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"Pendahuluan: Hiperhidrasi meningkatkan risiko kematian pada pasien hemodialisis (HD) kronik. Hiperhidrasi berdasarkan brain-type natriuretic peptide(BNP) plasma >356 pg/ml berisiko tinggi kematian pada pasien dengan HD kronik. Pengeluaran akumulasi air berlebih seminggu pada prosedur HD kronik dua kali seminggu lebih sedikit dibandingkan HD kronik tiga kali seminggu sehingga berpotensi lebih mudah mengalami hiperhidrasi. Penelitian ini bertujuan mengetahui proporsi pasien dengan hiperhidrasi serta hubungan usia, tekanan darah sistolik(TDS)pradialisis, interdialytic weight gain(IDWG), dan ultrafiltrasi(UF) dengan hiperhidrasipada pasien HD kronik dua kali seminggudi Rumah Sakit Umum Pusat Nasional(RSUPN)Dr. Cipto Mangunkusumo.Metode: Penelitian ini merupakan studi potong lintang untuk mengetahui proporsi pasien dengan hiperhidrasi,serta hubungan usia, TDS pradialisis, IDWG, dan UF dengan hiperhidrasi pasien HD kronik dua kali seminggu di RSUPNCiptoMangunkusumo. Hiperhidrasi berdasarkan BNP plasma >356 pg/ml. Analisis bivariat dan multivariat dilakukan untuk mengetahui hubungan usia, TDS pradialisis, IDWG, dan UF dengan hiperhidrasi. Hasil: Sebanyak 129 pasien yang dianalisis. Hiperhidrasi didapatkan sebesar 62%. Pada analisis multivariat menunjukkan bahwa TDS pradialisis berhubungan dengan hiperhidrasi (adjusted OR=3,84; IK 95%: 1,51-9,74; p<0,005) Kesimpulan: Proporsi pasien dengan hiperhidrasi pada HD kronik dua kali seminggu sebesar 62%. Pada analisis multivariat didapatkan hanya TDS pradialisis berhubungan dengan hiperhidrasi.

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Introduction: Hyperhydration is an independent higher mortality risk factor in maintenance hemodialysis (MHD) patients. In Indonesia, twice-weekly HD is the most common of MHD. Twice-weekly HD patients may have higher risk of interdialytic water accumulation lead hyperhydration than thrice-weekly HD patients.The aim of study was identifying the proportion of patients with hyperhydration, and relationship of age, predialytic systolic blood pressure (SBP), interdialytic weight gain (IDWG), and ultrafiltration (UF) to hyperhydration in twice-weekly HD patients at Dr. Cipto Mangunkusumo National General Hospital. Methods: A cross sectional study in twice-weekly HD patients at Dialysis Unit-Dr. Cipto Mangunkusumo National General Hospital. Hyperhydration was based on plasma brain-type natriuretic peptide (BNP) >356 pg/ml. Bivariate and multivariate analysis was done to analyze relationship of age, predialytic SBP, IDWG, and UF with hyperhydration. Results:One hundred twenty-nine patients were analyzed, proportion of patients with hyperhydration in twice--weekly HD patients was 62%. In multivariate analysis, predialytic SBP was related to hyperhydration (adjusted OR= 3.84; 95% CI, 1.51-9.74; p=0.005).

Conclusion: The proportion of patients with hyperhydration in twice-weekly HD patients was 62%. In multivariate analysis the predialytic SBP was related to hyperhydration in twice-weekly HD patients at Dr. Cipto Mangunkusumo National General Hospital."

"Latar Belakang: Hipertensi merupakan kasus terbanyak pada pasien hemodialisis HD . Tekanan nadi sentral merupakan prediktor yang kuat terhadap mortalitas dengan penyebab apa pun, banyak faktor yang mempengaruhi tekanan nadi sentral, baik secara langsung maupun tidak langsung, di antaranya adalah interdialytic weight gain IDWG . IDWG dikatakan berhubungan dengan mortalitas akibat penyebab apa pun, namun belum jelas mekanismenya. Tujuan: Mengetahui tekanan nadi sentral dan korelasinya dengan IDWG pada pasien penyakit ginjal tahap akhir PGTA yang menjalani HD di RSCM. Metode: Penelitian ini merupakan studi potong lintang pada pasien PGTA yang menjalani HD di RSCM. Dilakukan pemeriksaan tekanan nadi sentral dengan alat sfigmokor, dan dihitung IDWG dalam satu bulan terakhir, selanjutnya dikorelasikan. Hasil: Didapatkan 67 subyek yang memenuhi kriteria inklusi. Median usia 53.0 rentang inter-kuartil [RIK] 44.0-62.0 tahun, subyek dengan jenis kelamin perempuan lebih banyak ditemukan. Lamanya menjalani HD median 51,3 RIK 23,8-88,8 bulan. Median tekanan nadi sentral 45 RIK 32,67-56,67 mmHg. Rerata IDWG adalah 2,71 simpang baku [SB] 1,08 kg atau 5,04 SB 1,88 . Tekanan nadi sentral tidak berkorelasi dengan IDWG dengan r = 0,088 p=0,478. Simpulan: Tekanan nadi sentral pada pasien PGTA yang menjalani HD di RSCM mediannya sebesar 45 RIK 32,67-56,67 mmHg. Tekanan nadi sentral tidak berkorelasi dengan IDWG.

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Background: Hypertension is the most prevalent case in patients undergoing hemodialysis HD . Central pulse pressure is a strong predictor of mortality of any cause. Many factors are related to central pulse pressure, either directly or indirectly, including interdialytic weight gain IDWG. IDWG are said to be associated with mortality of any cause in HD patients, but the mechanism underlying that association remained unclear.

Objective: To find central pulse pressure and its correlation with IDWG in end stage renal disease ESRD patients undergoing HD in Rumah Sakit Cipto Mangunkusumo, Indonesia.

Methods: Cross sectional study on all ESRD patients undergoing HD in Rumah Sakit Cipto Mangunkusumo. Central pulse pressure was measured using Sphygmocor. IDWG of patients within the last month were obtained, and then a correlation analysis was conducted on both variables.

Results: This study included 67 subjects that met inclusion criteria. The median range age of participants was 53.0 44.0 62.0 years old, with more female subjects present. The median range of duration of HD was 51.3 23.8 88.8 months. Median range of central pulse pressure was 45 32,67 56,67 mmHg. The mean of IDWG was 2.71 standard deviation SD 1.08 kg or 5.04 SD 1.88. This study found that there were no correlation between central pulse pressure and IDWG, r 0.088 p 0.478.

Conclusions: Median range of central pulse pressure in ESRD patients undergoing HD in CMGH was 45 32,67 56,67 mmHg. Central pulse pressure had no correlation with IDWG. "

"ABSTRAK Latar Belakang: Skor kualitas hidup yang rendah pada pasien hemodialisis (HD) dikatakan berhubungan dengan peningkatan risiko mortalitas. Namun, belum ada penelitian yang melaporkan hubungan langsung antara laju aliran darah (Qb) dan skor kualitas hidup pada pasien HD dua kali seminggu.Tujuan: Mengetahui hubungan antara laju aliran darah (Qb) dengan skor kualitas hidup pada pasien-pasien yang menjalani hemodialisis kronik dua kali seminggu.Metode: Penelitian potong-lintang ini dilakukan di Unit Hemodialisis di Rumah Sakit Cipto Mangunkusumo, Jakarta. Pasien dengan gangguan fungsi luhur, chronic heart failure NYHA (New York Heart Association) kelas III-IV, buta, imobilisasi ketergantungan berat serta menolak ikut penelitian tidak diikutsertakan dalam penelitian. Pasien kemudian dibagi menjadi grup 1 (Qb > 250 ml/menit) dan grup 2 (Qb ≤ 250 ml/menit). Skor kualitas hidup dinilai menggunakan kuesioner KDQOL-SFTM, yang dibagi dalam skor fisik (PCS), mental (MCS) dan masalah terkait penyakit ginjal (KDCS). Hubungan antara Qb dan skor kualitas hidup dianalisis menggunakan metode chi-square serta regresi logistik untuk mendapatkan nilai rasio prevalensi (RP) yang adjusted.Hasil: Sebanyak 132 pasien dimasukkan kedalam analisis penelitian. Nilai Qb digrup 1 memiliki hubungan dengan skor PCS ≥ 44 (RP 1,86; IK 95% 1,15-2,99), serta skor KDCS ≥ 52 (RP 1,41; IK 95% 1,03-1,92). Setelah analisis multivariat, nilai Qb digrup 1 masih berhubungann dengan skor PCS ≥ 44 (RP adjusted 1,87; IK 95% 1,15-2,51) dan skor KDCS ≥ 52 (RP adjusted 1,31; IK 95% 1,004-1,50).Simpulan: Nilai Qb > 250 ml/menit memiliki hubungan yang signifikan dalam kualitas hidup fisik dan masalah terkait penyakit ginjal yang lebih baik pada pasien hemodialisis 2 kali seminggu.

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ABSTRACT

Background. A low quality of life (QoL) score in hemodialysis (HD) patients was related to increased risk of mortality. However, there was no study reported the direct relationship between BFR and QoL in twice-weekly HD patients.

Objectives. To determine the relationship between blood flow rate and quality of life in twice-weekly hemodialysis patients.

Methods. This cross-sectional study was conducted at the Hemodialysis Unit in Cipto Mangunkusumo Hospital, Jakarta. Patients with neurocognitive impairment, chronic heart failure NYHA (New York Heart Association) class III-IV, blindness, immobilization with severe dependence and refused to participate were excluded in the study. Patients were divided into group 1 (BFR > 250 ml/min) dan group 2 (BFR ≤ 250 ml/min). The QoL was assessed using KDQOL-SFTM questionnaire, which was divided in physical (PCS), mental (MCS) and kidney disease-related (KDCS) scores. Relationship between BFR and QoL scores were analyzed using chi-square and logistic regression methods in order to determine adjusted Prevalence Ratio (PR).

Results. A total of 132 patients were included in the analysis. The BFR in group 1 was associated with PCS scores ≥ 44 (PR 1.86; 95% CI 1.15-2.99), as well as KDCS scores ≥ 52 (PR 1.41; 95% CI 1.03-1.92). After multivariate analysis, BFR values ​​of patients in group 1 were still associated with PCS scores ≥ 44 (adjusted PR 1.87; 95% CI 1.15-2.51) and KDCS scores ≥ 52 (adjusted PR 1.31; 95% CI 1.004-1.50).

Conclusion. The BFR values > 250 ml/min had a significant relationship for better physical and kidney disease-related quality of life in twice-weekly HD patients."

"Penambahan berat badan diantara dua waktu hemodialisis (interdialysis weight gain = IDWG) melebihi standart 1,5 kg dapat berdampak terhadap kualitas hidup pasien CKD. Efek negatif terhadap keadaan pasien, diantaranya hipotensi, kram otot, hipertensi, sesak nafas, mual, muntah, edema perifer, ascites.Tujuan dari penelitian ini mengetahui hubungan antara penambahan berat badan di antara dua waktu hemodialisis (interdialysis weight gain = IDWG) dan kualitas hidup pasien , baik domain kesehatan fisik, psikologis, hubungan sosial dan lingkungan.Metode penelitian ini menggunakan deskriptif korelasi dengan pendekatan cross sectional. Sampel sebanyak 76 pasien.Hasil analisis menggunakan one way analysis of variance menunjukkan terdapat hubungan yang signifikan antara penambahan berat badan diantara dua waktu hemodialisa dengan kualitas hidup pada semua domain (p = 0,000, ά 0,05). Domain kesehatan fisik 21,62 (SD 5,18) domain psikologis 18,45 (SD 18,45) domain hubungan sosial 9,24 (SD 9,24) dan domain lingkungan 25,67 (SD 25,67). Variabel confounding tidak mempunyai kontribusi terhadap kualitas hidup (p>0,05).Rekomendasi hasil penelitian lebih lanjut adalah meneliti hubungannya karakteristik adat istiadat, budaya, stress dan kecemasan terhadap kualitas hidup.

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Weight gain between the two time of hemodialysis (Interdialysis Weight Gain = IDWG) in excess of 1.5 kg standard can implicate on quality of life to Chronic Kidney Disease (CKD) patient. The negative effect of IDWG on patient conditions, are hypotension, muscle cramps, hypertension, shortness of breath, nausea, vomiting, peripheral edema, ascites.The objectives of this study is to ascertain the relationship between IDWG and patients quality of life (QoL) in term of physical health domain, psychological, social relationships and environment.This research method used descriptive correlation with cross sectional approach. Sample of 76 patients.Analysis outcome used one way analysis of variance indicated that there were any significant relationship between weight gain in between two time hemodialysis with quality of life (QoL) on all domains (p = 0.000, ά 0.05). Physical health domain 21.62 (SD 5.18), Psychological domain 18.45 (SD 18.45) Social relations domain 9.24 (SD 9.24) and Environment domain 25.67 (SD 25.67). The confounding variables did not contribute to the quality of life (p> 0.05).The Recommendation of the following of this study outcome are to investigate the relationship of patient life in many characteristics of custom, cultural, stress and anxiety with quality of life."

"Health Care-Associated Infection (HAIs) telah menjadi topik besar dari tahun ketahun. Tujuan dari penelitian ini adalah untuk mengetahui hubungan berat lahir dengan ketahanan bayi terhadap infeksi aliran darah (IAD). Variabel lain yang ikut dianalisis hubungannya dengan ketahanan bayi terhadap IAD adalah, jenis kelamin, usia gestasi, APGAR, kelainan kongenital, usia ibu saat melahirkan, penyakit maternal dan penggunaan alat invasif seperti kateter intravena, ETT dan NC-CPAP. Desain penelitian adalah kohort retrospektif dengan menggunakan metode Kaplan Meier, menggunakan rekam medis pasien perinatologi Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo.tahun 2012. Selama periode pengamatan, dari 298 bayi yang memenuhi kriteria inklusi penelitian, diketahui ketahanan terhadap IAD pada non BBLR 72,4% dibandingkan dengan BBLR 69,3%. Insiden IAD sebesar 8,7 % (5,9/1000) dengan median waktu ketahanan terhadap infeksi adalah 10 hari. Berat lahir memiliki efek protektif terhadap IAD sebesar 0,54 (p > 0,05), sedangkan kateter sentral diketahui memiliki efek resiko yang besar terhadap kejadian IAD (HR= 6,5; 95% CI: 2,4-17,6; p< 0,001).

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Health Care-Associated Infection (HAIs) has become a major topic from year to year. The objective of this study was to assess relation of birth weight to Blood Stream Infections (BSI) survival rate in neonates. Other variables were also analyzed related to survival rate were sex, gestational age, APGAR score, congenital abnormality, maternal age, maternal disease and presence of invasive devices such as intravenous catheters, ETT and NC-CPAP.

This was a retrospective cohort study with Kaplan Meier method, using patients? medical record of Unit Perinatology National General Hospital of Dr. Cipto Mangunkusumo in 2012. During study period, among 298 infants who met inclusion criterias, survival rate of BSI in LBW was 72,4% compared with 69,3% in HBW. Total incidence of BSI was 8,7% (5,9 / 1000) with a median survival time was 10 days. Birth weight has a protective effect on BSI of 0,54 (p> 0,05), while central catheters are known to have highly effect on BSI (HR = 6.5, 95% CI: 2,4 to 17,6, p <0,001)."

"Pengetahuan mengenai PD memainkan peran penting dalam mempengaruhi sikap pengasuh. Diketahui bersama bahwa meningkatkan taraf pengetahuan dapat membantu pengasuh mengatasi beban tertentu yang berkaitan dengan perawatan Pasien PD. Penelitian ini membahas tentang mengidentifikasi hubungan antara pengetahuan dan perilaku di antara para perawat pasien PD. Delapan belas sampel diambil dari Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo. Setiap individu telah diwawancara melalui panggilan suara dan pembagian kuesioner. Di awal pengambilan survei, pihak yang diwawancara diminta untuk menjawab pertanyaan-pertanyaan yang berkaitan dengan biodata pengasuh dan informasi pasien; usia, jenis kelamin, pekerjaan, tingkat pendidikan, hubungan dengan pasien, stadium PD Hoehn & Yahr, dan tanggal diagnosis PD. Diikuti dengan 10 pertanyaan benar atau salah tentang pengetahuan dasar PD dan diakhiri dengan 10 pertanyaan empat-skala Likert yang mencakup sikap dari para perawat pasien PD. Secara keseluruhan, para pengasuh mendapatkan hasil yang cukup tinggi (> 40%) di kedua kuesioner yang telah diberikan. Tidak ada signifikansi statistik dalam kaitannya dengan hubungan antara pengetahuan dan sikap. Secara keseluruhan, penelitian ini menunjukkan bahwa tidak ada hubungan yang signifikan antara pengetahuan dan sikap pengasuh. Namun, hal itu bertentangan dengan penelitian lain. Perbedaannya mungkin karena ukuran sampel. Diperlukan studi lebih lanjut untuk mengidentifikasi hubungan dan dampak Pendidikan.

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Knowledge may play an important role in influencing the caregivers’ attitudes and the overall quality of care towards PD patients. It was known that improving knowledge can help caregivers overcome certain burdens, relative to PD care. This study identifies and discusses the relationship between knowledge and the attitude amongst caregivers of PD patients in RSCM. 18 samples were collected from Dr. Cipto Mangunkusumo National Central General Hospital. Individuals were interviewed with a questionnaire via voice call. Caregivers were initially asked for their biodata and patient’s information; age, gender, occupation, education level, relationship to the patient, patient’s Hoehn & Yahr PD stage, and date of onset PD diagnosis. Afterward, they have given 10 true or false questions about basic PD knowledge and 10 four-point Likert Scale questions that covered the attitudes of the caregivers. Caregivers overall mostly achieved “moderate-high” (>40%) levels from both attitude and knowledge questionnaires given. It was found that there no statistical significance in the relationship between knowledge and attitude (p=0.316). The study shows that there is no significant relationship between knowledge and attitude of caregivers. The distinction may be due to the sample size. Further studies in regards to identifying the relationship and well the impact of education are needed."

"ABSTRAKInterdialytic weight gain IDWG merupakan masalah yang dijumpai pada pasien hemodialisis HD dan mempengaruhi probabilitas kesintasan akibat adanya akumulasi cairan. Penelitian ini bertujuan untuk mengetahui kesintasan tiga tahun pertama pasien HD kronik berdasarkan IDWG. Desain penelitian menggunakan studi kohort retrospektif dengan metode Kapplan-Meier untuk analisis kesintasan pada 72 responden. Hasil penelitian menunjukkan bahwa terdapat 87.5 responden mengalami IDWG berlebih dengan 16.7 responden mengalami event, dan tidak terdapat hubungan yang signifikan antara IDWG berlebih dan HID terhadap kesintasan tiga tahun. Hal ini disebabkan terpenuhinya dosis HD dan kecepatan aliran darah yang mempengaruhi tercapainya adekuasi HD. Hasil penelitian ini dapat memotivasi perawat untuk memantau IDWG, pencapaian dosis HD dan berat badan pada akhir sesi HD.

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ABSTRACTInterdialytic weight gain IDWG is a problem in hemodialysis patients and influencing the probability of survival due to fluid accumulation. This study aims to assess the survival the first three years of chronic hemodialysis patients based interdialytic weight gain. The study design used a retrospective cohort study using Kapplan Meier method for survival analysis on 72 respondents. The results showed that there were 87.5 of respondents experiencing excessive IDWG with 16.7 of them experienced event, and there was no significant association between excessive IDWG and intradialysis hypotension against the survival of three years. This could be resulted by the fulfillment of the hemodialysis dose and quick of blood Qb which affect the achievement of hemodialysis adequacy. The results of this study can motivate nurses in monitoring IDWG, achieving hemodialysis dose and body weight at the end of hemodialysis session. "

"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.

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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."

"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.

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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."

"Konseling analisis transaktional merupakan bentuk konseling yang dapat diterapkan untuk mengatasi kenaikan interdialytic weight gain pada pasien chronic kidney disease. Tujuan dari penelitian ini adalah untuk mengetahui efektifitas konseling analisis transaktional tentang pembatasan cairan terhadap penurunan interdialytic weight gain pada pasien chronic kidney disease yang menjalani hemodialisa. Penelitian ini menggunakan desain quasi experiment dengan pendekatan pretest-posttest control group. Responden penelitian ini sebanyak 24 responden. Analisis bivariat dan univariat menggunakan uji statistik t-test dan annova. Hasil penelitian menunjukkan bahwa konseling analisis transaktional berpengaruh terhadap penurunan interdialytic weight gain dengan nilai p=0,0003. Perawat disarankan menerapkan konseling analisis transaktional ini guna mengantisipasi peningkatan interdialytic weight gain yang berlebihan.

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Transactional analysis counseling is a tipe of counseling that can be applied to addres of interdialytic weight gain in patients with chronic kidney disease. The goal of this research was to determine the effectiveness of transactional analysis counseling on a fluid restriction interdialytic weight gain in patients with chronic kidney disease undergoing hemodialysis. This study used a quasi experiment design approach to pretest-posttest control group. The respondents of this study were 24 patients. Univariate and bivariate analyzes were using the statistical of test t-test and ANNOVA. The study conclude that transactional analysis counseling effects the in reducting of interdialytic weight gain with p = 0.0003. Therefore, nurses are advised to apply transactional analysis counseling to anticipate interdialytic weight gain."