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"Latar Belakang: Pneumonia komunitas berat (severe community acquired pneumonia atau SCAP) merupakan salah satu bentuk penyakit kritis yang sering dijumpai dengan angka mortalitas jangka pendek yang tinggi. Pelbagai model prediksi klinis general telah banyak dievaluasi memiliki performa yang baik dalam memprediksi luaran klinis untuk penyakit kritis, namun evaluasi performa SAPS 3 sebagai salah satu sistem skor yang luas digunakan dalam perawatan intensif terhadap SCAP hingga saat ini belum memadai untuk memandu klinisi dalam menangani kasus tersebut. Tujuan: Penelitian ini bertujuan untuk mengetahui proporsi mortalitas SCAP serta mengevaluasi performa kalibrasi dan diskriminasi dari SAPS 3 terhadap mortalitas rawat inap. MetodeL Penelitian ini menggunakan desain kohort retrospektif dan mengambil data rekam medis dari pasien dengan SCAP yang masuk rawat di instalasi gawat darurat, ruang perawatan high care maupun intensive care di RSUPN Cipto Mangunkusumo selama 3 tahun (Maret 2019-Maret 2021). Dilakukan penilaian mortalitas rawat inap selama 30 hari perawatan. Data terkumpul dianalisis dengan uji Hosmer-Lemeshow goodness-of-fit untuk mengetahui performa kalibrasi dan pembuatan kurva Receiver Operating Curve (ROC) untuk mengetahui performa diskriminasi skor SAPS 3 terhadap luaran mortalitas rawat inap. Hasil: Diperoleh 484 subjek SCAP dengan proporsi mortalitas 49,2%. Sebanyak 73,8% adalah infeksi viral (COVID-19) dan sisanya bakterial (25,6%) dan campuran fungal-bakterial (0,6%). Performa kalibrasi adalah baik (p=0,519, koefisien korelasi r=0,993). Performa diskriminasi tampak sangat baik untuk skor total SAPS 3 dengan nilai AUC 0,921 (IK95% 0,898-0,944). Kesimpulan: Performa kalibrasi dan diskriminasi SAPS 3 dalam memprediksi mortalitas rawat inap SCAP adalah baik."

"Latar belakang: Skor SAPS 3 (Simplified Acute Physiology Score 3) merupakan sistem skor mutakhir yang dikembangkan untuk memprediksi mortalitas pasien di unit perawatan intensif (UPI). Sebelum suatu sistem skor dapat diterapkan pada populasi yang berbeda maka harus dilakukan penilaian kesahihannya terlebih dahulu. tujuan dari penelitian ini adalah untuk menilai kesahihan skor SAPS 3 dan persamaan baru SAPS 3 pada pasien UPI RSCM. Metode: Studi kohort retrospektif menggunakan data rekam medis pasien yang dirawat di UPI RSCM Januari-Juli 2012 dengan metode pengambilan sampel konsekutif. Dilakukan analisis bivariat dilanjutkan dengan analisis multivariat dengan persamaan regresi logistik metode stepwise backward. Kemampuan kalibrasi skor SAPS 3 dinilai dengan uji Hosmer-Lemeshow sedangkan kemampuan diskriminasi dianalisis dengan nilai AUC. Hasil: Selama penelitian terkumpul 550 pasien yang dirawat di UPI RSCM. Persamaan baru SAPS 3 didapatkan y = -4,765 + (0,319 x total skor) dengan 7 variabel sebagai prediktor kuat. Skor SAPS 3 baru dan Australasia memiliki kemampuan kalibrasi dan diskriminasi yang baik dengan uji Hosmer-Lemeshow p = 0,383 dan p = 0,123 dengan nilai AUC 0,901 dan 0,945. Kesimpulan: Skor SAPS 3 memiliki kemampuan yang baik (sahih) dalam memprediksi mortalitas pasien di UPI RSCM.

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Background: Simplified Acute Physiology Score 3 (SAPS 3) has been developed to estimate mortality in intensive care unit. However, this model need to be validated before it use in different populations. The aim of this study was to validate the performance of SAPS 3 score in the intensive care unit (ICU) Cipto Mangunkusumo Hospital population and to find new equation of SAPS 3 for ICU Cipto Mangunkusumo Hospital population.

Methods: A retrospective cohort study with consecutive sampling was done to patients hospitalized in the ICU Cipto Mangunkusumo Hospital from January to July 2012. Bivariate analysis was performed, continued with multivariate analysis with stepwise backward method of logistic regression equation. Calibration was assessed by Hosmer-Lemeshow test while discrimination was analyzed using the area under the receiver operator curve (AUC).

Results: A total of 550 patients were included in this study. New equation of SAPS 3 score is y = -4,765 + (0,319 x total score) with 7 variable found as strong predictor. Both new and Australasia SAPS 3 equation have a good calibration and discrimination performance with Hosmer-Lemeshow test p = 0,383 and p= 0,123 with AUC = 0,901 and 0,945.

Conclusion: SAPS 3 score has a good performance in predicting mortality of intensive care unit patients in Cipto Mangunkusumo Hospital."

"Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo.

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Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia.

Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo.

Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test.

Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86.

Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital."

"Community acquired pneumonia (CAP) oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang tinggi. CAP akibat PRO memerlukan terapi antibiotik spektrum luas, skor Drugs Resistance in Pneumonia (DRIP) mampu memprediksi kasus tersebut. Penggunaan skor DRIP dapat mencegah kegagalan terapi antibiotik empirik dan mempersingkat lama rawatan, untuk itu diperlukan validasi. Penelitian ini merupakan studi Cohort Retrospektif pada pasien CAP yang dirawat inap selama periode Januari 2019 hingga Juni 2020. Data diambil dari rekam medis, kegagalan antibiotik bila terdapat kematian, pindah rawat ICU dan eskalasi antibiotik. Performa skor DRIP dianalisis dengan menentukan nilai kalibrasi dan diskriminasi, uji Hosmer-Lemeshow dan Area Under Curve (AUC). Diperoleh 480 pasien yang telah memenuhi kriteria. Terdapat 331 pasien (69%) dengan skor DRIP <4 dan 149 pasien (31%) dengan skor DRIP ≥4, dengan jumlah kegagalan antibiotik sebesar 283 pasien (59%), 174 pasien (61,4%) skor DRIP <4 dan 109 pasien (38,5%) skor DRIP ≥4. Kalibrasi DRIP menggunakan uji Hosmer-Lemeshow diperoleh p-value = 0,667 (p>0,05), diskriminasi AUC pada kurva ROC diperoleh 0,651 (IK 95%; 0,601-0,700). Skor DRIP menunjukkan performa yang cukup baik dalam memprediksi kegagalan antibiotic empiric pada pasien CAP yang terinfeksi PRO. Skor DRIP tidak berhubungan dengan lama rawatan di Rumah Sakit.

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Community-acquired pneumonia (CAP) caused by drug resistant pathogens (DRP) has a high level of severity. The incidence of CAP due to DRP requires broad spectrum antibiotic therapy, the Drugs Resistance in Pneumonia (DRIP) score is able to predict these cases. The use of the DRIP score can prevent antibiotic failure and minimize length of hospitalization, but validation is needed . This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from patient medical records, and failure of empiric antibiotics occurs when one of this criteria are found: patient mortality, ICU transfer and escalation of antibiotics as well as length of stay. Furthermore, the performance of the DRIP score was analyzed by determining the calibration and discrimination, using the Hosmer-Lemeshow test and the Area Under Curve (AUC). There were 480 patients who met the criteria. There were 331 patients (69%) with a DRIP score <4 and 149 patients (31%) with a DRIP score ≥4, with a total of 283 patients (59%) of antibiotic failures which were detailed in 174 patients (61.4%) with a DRIP score <4 and 109 patients (38.5%) DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value=0.667 (p>0.05), AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). The DRIP score showed good performance in predicting failure of empiric antibiotics in infected CAP patients. PRO. The DRIP score is not related to the length of stay in the hospital."

"Latar Belakang: Dalam beberapa tahun terakhir, permasalahan yang sering muncul pada pneumonia komunitas adalah terkait timbulnya patogen penyebab yang bersifat resisten obat. Skor DRIP merupakan suatu model prediksi terhadap Patogen Resisten Obat (PRO) pada pneumonia komunitas. Skor DRIP memiliki akurasi prediksi patogen PRO yang lebih baik dibandingkan dengan beberapa alternatif skor lain termasuk kriteria HCAP. Belum adanya studi validasi terhadap penggunaan skor DRIP di Indonesia sehingga belum diketahui tingkat akurasi prediksi skor ini pada populasi, karakteristik pasien dan pola kuman di Indonesia terutama di RSUPN dr. Cipto Mangunkusumo Jakarta.Tujuan: Penelitian ini dilakukan untuk mengetahui performa skor DRIP sebagai instrumen dalam memprediksi infeksi akibat patogen PRO pada pneumonia komunitas di RSUPN dr. Cipto Mangunkusumo Jakarta.Metode: Suatu penelitian dengan menggunakan desain potong lintang. Subyek penelitian adalah pasien pneumonia komunitas yang dirawat di RS Cipto Mangunkusumo pada periode Januari 2019 hingga Juni 2020. Penelitian dilakukan dengan mengambil data rekam medis pasien pneumonia komunitas yang dirawat inap. Didefinisikan sebagai PRO apabila dari hasil kultur sputum didapatkan resisten terhadap antibiotik golongan β-laktam non pseudomonas (ceftriaxone, cefotaxime, ampicilin sulbaktam), Makrolid (azitromisin) dan fluorokuinolon respirasi (levofloxacin, moxifloxacin). Performa skor dianalisis dengan menentukan nilai kalibrasi dan diskriminasi menggunakan uji Hosmer-Lemeshow dan AUROC.Hasil: Sebanyak 254 subyek yang memenuhi kriteria pemilihan diikutkan dalam penelitian. Terbagi menjadi kelompok PRO 103 pasien (40,6%) dan non PRO 151 pasien (59,4%). Hasil analisis kalibrasi skor DRIP dengan uji Hosmer-Lemeshow didapatkan nilai p=0,001 (p<0,05). Sementara untuk analisis diskriminasi skor DRIP dari kurva ROC didapatkan nilai AUC 0,759 (IK95%;0,702-0,810). Pada skor ≥ 4, skor DRIP memiliki nilai sensitivitas 70,9%, spesifisitas 92,7%, nilai prediksi positif 86,9%, dan nilai prediksi negatif 82,3%.Simpulan: Skor DRIP memiliki performa yang baik untuk memprediksi infeksi akibat patogen PRO pada pneumonia komunitas.

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Background: In recent years, problems that often arise in community-acquired pneumonia are related to drug-resistant pathogens. The DRIP score is a predictive score model for Drug-Resistant Pathogens (DRP) in community-acquired pneumonia. It also has a better DRP pathogen prediction accuracy compared to other alternative scores including HCAP. There is no validation study on the use of the DRIP score in Indonesia, so the accuracy of this score prediction in the population, patient characteristics and germ patterns in Indonesia is not known, especially in RSUPN dr. Cipto Mangunkusumo Jakarta.

Objective: This study aims to determine the performance of the DRIP score as an instrument in predicting infection due to DRP pathogens in community-acquired pneumonia at Cipto Mangunkusumo Hospital Jakarta, Indonesia.

Methods: A study with cross-sectional design, on community-acquired pneumonia patients who were treated at Cipto Mangunkusumo Hospital in the period January 2019 to June 2020. Furthermore, this was conducted by reviewing medical records of inpatients. It is defined as DRP if the sputum culture results show resistance to non pseudomonas β-lactam antibiotics (ceftriaxone, cefotaxime, ampicillin-sulbactam), macrolides (azithromycin) and respiratory fluoroquinolones (levofloxacin, moxifloxacin). Score performance analyzed by determining the calibration and discrimination values using the Hosmer-Lemeshow and AUROC tests.

Results: 254 subjects who met the selection criteria were included in the study. It was divided into a PRO group of 103 patients (40.6%) and a non-PRO of 151 patients (59.4%). The results of the calibration analysis of the DRIP score with the Hosmer- Lemeshow test obtained a value of p=0.001 (p<0.05). Discrimination analysis from ROC curve got an AUC value of 0.759 (CI95%; 0.702-0.810). At a threshold ≥ 4 points, DRIP score demonstrated a sensitivity of 70,9%, a specificity of 92,7%, a positive predictive value of 86,9%, a negative predictive value of 82,3%.

Conclusions: The DRIP score have good performance to predict infections due to DRP pathogens in community-acquired pneumonia."

"Latar belakang: Keputusan pasien untuk menjalani bedah pintas koroner dipengaruhi risiko mortalitas. Skor Age, Creatinine and Ejection Fraction ACEF merupakan prediktor mortalitas 30 hari pascabedah pintas koroner yang sederhana dan telah ditunjukkan memiliki performa yang setara dengan skor lain yang lebih kompleks. Tujuan: Menilai performa kalibrasi dan diskriminasi skor ACEF dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSUPN Dr. Cipto Mangunkusumo RSCM. Metode: Penelitian ini merupakan studi kohort retrospektif terhadap pasien penyakit jantung koroner dewasa yang menjalani bedah pintas koroner di unit Pelayanan Jantung Terpadu PJT RSCM tahun 2013 ndash; 2015. Usia, kreatinin, dan fraksi ejeksi dinilai sebelum pasien menjalani bedah. Pasien diikuti hingga 30 hari pascabedah untuk dilihat outcome-nya meninggal atau tidak. Performa kalibrasi skor ACEF dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor ACEF dinilai dengan area under the curve AUC. Hasil: Sebanyak 308 subjek diikutsertakan dalam analisis. Performa kalibrasi skor ACEF dengan uji Hosmer-Lemeshow menunjukkan p=0,991 dan plot kalibrasi menunjukkan koefisien korelasi r=0,95. Performa diskriminasi skor ACEF ditunjukkan dengan nilai AUC sebesar 0,728 IK95 0,644; 0,811. Simpulan: Skor ACEF memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSCM.

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Background: The preference of patients to undergo coronary artery bypass grafting CABG surgery is influenced by the risk of mortality. Age, Creatinine and Ejection Fraction ACEF score is a simple predictor of 30 day mortality following CABG surgery and had been shown to be equivalent to more complex models.

Aim: To assess calibration and discrimination performance of ACEF score in predicting 30 day mortality following CABG surgery in Cipto Mangunkusumo Hospital.

Methods: This was a retrospective cohort study of adult coronary artery disease patients undergoing CABG surgery in Integrated Cardiovascular Center, Cipto Mangunkusumo Hospital between 2013 ndash 2015. Age, creatinine, and ejection fraction value were obtained before surgery. The subjects were followed up for up to 30 days postoperatively to assess the outcome dead or alive. Calibration performance were assessed by Hosmer Lemeshow test and calibration plot. Discrimination performance were assessed by the area under the curve AUC.

Results: A total of 308 subjects were included in analysis. Hosmer Lemeshow test of ACEF score showed p 0.991 and calibration plot showed r 0.95. Discrimination of ACEF score was shown by the AUC value of 0.728 95 CI 0.644 0.811.

Conclusion: ACEF score have a good calibration and discrimination performance in predicting 30 day mortality following CABG surgery in Cipto Mangunkusumo Hospital."

"Background: Community acquired pneumonia (CAP) in the elderly is still a major problem due to its high morbidity and mortality. There is considerable variability in ?the result of various studies on prognostic factors. The prognostic factors in Indonesia have not been identified.Methods: We performed a prospective cohort study on 147 elderly patients hospitalized with CAP in the internal medicine ward of Cipto Mangunkusumo National Central General Hospital, Jakarta from September 2002 to March 2003. We calculated the survival rate during hospitalize-tion. We used Cox proportional-hazard regression analysis to examine factors associated with mortality in the first 48 hours of hospitalization. .Results: There were 34 deaths (23.1) associated with CAP in 1471 person-days. The survival rate at day 5, 10 and 15 were 88.9%, 77.2 and 67.2% respectively. Severe. pneumonia, an serum albumin of d"3.5 g/dL, reducedconsciousness, temperature > 37.0"C, and a hemoglobin level of d" 9.0 g/dL demonstrated a tendency towards increased mortality rate. Other factors such as age, sex, immobilization, swollen disorders, co-morbidities, leukocyte count, and serum creatinine level demonstrated no significant relationship with mortality.Conclusion: Severe pneumonia, low serum albumin, decreased consciousness, high temperature and low hemoglobin level in the first 48 hours hospitalization were found to be worse prognostic factors. Early identification and modification of these factors are recommended."

"Latar Belakang: Kegagalan ekstubasi akibat pneumonia berat meningkatkan morbiditas dan mortalitas. Imunitas adaptif sistemik berupa fraksi dan rasio sel T limfosit CD4/CD8 darah memiliki peranan penting sebagai prediktor lemah mortalitas. Dibutuhkan studi lanjutan untuk mengetahui imunitas adaptif lokal melalui Bronchoalveolar Lavage (BAL) pada kedua paru.Tujuan: Mengetahui perbedaan kadar dan rasio sel T limfosit CD4/CD8 Bronchoalveolar Lavage sesuai status ekstubasi dan status mortalitas pada pneumonia berat.Metode: Penelitian ini menggunakan desain kohort prospektif pada 40 pasien pneumonia berat. Data primer diambil dari pasien yang terintubasi dan menjalani tindakan bronkoskopi di perawatan IGD dan ruang intensif RSCM sejak November 2020 hingga Januari 2021. Analisa univariat dan bivariat dengan uji beda rerata digunakan pada data skala numerik dengan sebaran normal dan uji Mann Whitney dengan sebaran tidak normal. Hasil: Proporsi gagal ekstubasi sebesar 80% dan proporsi mortalitas sebesar 75%. Terdapat perbedaan bermakna pada fraksi sel T limfosit CD4 BAL pada paru cidera berat kelompok berhasil ekstubasi dan gagal ekstubasi (p=0,006); kelompok pasien hidup dan meninggal (p=0,002). Fraksi CD4 darah dan rasio CD4/CD8 darah ditemukan lebih tinggi secara bermakna pada kelompok berhasil ekstubasi dibandingkan dengan gagal ekstubasi; juga ditemukan lebih tinggi pada kelompok yang hidup dibandingkan yang meninggal.Kesimpulan: Fraksi CD4 BAL pada paru cidera berat berbeda secara statistik bermakna lebih tinggi pada kelompok pasien berhasil ekstubasi dibandingkan dengan kelompok pasien gagal ekstubasi dan kelompok pasien hidup dibandingkan dengan kelompok pasien meninggal.

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Background: Extubation failure due to severe pneumonia increases morbidity and mortality. Systemic adaptive immunity, T lymphocyte cells CD4/CD8 in blood, has special role as a mortality predictor in severe pneumonia. Further study still needed to evaluate local adaptive immunity through bronchoalveolar lavage celluler examination in both lung.

Objective: The aim of this study was to find out the differences between T lymphocytes CD4/CD8 in both lung based on extubation status and mortality status.

Methods: We performed a cohort prospective study of 40 patients with severe pneumonia whom underwent endotracheal intubation and bronchoscopy hospitalized in intensive care unit between November 2020 to January 2021 in Dr. Cipto Mangunkusumo National General Hospital. Primary data was taken and analyzed using univariat and bivariat to investigate mean or median differences with unpaired t-test for normal numeric distribution data and Mann-Whitney test for abnormal distribution numeric data.

Result: The proportion of extubation failure was 80% and mortality rate was 75%. There were significantly different results of BALF CD4 T cells lymphocyte fraction in severe pneumonia group of patients based on extubation status (p=0,006) and mortality status (p=0,002). Blood CD4 T cells lymphocyte fraction and blood CD4/CD8 T cells lymphocyte ratio were found significantly higher in the successfully extubation group of patients compared to extubation failure group of patients; and also significantly higher in survived group of patients compared to mortality group of patients with pneumonia severe.

Conclusion: Fraction of CD4 BALF in severely injured pneumonia lungs group of patients who had succesful intubation processes were statistically different compared to the group of patients with unsuccesful extubation. Fraction of CD4 BALF were also found statistically different in the group of patients who were survived compared to the group of patients who were passed away."

"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."