results and Discussion: There were 112 patients with solid tumors, 51% male,
with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,
while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41
(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In
the absence of sepsis, the PCT level was significantly higher in patients with
metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)
vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis
had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.
0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis
in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT
for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a
sensitivity of 86% and specificity of 88%.
Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid
tumors is higher than patients without metastasis. Cut off point of PCT for sepsis
diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)
in patients with solid tumors without sepsis remains unclear. Previous studies did
not provide conclusive results. Cut off point of PCT for sepsis diagnosis in
metastatic solid tumors is also unknown.
Objective: To determine the role of PCT in the diagnosis of sepsis toward
metastatic solid tumors patients.
Methods: A cross sectional study was conducted in solid tumor patients who were
admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December
2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in
patients. Procalcitonin level, as well as routine blood examination, was performed
to determine the differences of PCT level among solid tumor patients with and
without metastasis. Cut off point of PCT for diagnosing sepsis in patients with
metastatic solid tumors was determined using ROC curve.
Results and Discussion: There were 112 patients with solid tumors, 51% male,
with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,
while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41
(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In
the absence of sepsis, the PCT level was significantly higher in patients with
metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)
vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis
had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.
0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis
in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT
for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a
sensitivity of 86% and specificity of 88%.
Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid
tumors is higher than patients without metastasis. Cut off point of PCT for sepsis
diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)
in patients with solid tumors without sepsis remains unclear. Previous studies did
not provide conclusive results. Cut off point of PCT for sepsis diagnosis in
metastatic solid tumors is also unknown.
Objective: To determine the role of PCT in the diagnosis of sepsis toward
metastatic solid tumors patients.
Methods: A cross sectional study was conducted in solid tumor patients who were
admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December
2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in
patients. Procalcitonin level, as well as routine blood examination, was performed
to determine the differences of PCT level among solid tumor patients with and
without metastasis. Cut off point of PCT for diagnosing sepsis in patients with
metastatic solid tumors was determined using ROC curve.
Results and Discussion: There were 112 patients with solid tumors, 51% male,
with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,
while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41
(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In
the absence of sepsis, the PCT level was significantly higher in patients with
metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)
vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis
had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.
0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis
in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT
for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a
sensitivity of 86% and specificity of 88%.
Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid
tumors is higher than patients without metastasis. Cut off point of PCT for sepsis
diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)
in patients with solid tumors without sepsis remains unclear. Previous studies did
not provide conclusive results. Cut off point of PCT for sepsis diagnosis in
metastatic solid tumors is also unknown.
Objective: To determine the role of PCT in the diagnosis of sepsis toward
metastatic solid tumors patients.
Methods: A cross sectional study was conducted in solid tumor patients who were
admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December
2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in
patients. Procalcitonin level, as well as routine blood examination, was performed
to determine the differences of PCT level among solid tumor patients with and
without metastasis. Cut off point of PCT for diagnosing sepsis in patients with
metastatic solid tumors was determined using ROC curve.
Results and Discussion: There were 112 patients with solid tumors, 51% male,
with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,
while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41
(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In
the absence of sepsis, the PCT level was significantly higher in patients with
metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)
vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis
had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.
0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis
in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT
for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a
sensitivity of 86% and specificity of 88%.
Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid
tumors is higher than patients without metastasis. Cut off point of PCT for sepsis
diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT)
in patients with solid tumors without sepsis remains unclear. Previous studies did
not provide conclusive results. Cut off point of PCT for sepsis diagnosis in
metastatic solid tumors is also unknown.
Objective: To determine the role of PCT in the diagnosis of sepsis toward
metastatic solid tumors patients.
Methods: A cross sectional study was conducted in solid tumor patients who were
admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December
2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in
patients. Procalcitonin level, as well as routine blood examination, was performed
to determine the differences of PCT level among solid tumor patients with and
without metastasis. Cut off point of PCT for diagnosing sepsis in patients with
metastatic solid tumors was determined using ROC curve.
Results and Discussion: There were 112 patients with solid tumors, 51% male,
with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis,
while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41
(36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In
the absence of sepsis, the PCT level was significantly higher in patients with
metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76)
vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis
had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs.
0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis
in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT
for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a
sensitivity of 86% and specificity of 88%.
Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid
tumors is higher than patients without metastasis. Cut off point of PCT for sepsis
diagnosis in metastatic solid tumors was 1,14 ng / mL. "
Fakultas Kedokteran Universitas Indonesia, 2016
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Atit Puspitasari Dewi
Kadar procalcitonin pada pasien kanker paru dengan pneumonia = Serum procalcitonin level in lung cancer patient with pneumonia
"Latar belakang: Pneumonia menjadi penyebab infeksi tersering yang meningkatkan mortalitas dan morbiditas pasien kanker paru. Serum procalcitonin (PCT) merupakan penanda hayati yang sering digunakan untuk mendiagnosis infeksi terutama pneumonia. Nilai titik potong kadar PCT untuk mendiagnosis pneumonia pada kanker paru sampai saat ini belum diketahui. Tujuan penelitian ini untuk mengetahui peran PCT dalam diagnosis pneumonia pada pasien kanker paru.
Metode: Penelitian uji diagnostik dengan desain potong lintang terhadap pasien kanker paru dan terduga pneumonia di Instalasi Gawat Darurat dan ruang perawatan paru RSUP Persahabatan Jakarta bulan Agustus-Oktober 2018. Pneumonia ditegakkan berdasarkan panduan pneumonia yang dikeluarkan oleh Persatuan Dokter Paru Indonesia. Pemeriksaan PCT dilakukan untuk mengetahui perbedaan kadar PCT pada kanker paru dengan dan tanpa pneumonia serta dilakukan analisis untuk menentukan titik potong optimal kadar PCT untuk diagnosis pneumonia pada pasien kanker paru dengan menggunakan ROC.
Hasil: Sebanyak 60 pasien kanker paru diikutsertakan. Pasien kanker paru dengan pneumonia sebanyak 31 orang (51,7%) dengan karakteristik laki-laki sebanyak 77,4% dan rerata usia 54,68±10,59 tahun, jenis kanker terbanyak adenokarsinoma (51,6%), stage IV (83,9%), skala tampilan 3 (45,2%), status gizi kurang (45,2%), dan bekas perokok (54,8%). Terdapat perbedaan bermakna median kadar PCT pasien kanker paru dengan pneumonia dibandingkan tanpa pneumonia [1,81 (0,08-200)μg/L berbanding 0,30 (0,05-3,67) μg/L;p<0,001]. Terdapat peningkatan kadar PCT pasien kanker paru dengan metastasis, komponen neuroendokrin, jumlah metastasis ≥ 2, metastasis hepar meskipun hasil ini tidak bermakna secara statistik. Serum PCT berperan lebih baik dibandingkan kadar leukosit dan hitung jenis neutrofil untuk membedakan antara pneumonia dan bukan pneumonia pada pasien kanker paru (p <0,001, p=0,297; p=0,290). Serum PCT memiliki akurasi yang baik dengan AUC 0,829 (IK 95% 0,722-0,935]. Titik potong optimal kadar PCT untuk mendiagnosis pneumonia pada pasien kanker paru adalah 0,65 μg/L dengan sensitivitas 77,4% dan spesifisitas 79,3%.
Kesimpulan: Kadar PCT pada pasien kanker paru dengan pneumonia lebih tinggi dibandingkan tanpa pneumonia. Titik potong optimal kadar PCT untuk diagnosis pneumonia pada kanker paru adalah 0,65 μg/L.
Background: Pneumonia accounts for higher morbidity and mortality than any other infections in lung cancer patients. Procalcitonin (PCT) is a clinical biomarker to diagnose infection including pneumonia. Cut off point to diagnose pneumonia in lung cancer patient still unclear. The study aims to determine the roleof PCT in diagnosing pneumonia in lung cancer patients.
Methods: Diagnostic test with cross sectional design was conducted in lung cancer patients with suspected pneumonia admitted to emergency and pulmonary ward of Persahabatan Hospital Jakarta, Indonesia between August – October 2018. A diagnosis of pneumonia was complying to the guideline provided by the Indonesian Society of Respirology. Serum PCT level (sPCT) between lung cancer patients with and without pneumonia was measured followed by statistical analysis. The optimal sPCT cut off point to diagnose pneumonia in lung cancer was determined using ROC curve.
Result: From sixty patients, lung cancer patients presented with pneumonia was found in 31 patients (51.7%) with mean age 54.68±10.59 yo, which 77.4% were males, 51.6% were adenocarcinomas, 83.9% were stage IV cases, 45.2% were patients with ECOG performance status of 3, 45.2% were underweight and 54.8% were ex-smokers. The sPCT were significantly higher in lung cancer with pneumonia compared to those without pneumonia [1.81 (0.08-200)μg/L vs 0.30 (0.05-3.67) μg/L; p<0.001]. The sPCT were higher in lung cancer accompanied with metastasis, neuroendocrine component, ≥2 metastatic sites and liver metastatic, although these results were not statistically significant. The sPCT showed a better performance in differentiating pneumonia in lung cancer compared to leucocyte count and absolute neutrophil count (p <0.001, p=0.297; p=0.290, respectively). The sPCT showed a good accuracy to diagnose pneumonia in lung cancer with AUC 0.829 (CI 95% 0.722-0.935). The optimal cut off point of sPCT to diagnose pneumonia in lung cancer was 0.65 μg/L with 77.4% sensitivity and 79,3% specificity.
Conclusion: The sPCT was significantly higher in lung cancer with pneumonia than those without pneumonia. The optimal cut off point of sPCT to diagnose pneumonia in lung cancer was 0.65 μg/L."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Dana Dharaniyadewi
Pengaruh Pemeriksaan Procalcitonin Semikuantitatif terhadap Adekuasi Terapi Antibiotik Empirik Awal dan Mortalitas pada Pasien Sepsis = "The Effect of Semi-quantitative Procalcitonin Assay to The Adequacy of Empirical Antibiotics and Mortality in Septic Patients"
"Pendahuluan. Sepsis merupakan suatu kondisi klinis yang serius dengan angka morbiditas dan mortalitas yang cukup tinggi. Procalcitonin (PCT) merupakan suatu penanda yang baik untuk diagnosis dini dan pengawasan infeksi. Studi ini bertujuan untuk melihat pengaruh pemeriksaan PCT semikuantitatif terhadap kecepatan dan ketepatan pemberian antibiotik empirik awal serta mortalitas pada pasien sepsis.
Metode. Desain studi ini adalah uji klinis diagnostik acak yang merupakan suatu pragmatic trial. Subjek pada penelitian ini adalah semua pasien sepsis berusia 18 tahun atau lebih dengan atau tanpa tanda hipoperfusi atau disfungsi organ yang berobat ke Instalasi Gawat Darurat Departemen Ilmu Penyakit Dalam RSUPN dr. Cipto Mangunkusumo. Subjek dirandomisasi menjadi dua kelompok, yaitu kelompok yang diperiksa PCT semikuantitatif dan tidak diperiksa PCT semikuantitatif. Hasil pemeriksaan PCT semikuantitatif akan diberitahukan kepada dokter yang merawat pasien. Luaran primer yang dinilai pada studi ini adalah mortalitas 14 hari dan Luaran sekunder adalah kecepatan dan ketepatan antibiotik empirik awal. Penilaian ketepatan antibiotik empirik dilakukan oleh sorang Konsultan Penyakit Tropik Infeksi berdasarkan Pedoman Umum Penggunaan Antibiotik Departemen Kesehatan Republik Indonesia.
Hasil. Dua ratus lima subjek memenuhi kriteria inklusi. Sembilan puluh lima dari 100 subjek pada kelompok yang diperiksa PCT dan 102 dari 105 subjek pada kelompok yang tidak diperiksa PCT dimasukkan ke dalam analisis. Mortalitas ditemukan lebih rendah pada kelompok yang diperiksa PCT (RR 0,53; IK 95% 0,36–0,77). Kelompok yang diperiksa PCT memiliki kemungkinan lebih besar untuk mendapatkan antibiotik empirik < 6 jam dibandingkan kelompok yang tidak diperiksa PCT (RR 2,48; IK 95% 1,88–3,26). Ketepatan jenis antibiotik empirik hampir sama pada kedua kelompok (RR 0,99; IK 95% 0,92–1,08).
Simpulan. Pemeriksaan PCT semikuantitatif mempengaruhi mortalitas dan kecepatan pemberian terapi antibiotik empirik awal pada pasien sepsis, namun tidak mempengaruhi ketepatan terapi antibiotik empirik awal yang diberikan.
Introduction. Sepsis is a serious clinical condition with a considerable morbidity and mortality. Procalcitonin (PCT) is a good biomarker for early diagnosis and infection monitoring. The present study aimed to investigate the effect of semi-quantitative PCT test to the empirical antibiotic initiation time, the appropriateness of empirical antibiotics and mortality in septic patients.
Methods. Study design was randomized diagnostic trial which was also a pragmatic trial. Septic patients more than 18 years old with and without signs of organ hypoperfusion or dysfunction who were admitted to Cipto Mangunkusomo hospital emergency department in internal medicine unit were eligible. Subjects were randomly assigned to either a semi-quantitative PCT-examined (study group) or a control group. Semi-quantitative PCT test result will be informed to physician who were taking care of the patients. The primary outcome was 14-day mortality. Secondary outcomes were the time of initiation and appropriateness of empirical antibiotics. A Tropical Infection Consultant will assess the appropriateness of empirical antibiotics based on Pedoman Umum Penggunaan Antibiotik Departemen Kesehatan Republik Indonesia.
Results. Two hundred five patients met the inclusion criteria. Ninety five of 100 subjects from study group and 102 of 105 subjects from control group were included in analysis. Mortality risk was lower in study group (RR 0.53; 95% CI 0.36–0.77). The study group had a greater probability to have a first dose of empirical antibiotic in less than 6 hours compared to the control group (RR 2.48; 95% CI 1.88–3.26). No effect was seen in appropriateness of empirical antibiotics between groups (RR 0.99; 95% CI 0.92–1.08).
Conclusions. Semi-quantitative PCT examination affect the empirical antibiotic initiation time and mortality in septic patients, but not the appropriateness of empirical antibiotics."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T-pdf
UI - Tesis Membership  Universitas Indonesia Library
cover
David, Steven
Profil prokalsitonin pada berbagai kelompok pasien sepsis = Procalcitonin profile in various groups of septic patients
"Latar Belakang : Sepsis memiliki mortalitas yang tinggi, dengan insiden yang semakin meningkat. Jenis mikroorganisme etiologi sepsis berhubungan dengan keparahan dan mortalitas pasien sepsis, dimana sepsis Gram negatif merupakan kelompok dengan keparahan dan mortalitas tertinggi. Kultur darah merupakan baku standar diagnosis etiologi sepsis dan dasar pemberian antimikroba definit, namun angka keberhasilannya rendah dan membutuhkan waktu beberapa hari. Pemeriksaan prokalsitonin (PCT) memiliki sensitivitas tinggi terhadap infeksi bakteri dan nilainya berbeda pada berbagai hasil kultur darah pasien sepsis. Belum ada data profil PCT pada pasien sepsis di Indonesia dan belum ada studi profil PCT pada sepsis non-bakteremia dengan fokus infeksi Gram negatif.
Tujuan : Mendapatkan data profil PCT pada berbagai kelompok pasien sepsis.
Metode : Penelitian ini merupakan studi potong lintang retrospektif terhadap data sekunder rekam medis dan laboratorium pasien sepsis yang dirawat di RSCM selama Januari 2013 ? Desember 2015. Dengan metode konsekutif subyek penelitian dikelompokkan berdasarkan etiologi sepsis.
Hasil : Nilai median PCT pada sepsis bakteremia Gram negatif, bakteremia Gram positif, fungemia, dan sepsis non bakteremia dengan fokus infeksi Gram negatif berturut-turut 13,9 ng/mL, 2,73 ng/mL, 2,56 ng/mL, dan 5,25 ng/mL. Berdasarkan derajat keparahan sepsis, nilai median PCT tertinggi didapatkan pada syok sepsis pada kelompok bakteremia Gram negatif (65,16 ng/mL).
Kesimpulan : Kelompok sepsis bakteremia Gram negatif memiliki nilan media PCT tertinggi
Background : Sepsis has high mortality rate, and its incidence has been increasing recently. Microbes types as sepsis etiology are related to severity and mortality of septic patients. Gram-negative sepsis is the highest severity and mortality group of septic patients. Blood culture is gold standard to confirm etiology of sepsis and guidance for administration of definit antimicrobes, but its success rate is low and needs some days for the results Procalcitonin (PCT) has high sensitivity for bacterial infection, and it has different levels due to various results of blood cultures of septic patients. There are no datas about PCT profile in septic patients in Indonesia, and no studies before about PCT profile in non-bacteremia sepsis with Gram-negative focal infection.
Aim: To obtain PCT profile in various groups of septic patients.
Method: A cross-sectional retrospective study was conducted to collect medical records and laboratory datas of septic patients at RSCM during January 2013 until December 2015. By consecutive sampling subjects were grouping base on sepsis etiology.
Result : PCT median values of Gram-negative bacteremia, Gram-positive bacteremia, fungemia, and non-bacteremia sepsis with Gram-negative focal infection are 13.9 ng/mL, 2.73 ng/mL, 2.56 ng/mL, and 5.25 ng/mL. Base on severity of sepsis, the highest level of PCT median (65.16 ng/mL) is found in septic shock in Gram-negative bacteremia group.
Conclusion: Gram-negative bacteremia sepsis has the highest level of PCT median."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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Dwi Yanti Anggraini
Pengaruh Heparin Terhadap Kadar Nuclear Factor Kappa Beta Sub Unit p65 dan Produksi Tumor Necrosis Factor Alpha Pada Isolat Monosit Dari Pasien Dengan Sepsis Berat = Effect of Heparin on NFkB p65 Sub Unit Level and TNF alpa Production in Monocyte Isolation From Severe Sepsis Patients
"Sepsis dikenal secara luas sebagai sindrom klinis yang merupakan hasil dari respon sistemik yang hebat terhadap infeksi dan melibatkan gangguan pada berbagai organ penderitanya Sepsis merupakan penyebab kematian tersering pada pasien yang dirawat di unit perawatan intensif Proses inflamasi dengan respon maladaptif terhadap proses tersebut merupakan mekanisme terjadinya disfungsi organ multipel dan kematian pada sepsis. Heparin juga diketahui dapat memodulasi proses inflamasi, namun belum banyak penelitian yang menjelaskan dosis heparin sebagai antiinflamasi. Penelitian ini ingin mengkaji lebih jauh pengaruh dosis heparin terhadap aktivasi faktor transkripsi Nuclear Factor Kappa Beta (NFkB) melalui pengukuran terhadap kadar NFkB sub unit p65 dan produksi sitokin proinflamasi Tumor Necrosis Factor Alpha (TNF-?) untuk memberikan dasar ilmiah mengenai penggunaan dosis heparin sebagai antiinflamasi pada pasien dengan sepsis berat. Penelitian ini merupakan eksperimental laboratorik dengan menggunakan sampel dari 5 orang sukarelawan sehat dan 10 orang pasien sepsis berat. Sel mononuklear darah tepi (peripheral blood mononuclear cells/PBMC) dari darah vena diperoleh dengan teknik Ficoll-hypaque. Fraksi non-monosit dari PBMC menggunakan Monoclonal Antibody Cell Sorter (MACS) microbeads. Isolasi monosit diresuspensi pada medium Roswell Park Memorial Institute (RPMI) yang disuplementasi dengan 10% fetal bovine serum (FBS). Sel kemudian dipaparkan dengan heparin 0.1 IU/ml (1?g/ml), 1 IU/ml (10 ?g/ml), dan 10 IU/ml (100 ?g/ml), sedangkan kontrol tidak diberi perlakuan. Setelah diinkubasi pada 37°C dan 5% CO2 selama 6 jam dan 24 jam, pelet sel diukur NFkB sedangkan supernatan diukur TNF-? dengan metode ELISA. Hasil penelitian menunjukkan kadar NFkB sub unit 65 dan produksi TNF-? pada kultur monosit pasien sepsis berat yang mendapat heparin ditemukan secara signifikan lebih rendah daripada kontrol. Heparin dosis rendah 0.1 IU/ml (1?g/ml), secara signifikan menurunkan aktivasi NF?B dan produksi TNF-? lebih besar. Penelitian ini menunjukkan bahwa heparin menghambat aktivasi NFkB sehingga menurunkan produksi sitokin TNF-?. Heparin dengan dosis rendah menunjukkan pengaruh sebagai antiinflamasi lebih besar. Hasil yang diperoleh diharapkan memberikan pemahaman baru mengenai pengaruh dosis heparin sebagai anti-inflamasi pada pasien sepsis berat.
Sepsis is a severe systemic response to infection, based on the Systemic Inflammatory Response Syndrome (SIRS) plus infection proven or clinically suspected infection, with evidence of organ failure due to hypo-perfusion. Anti-inflammatory therapy is one of the important therapeutic modality and applied potential as sepsis therapy. Inflammatory process with a maladaptive response to this process is the mechanism for the occurrence of multiple organ dysfunction and mortality in sepsis. Bacterial lipopolysaccharide binds to CD14 receptors and toll-like receptor (TLR) on the surface of monocytes and activates intracellular signal transduction involving beta-Kinase Inhibitor Kappa/IKKB that activates Nuclear Factor Kappa-Beta (NFkB) enter the nucleus and initiate transcription of RNA that encodes the production of cytokines TNF-?. Heparin has long been known as an anticoagulant, but also known to modulate the inflammatory process. This study want to examine further role of heparin as an anti-inflammatory to provide a scientific basis for the use of heparin in sepsis. Peripheral blood mononuclear cells (peripheral blood mononuclear cells/PBMC) of patients with severe sepsis obtained by Ficoll-Hypaque technique. Non-monocyte fraction of PBMC were removed using a Monoclonal Antibody Cell Sorter (MACS) microbeads. Isolation of monocytes resuspended in Roswell Park Memorial Institute medium (RPMI) supplemented with 10% fetal bovine serum (FBS). Cells then exposed to 0.1 IU heparin (1 ?g/ml), 1 IU (10 ug/ml), and 10 IU (100 ?g/ml), whereas controls did not. After incubation at 37°C and 5% CO2 for 6 hours and 24 hours, each sample is aspirated into micro centrifuge tube and rotated at a speed of 400 g for 5 min. Cell pellet was measured for NFkB and supernatant measured for TNF-?. Both were measured by ELISA. The results showed NFkB activation and TNF-? production in cultured monocytes severe sepsis patients who received heparin found to be significantly lower than controls. Low-dose heparin 0.1 IU (1?g/ml), significantly decreased the activation of NFkB and TNF-? production a lot more. This study demonstrates how heparin interfere an inflammatory response in severe sepsis patients monocytes through interrupt NFkB activation that decrease the production of cytokines TNF-?. The results are expected to provide new insights into the role of heparin as an anti-inflammatory in patients with severe sepsis."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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Alfan Arief
Kadar prokalsitonin sebagai pembeda demam infeksi dan demam inflamasi pascabedah jantung = Procalcitonin as differences on infectious and inflamation fever after cardiac surgery
"Latar belakang. Kejadian demam pascabedah jantung sering ditemukan akibat tindakan pembedahan maupun penggunaan mesin pintas jantung paru (PJP), demam tersebut sulit dibedakan antara demam akibat infeksi atau inflamasi. Penegakan diagnosa infeksi dengan pemeriksaan kultur membutuhkan waktu lama dan kadang tidak tumbuh bakteri. Prokalsitonin (PCT) diharapkan sebagai penanda infeksi tanpa harus menunggu hasil kultur.
Tujuan. Penelitian ini bertujuan menilai kadar PCT dapat membedakan demam infeksi dengan demam inflamasi pada pascabedah jantung.
Metode. Penelitian ini dikerjakan di Unit Pelayanan Jantung Terpadu RSCM, dengan subyek pasien dewasa pascabedah jantung terbuka dengan menggunakan mesin PJP diikuti selama lima hari adanya demam dengan suhu ≥ 37,8° C, tanda dan gejala infeksi. Semua subyek diperiksa PCT dan kultur darah sebelum pembedahan, hari pertama, kedua dan kelima pascabedah. Pemeriksaan kultur dikerjakan atas indikasi klinis adanya infeksi.
Hasil. Sebanyak 59 subyek pascabedah jantung menggunakan mesin PJP, terdapat dua subyek dropout (meninggal pada hari pertama dan kedua), 22 (37,28%) tidak demam, 32 (54,24%) demam inflamasi dan 5 (8,48%) demam infeksi. Infeksi ditemukan dari kultur sputum (Klebsiella pneumonie), hasil kultur darah, luka operasi, dan urin tidak ditemukan pertumbuhan bakteri. Didapatkan kadar PCT demam infeksi 13,48 ng/ ml dan demam inflamasi 6,90 ng/ ml.
Simpulan. Kadar PCT demam infeksi (13,48 ng/ ml) lebih tinggi daripada demam inflamasi (6,90 ng/ ml). Tidak ada beda kadar PCT demam infeksi dan demam inflamasi secara statistik dengan p adalah 0,371.
Background. Post cardiac surgery fevers usually caused by surgery itself or cardiopulmonary bypass (CPB). Difficulties to differentiated fever caused infection or inflammation. Bacterial culture to prove infections take a long time and sometimes the result is negative. Procalcitonin is sugested infection marker without wait for culture.
Goal. The aim of this study is to know procalcitonin level can differentiate fever cause infectious or inflammation.
Methods. This study performed at Integrated Cardiovascular Unit in RSCM, on adult patients who had open cardiac surgery with CPB, observed for temperature ≥ 37,8° C, sign and symptoms of infections, for 5 days. PCT levels and blood culture performed before surgery, first, second and 5th day after surgery. Culture from other sites performed as indicated.
Results. There are 59 have cardiac surgery with CPB, There are two subject dropout (died on 1st and 2nd days), 22 had no fever (37,28%), 32 had inflammation fever (54,24%) and 5 had infectious fever (8,48%). Infection confirmed by bronchial wash culture (Klebsiella pneumonie), no surgical wound infection, blood and urine culture were negative. We have PCT levels infectious group 13,48 ng/ ml and inflammation group 6,90 ng/ ml.
Conclussion. PCT levels infectious group (13,48 ng/ ml) higher than inflammation group (6,90 ng/ ml). Non parametric diagnostic Mann Whitney U test there are no significant differences of PCT levels between infectious and inflammation group, p=0,371."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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Bonita Effendi
Peran sistem skor qSOFA dan prokalsitonin sebagai prediktor mortalitas pada pasien sepsis bakteremia gram negatif = The role of qSOFA score and procalcitonin for mortality prediction of gram-negative bacteremia
"Latar Belakang Sepsis masih menjadi penyebab utama morbiditas dan mortalitas. Diagnosis dini dan inisiasi bundle care dapat memperbaiki luaran pasien dengan sepsis. Namun, akurasi diagnosis sepsis masih sulit. Bakteremia Gram-negatif memiliki risiko syok sepsis lebih tinggi dan prognosis yang lebih buruk. Tujuan penelitian adalah mengetahui peran skor qSOFA, prokalsitonin, serta gabungan skor qSOFA dan prokalsitonin untuk memprediksi mortalitas pasien sepsis bakteremia Gram-negatif.
Metode Penelitian kohort retrospektif dan prospektif menggunakan data rekam medik dan registri pasien sepsis Divisi Penyakit Tropik dan Infeksi Departemen Ilmu Penyakit Dalam RSCM melibatkan pasien berusia >18 tahun yang dirawat di RSCM selama Maret 2017-Oktober 2020. Data yang diekstraksi adalah karakteristik sampel, data pemeriksaan klinis dan laboratorium, serta luaran yaitu mortalitas dalam perawatan rumah sakit selama 28 hari pemantauan.
Hasil 128 subyek penelitian terdiri atas 50,8% pasien laki-laki dengan median usia 48 (RIK 46-51) tahun. Mortalitas pasien dengan bakteremia Gram-negatif terjadi pada 51,6% dengan kesintasan kumulatif 48,4% (SE 0,96%). Peran skor qSOFA terbaik untuk memprediksi mortalitas dalam 28 hari perawatan dengan (AUROC 0,74; IK95% 0,66-0,82). Prokalsitonin menunjukkan performa yang buruk (AUROC 0,45; IK 95% 0,36-0,54) dalam memprediksi mortalitas pasien bakteremia Gram-negatif di RSCM. Bila dibandingkan dengan hasil nilai titik potong skor qSOFA, nilai AUROC skor qSOFA ditambah prokalsitonin, tidak berbeda bermakna AUROC 0,74 vs AUROC 0,75.
Kesimpulan Performa skor qSOFA merupakan sistem skor terbaik dalam memprediksi mortalitas pasien dewasa dengan sepsis bakteremia Gram-negatif yang dirawat di RSCM. Performa gabungan skor qSOFA dan prokalsitonin tidak memberikan penambahan performa prediktor mortalitas dalam perawatan pasien dewasa dengan sepsis bakteremia Gram-negatif yang dirawat di RSCM.
Background. Sepsis is a leading cause of mortality and morbidity globally. Early diagnosis and initiation of bundle care may improve the outcome. However, accurate diagnosis of sepsis is still challenging. Gram-negative bacteremia was reported to have higher risk of septic shock and poor prognosis. Aim of this study is to evaluate the role of qSOFA and procalcitonin in predicting mortality risk in patients with Gram-negative bacteremia, furthermore adding procalcitonin to the qSOFA score may improve the ability to predict mortality.
Methods. This was a retrospective and prospective cohort study performed based on medical records and sepsis registry of Tropical and Infectious Disease Division, Internal Medicine Department of Cipto Mangunkusumo Hospital, conducted on patients aged > 18 years of age hospitalized from March 2017 until October 2020. The following data were obtained: sample characteristics, laboratory parameters, and 28-day mortality outcomes during hospitality.
Results. 128 patients were enrolled. There are 50.8% male patients with median (IQR) of age 48 (46-51) years. Mortality rate of Gram-negative bacteremia is 51.6% with cumulative survival 48.4% (SE 0.96%). The role of qSOFA score to predict 28-day mortality rate is (AUROC 0.74; 95% CI 0.66-0.82). Procalcitonin shows poor performance in predicting mortality of patients with Gram-negative bacteremia (AUROC 0.45, 95% CI 0.36-.0.54). Combining qSOFA score with procalcitonin does not improve the ability to predict the 28-day mortality risk (AUROC 0.75, 95% CI 0.66-0.84).
Conclusion. qSOFA score shows good performance in predicting mortality of patients with sepsis due to Gram-negative bacteremia. By adding procalcitonin does not improve its ability to predict mortality risk of patients with sepsis due to Gram-negative bacteremia."
Depok: Fakultas Kedokteran Universitas Indonesia, 2021
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Erna Parmawati
Peranan presepsin, c-reactive protein dan procalcitonin sebagai penanda respons terapi dan prognosis sepsis neonatorum awitan lambat pada neonatus prematur = The Role of presepsin, c-reactive protein and procalcitonin as markers of therapeutic response and prognosis of late onset neonatal sepsis in preterm neonates
"Pendahuluan: C-reactive protein CRP dan procalcitonin PCT merupakan penanda diagnostik dan pemantauan sepsis neonatorum yang paling banyak digunakan. Saat ini terdapat penanda sepsis baru yaitu Soluble CD14 subtype sCD14-ST presepsin. Penelitian ini bertujuan untuk mengetahui manfaat pemeriksaan serial kadar presepsin, CRP dan PCT serta korelasi antara kadar presepsin dengan kadar CRP dan PCT sebagai penanda respons terapi dan prognosis pasien SNAL pada neonatus prematur.
Metode: Desain penelitian kohort prospektif. Subjek penelitian terdiri dari 40 neonatus prematur sehat dan 40 pasien neonatus prematur SNAL dan dilakukan pemeriksaan kadar presepsin, CRP dan PCT, selanjutnya dilakukan pemantauan kadar presepsin, CRP dan PCT pasien neonatus prematur SNAL hari ke-3 dan ke-6 setelah diterapi. Pasien neonatus prematur SNAL dikelompokkan menjadi 20 pasien respons terapi dan 20 pasien non respons. Mortalitas pasien neonatus prematur SNAL ditentukan pada pemantauan hari ke-30.
Hasil: Median kadar presepsin, CRP dan PCT pada neonatus prematur SNAL masing-masing adalah 1559 pg/mL 427 ndash; 4835 pg/mL, 16.35 mg/L 0.1 ndash; 245.6 dan 4.11 ng/mL 0.17 ndash; 54.18 lebih tinggi secara bermakna dibandingkan pada neonatus prematur sehat 406 pg/mL 195 ndash; 562 pg/mL, 1.22 mg/L 0.1 ndash; 3.69 dan 0.03 0.01 ndash; 0.04 dengan nilai p.
Introduction: C reactive protein CRP and procalcitonin PCT are marker of neonatal sepsis diagnostics and monitoring of the most widely used. Currently there is a new marker of sepsis that is Soluble CD14 subtype sCD14 ST presepsin. This study aims to determine the benefits of serial presepsin levels, CRP and PCT as well as the correlation between presepsin with CRP and PCT as a marker of response to therapy and prognosis of patients SNAL in premature neonates.
Methods. This was prospective cohort, from 20 healthy preterm neonates and 40 LOS preterm neonates patient. The concentration of presepsin, CRP and PCT were analysed. Presepsin, CRP and PCT measured in both group and in 3rd 6th day sepsis follow up after therapy. Therapeutic respons was done in 20 LOS preterm neonates patient and 20 preterm neonates patient was not. The mortality of LOS preterm neonates patient saw in 30th day observation.
Results: Median of presepsin, CRP and PCT in LOS preterm neonates are 1559 pg mL 427 ndash 4835 pg mL, 16.35 mg L 0.1 ndash 245.6 and 4.11 ng mL 0.17 ndash 54.18, respectively, are significantly higher than healty preterm neonates 406 pg mL 195 ndash 562 pg mL, 1.22 mg L 0.1 ndash 3.69 and 0.03 0.01 ndash 0.04, p value "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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Ari Basukarno
Nilai Batas Testosteron dan Kadar FSH pada Pasien dengan Azoospermia = Cut-Off Value of Testosterone and FSH Level in Patient with Azoospermia
"Follicle-stimulating hormone (FSH) dan Testosteron merupakan hormon penting untuk spermatogenesis. Peningkatan FSH serum dan penurunan testosteron berhubungan dengan spermatogenesis abnormal. Azoospermia dapat diklasifikasikan sebagai azoospermia obstruktif dan nonobstruktif. Penelitian ini bertujuan untuk mengetahui nilai batas untuk pemeriksaan testosteron dan FSH dalam memprediksi azoospermia obstruktif dan non-obstruktif. Dari 1.064 pasien, 120 pasien memenuhi kriteria inklusi dan eksklusi. Terdapat 66,7% pada kelompok obstruktif dengan 33,3% pada kelompok non-obstruktif. Tidak ada perbedaan dalam hal usia (36,83 vs 36,62 tahun). Testosteron adalah 405.54 ± 186.14 ng/dL vs 298.84 ± 161.45 ng/dL (p = 0.002) sedangkan FSH adalah 8,53 ± 8,43 mIU/mL vs 20,12 ± 11,89 mIU / mL (p <0,001) untuk azoospermia obstruktif dan non-obstruktif masing-masing. Rata-rata testis 17,74 ± 4,03 cc dan 17,50 ± 4,23 cc sedangkan pada kelompok non obstruktif masing-masing 12,97 ± 5,18 cc dan 13,37 ± 5,31 cc untuk testis kiri dan kanan. Nilai FSH diatas 10,36 mIU/mL mempunyai sensitivitas 82,1% dan spesifisitas 79,5% untuk memprediksi azoospermia non obstruktif. Sayangnya, Testosteron tidak dapat digunakan untuk memprediksi klasifikasi azoospermia. Azoospermia obstruktif dan non-obstruktif dapat diprediksi menggunakan FSH tetapi tidak dengan kadar serum testosteron. Populasi testosteron yang lebih tinggi harus digunakan untuk studi lebih lanjut.
Follicle-stimulating hormone (FSH) and Testosterone are important for spermatogenesis. Increased serum FSH and decreased testosterone are related to abnormal spermatogenesis. Azoospermia can be classified as obstructive and nonobstructive azoospermia. This study aims to discover cut-off value of Testosterone and FSH in predicting obstructive and non-obstructive azoospermia. From 1064 patients, 120 fulfilled inclusion and exclusion criteria. There were 66.7% in obstructive with 33.3% in non-obstructive group. No difference in terms of age (36,83 vs 36,62 y.o). Testosterone were 405.54 ± 186.14 ng/dL vs 298.84 ± 161.45 ng/dL (p = 0.002) while FSH was 8,53 ± 8,43 mIU/mL vs 20,12 ± 11,89 mIU/mL (p < 0.001) for obstructive and non-obstructive azoospermia respectively. Average testicular were 17.74 ± 4.03 cc and 17.50 ± 4.23 cc while in non-obstructive group are 12.97 ± 5.18 cc and 13.37 ± 5.31 cc for right and left testis respectively. FSH value above 10.36 mIU/mL has sensitivity 82.1% and specificity 79.5% for predicting non-obstructive azoospermia. Unfortunately, Testosterone could not be used in predicting azoospermia classification. Obstructive and non-obstructive azoospermia could be predicted using FSH but not testosterone serum level. Higher testosterone population should be used for further study."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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