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"Tetralogy of Fallot (TOF) merupakan salah satu kelainan jantung kongenital sianotik paling umum, dengan insiden sekitar empat dari setiap 10.000 kelahiran hidup. Operasi koreksi TOF dapat diperberat dengan cedera ginjal akut yang berkaitan dengan morbiditas dan mortalitas yang signifikan. Prevalensi cedera ginjal akut pada populasi pasien pascaoperasi koreksi TOF belum banyak diketahui. Penelitian ini menggunakan metode kohort restrospektif. Data diambil secara sekunder dari rekam medis RSPJNHK terhadap semua pasien TOF yang di lakukan koreksi TOF pada tahun 2019 -2023.Terdapat 520 pasien yang dianalisis dalam penelitian ini. Terdapat hubungan bermakna antara kelompok cedera ginjal akut dan kelompok tidak cedera ginjal akut pada variabel lama CPB (p=0.000; MD =-35.78; IK 95% -51.21 - -20.35) dan lama klem silang aorta (p=0.000;MD =-13.68(IK 95% -21.42 - -5.94). Terdapat hubungan bermakna secara antara lesi residual pulmonary regurgitation (p=0.024; RR=1.56; IK 95% 1.07 – 2.28, dan lesi residual pulmonary stenosis dan kejadian cedera ginjal akut (p=0.035; RR =1.49; IK 95% 1.03 – 2.15). Dapat disimpulkan bahwa lama CPB, klem silang aorta dan adanya lesi residual yakni pulmonary regurgitation dan pulmonary stenosis berhubungan dengan kejadian cedera ginjal akut pada pasien yang menjalani koreksi TOF.

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Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart defects, with an incidence of approximately four per 10,000 live births. Corrective surgery for TOF is often complicated by acute kidney injury (AKI), which is associated with significant morbidity and mortality. The prevalence of AKI in patients undergoing postoperative TOF correction is not well established. A retrospective cohort study was conducted using medical records from PJNHK Hospital. Data was collected for TOF patients who underwent corrective surgery between 2019 and 2023. A total of 520 patients were analysed. There was a significant difference between the AKI group and the non-AKI group in terms of cardiopulmonary bypass (CPB) duration (p = 0.000; MD = -35.78; 95% CI: -51.21 to -20.35) and aortic cross-clamp time (p = 0.000; MD = -13.68; 95% CI: -21.42 to -5.94). Residual pulmonary regurgitation lesions were significantly associated with AKI incidence (p = 0.024; RR = 1.56; 95% CI: 1.07–2.28), as were residual pulmonary stenosis lesions (p = 0.035; RR = 1.49; 95% CI: 1.03–2.15). In conclusion, CPB duration, aortic cross-clamp time, and the presence of residual lesions, such as pulmonary regurgitation and pulmonary stenosis, are significantly associated with the incidence of acute kidney injury in patients undergoing TOF corrective surgery."

"Latar Belakang: Gangguan ginjal akut sering terjadi pada penderita sirosis hati dan berhubungan dengan meningkatnya mortalitas. Model prediksi terjadinya gangguan ginjal akut yang dapat dihitung saat masuk perawatan diharapkan dapat mnemukan pasien yang memiliki resiko dehingga dapat dilakukan upaya mencegah terjadinya gangguan ginjal akut.Tujuan: Penelitian ini dilakukan untuk mengetahui hubungan antara perdarahan saluran cerna, riwayat parasintesis besar, skor MELD, sepsis, peritonitis bakterial spontan, kadar albumin serum, kadar hemoglobin dan rasio netrofil terhadap limfosit dengan terjadinya gangguan ginjal akut pada pasien sirosis hati dan membuat suatu model prediksi terjadinya gangguan ginjal akut pada pasien sirosis hati.Metode: : Analisis data dilakukan terhadap 209 pasien sirosis hari yang dirawat inap di RSUPN Cipto Mangunkusumo dari tanggal 1 January 2019 hingga 31 December 2019. Gangguan ginjal akut didefenisikan dengan terjadinya peningkatan kadar kreatinin serum ≥ 0.3 mg/dL dalam 48 perawatan.Hasil: Terdapat 45 pasien (21,5%) mengalami gangguan ginjal akut.. rasio netrofil terhadap limfosit (p<0.001), skor MELD (p<0.001) and kadar albumin serum (p<0.001) berhubungan dengan terjadinya gangguan ginjal akut. Rasio netrofil limfosi lebih dari 8 (nilai prediksi 2), kadar bilirubin total serum lebih dari 1,9 (nilai prediksi 2) dan kadar albumin serum kurang dari 3(nilai prediksi 1) merupakan nilai batas untuk prediksi. Skor prediksi ≥4 dapat menjadi prediktor terjadinya gangguan ginjal akut pada pasien sirosis hati dengan sensitifitas 97,3%.Simpulan: Rasio netrofil terhadap limfosit, skor MELD, kadar albumin serum berhubungan dengan terjadinya gangguan ginjal akut pada penderita sirosis hati yang dirawat inap.Suatu sistem skor dengan menggunakan rasio netrofil terhadap limfosit, kadar bilirubin total serum dan kadar albumin serum merupakan prediktor yang dapat digunakan untuk prediksi terjadinya gangguan ginjal akut ini.

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Background : Development of acute kidney injury (AKI) is common and is associated with poor outcomes. A risk prediction score combining values easily measured at admission could be valuable to stratify patients for prevention, monitoring and early intervention, ultimately improving patient care and outcomes.

Objective: This study aimed to determine association of gastrointestinal bleeding history, large paracentesis history, MELD score, sepsis, spontaneous bacterial peritonitis, serum albumin level, hemoglobin level and netrophyl lymphocyte ratio for development of acute kidney injury in cirrhosis patients and to know the prediction score for the development of AKI in hospitalized cirrhosis patients

Methods: A cross-examined the data from a retrospective analysis of 209 patients with cirrhosis admitted to the Cipto Mangunkusumo Hospital from January 2019 to December 2019. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL within 48 hours from baseline. A receiver operating characteristic (ROC) curve was produced to assess the discriminative ability of the variables. Cutoff values were defined as those with highest validity. The final AKI risk score model was assessed using the ROC curve.

Results: A total of 45 patients (21,5%) developed AKI. Higher NLR (p<0.001), Model of End-stage Liver Disease (MELD) (p<0.001) and lower serum albumin level (p<0.001) were independently associated with AKI. Finding the prediction score of acute kidney injury, cut off values with the highest validity for predicting AKI were determined and defined as 8 for the neutrophil lymphocyte ratio, 1,9 for total bilirubine serum and 3 for serum albumin level. The risk score was created allowing 2 points if the netrophyl lymphocyte ratio is higher than 8, 2 point if the serum total bilirubine is higher than 1,9 and 1 point if the serum albumin is lower than 3. The AUROC curve of the risk prediction score for AKI was 0.842. A risk score of ≥4 points predicts AKI in cirrhotic patients with a sensitivity of 97,3%.

Conclusions: The netrophyl lymphocyte ratio, MELD score and albumin level are associated with the development of AKI in hospitalized cirrhosis patients. A score combining netrophyl lymphocyte ratio, serum bilirubin and albumin level demonstrated a strong discriminative ability to predict AKI in hospitalized cirrhotic patients"

"Latar Belakang : Kejadian AKI di unit perawatan intensif berhubungan dengan peningkatan mortalitas, morbiditas pasca AKI dan biaya perawatan tinggi. Penelitian mengenai faktor-faktor yang berhubungan dengan mortalitas pasien AKI di unit perawatan intensif di Indonesia khususnya RSUPN dr. Cipto Mangungkusumo belum pernah dilakukan.Tujuan: Mengetahui prevalensi AKI, angka mortalitas pasien AKI, dan faktor- faktor yang berhubungan dengan peningkatan mortalitas pasien AKI di unit perawatan intensif di ICU RSUPN dr. Cipto Mangunkusumo.Metode : Penelitian kohort retrospektif terhadap seluruh AKI di unit perawatan intensif di RSUPN Cipto Mangunkusumo periode Januari 2015 ndash; Desember 2016. Dilakukan analisis hubungan bivariat saampai dengan multvariat dengan STATA Statistics 15.0 antara faktor usia >60 tahun, sepsis, ventilator, durasi ventilator, dialisis, oligoanuria, dan skor APACHE II saat admisi dengan mortalitas. Hasil : Prevalensi pasien AKI di unit perawatan intensif didapatkan 12,25 675 dari 5511 subjek dan sebanyak 220 subjek 32,59 dari 675 subjek yang dianalisis meninggal di unit perawatan intensif. Faktor-faktor yang berhubungan dengan peningkatan mortalitas pada analisis multivariat adalah sepsis OR 6,174; IK95 3,116-12,233 , oligoanuria OR 4,173; IK95 2,104-8,274 , ventilator OR 3,085; IK95 1,348-7,057 , skor APACHE II saat admisi 1/2 [OR 1,597; IK95 1,154-2,209], dan durasi ventilator OR 1,062; IK95 1,012-1,114 . Simpulan : Prevalensi pasien AKI dan angka mortalitasnya di unit perawatan intensif RSUPN dr. Cipto Mangunkusumo didapatkan sebesar 12,25 dan 32,59 . Sepsis, oligoanuria, ventilator, skor APACHE II saat admisi 1/2, dan durasi ventilator merupakan faktor-faktor yang berhubungan bermakna dengan peningkatan mortalitas pasien AKI di unit perawatan intensif. Kata Kunci : Acute Kidney Injury, Faktor Risiko, Mortalitas, Unit Perawatan Intensif

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Background Acute kidney Injury AKI in ICU associated with increased mortality rate, morbidity post AKI, and high health care cost. There is no previous study about factors associated with mortality of AKI patients in ICU in Indonesia, especially at dr. Cipto Mangunkusumo National Central General Hospital.Aim To identify prevalence, mortality rate, and factors associated with mortality of AKI patients in ICU.Method This is a retrospective cohort study. Data were obtained from all of medical records of AKI patients period January 2015 until December 2016 in ICU at Cipto Mangunkusumo hospital. Association of risk factors age 60 years old, sepsis, ventilator, duration of ventilator, oligoanuria, and APACHE II score at admission and mortality will be analyzed using STATA Statistics 15.0. Results AKI prevalence in ICU was 12,25 675 subjects from total 5511 subjects . A total of 220 subjects out of 675 subjects AKI died at ICU. Sepsis OR 6,174 95 CI 3,116 12,233 , oligoanuria OR 4,173 95 CI 2,104 8,274 , ventilator OR 3,085 95 CI 1,348 7,057 , APACHE II score at admission 1 2 OR 1,597 95 CI 1,154 2,209 , and duration of ventilator OR 1,062 95 CI 1,012 1,114 . were significant factors associated with mortality of AKI patients in ICU. Conclusion AKI prevalence and mortality rate in ICU at dr. Cipto Mangunkusumo National Central General Hospital were 12,25 and 32,59 . Sepsis, oligoanuria, ventilator, APACHE II score at admission 1 2, and duration of ventilator were significant factors associated with mortality of AKI patients in ICU. Keywords Acute Kidney Injury, Intensive Care Unit, Mortality, Risk Factor "

"Latar Belakang : Insiden Acute Kidney Injury (AKI) pada pasien coronavirus disease 2019 (COVID-19) yang dirawat di Intensive Care Unit (ICU) yang dilaporkan dari berbagai penelitian adalah 23% sampai dengan 81% dengan mortalitas yang makin tinggi dengan semakin tingginya serum kreatinin. Terdapat perbedaan komorbiditas yang mendasari populasi yang diperiksa, serta variasi dalam praktik dan metode diagnosis dan pelaporan AKI. Evaluasi dini pemantauan fungsi hati, ginjal, serta parameter hematologi, sangat penting untuk memprediksi perkembangan COVID-19. Berdasarkan hal diatas perlu diketahui variabel apa yang dapat mempengaruhi terjadinya AKI.Tujuan : Tujuan penelitian ini adalah menganalisis insiden AKI pada pasien COVID-19 yang dirawat di ICU RSCM dan menganalisis pengaruh umur, jenis kelamin, komorbid, kreatinin, ureum, trombosit, leukosit, nilai Neutrophil Lymphocyte Ratio (NLR), C- Reactive Protein (CRP), obat vasoaktif dan obat nefrotoksik terhadap angka kejadian AKI pada pasien COVID-19 yang dirawat di ICU RSCM.Metode : Penelitian ini merupakan studi observasional retrospektif dengan desain case control study. Data yang digunakan adalah data sekunder dari rekam medis pasien COVID-19 yang dirawat di ICU RSCM. Kriteria penerimaan adalah pasien dengan usia≥ 18 tahun dan terkonfirmasi COVID-19 dengan RT-PCR positif. Kriteria penolakan adalah pasien dengan riwayat transplantasi ginjal, dan pasien Chronic Kidney Disease (CKD) gagal ginjal yang menjalani dialisis. Kriteria pengeluaran adalah pasien dengan data rekam medis yang tidak lengkap.Hasil : Dari 370 pasien yang terkonfirmasi COVID-19 yang dirawat di ICU RSCM, 152 pasien memenuhi kriteria inklusi dari 148 subjek yang direncanakan. Hasil analisis bivariat didapatkan usia, komorbid, ureum, kreatinin dan obat vasoaktif mempunyai perbedaan bermakna terhadap angka kejadian AKI. Setelah dilakukan analisis multivariat regresi logistik didapatkan komorbid (odd ratio 2,917; 95 % confidence interval, 1,377 – 6,179; p value 0,005) dan obat vasoaktif (odd ratio 2,635; 1,226 – 5,667, p value 0,013) merupakan faktor prediktor AKI pada pasien COVID-19 yang dirawat di ICU RSUPN dr. Cipto Mangunkusumo Jakarta.Kesimpulan : Insiden AKI pada pasien COVID-19 yang dirawat di ICU RSUPN Dr. Cipto Mangunkusumo Jakarta adalah 30,9%. Komorbid dan obat vasoaktif merupakan faktor prediktor AKI pada pasien COVID-19 yang dirawat di ICU RSUPN dr Cipto Mangunkusumo Jakarta.

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Background: The incidence of Acute Kidney Injury (AKI) in COVID-19 patients treated in the Intensive Care Unit (ICU) reported from various studies is 23% to 81%, with higher mortality with higher serum creatinine. There are differences in the underlying comorbidities of the populations examined, as well as variations in practice and methods of diagnosing and reporting AKI. Early evaluation and monitoring of liver and kidney function, as well as hematological parameters, is very important to predict the development of COVID-19. By examining the predictor factors for the incidence of AKI in COVID-19 patients treated in the RSCM ICU, were there any predictor factors that were different from previous studies.

Purpose: The aim of this study was to analyze the incidence of AKI in COVID-19 patients treated at the RSCM ICU and to analyze the effect of age, gender, comorbidities, creatinine, urea, platelets, leukocytes, Neutrophil Lymphocyte Ratio (NLR), CRP, vasoactive drugs, and nephrotoxic drugs on the incidence of AKI in COVID-19 patients treated in the RSCM ICU.

Methods: This research is a retrospective observational study with a case-control study design. The data to be used is secondary data from the medical records of COVID-19 patients treated in the RSCM ICU. The acceptance criteria are patients aged ≥ 18 years and confirmed COVID-19 by positive RT-PCR. The criteria for rejection were patients with a history of kidney transplantation, and CKD patients undergoing dialysis. The exclusion criteria were patients with incomplete medical record data.

Results: Of the 370 patients with confirmed COVID-19 who were treated at the RSCM ICU, 152 patients met the inclusion criteria of the 148 planned subjects. The results of bivariate analysis showed that age, comorbidities, urea, creatinine, and vasoactive drugs had significant differences in the incidence of AKI. After multivariate logistic regression analysis, we found comorbid (OR 2.917; 95% CI, 1.377 – 6.179; p value 0.005) and vasoactive drugs (OR 2.635; 1.226 – 5.667, p value 0.013) is a predictor factor for AKI in COVID-19 patients treated at the ICU RSUPN Dr. Cipto Mangunkusumo Jakarta.

Conclusion: Incidence of AKI in COVID-19 patients treated at ICU RSUPN Dr. Cipto Mangunkusumo Jakarta is 30.9%. Co-morbidities and vasoactive drugs are predictors of AKI in COVID-19 patients treated at the ICU RSUPN Dr. Cipto Mangunkusumo Jakarta."

"Latar belakang: Peningkatan pada hemoglobin (Hb) dan hematokrit (Ht) pada anak dengan penyakit jantung bawaan sianosis. Kondisi ini menyebabkan perubahan hemodinamik dan koagulasi yang dapat meningkatkan mortalitas dan morbiditas pasien. Operasi reparasi Tetralogy of Fallot (TOF) di Indonesia seringkali terlambat sehingga pasien menderita hipoksemia kronis. Penelitian ini bertujuan untuk mengetahui hubungan kadar Hb dan Ht pada luaran hasil operasi reparasi TOF serta mengetahui titik potong Hb dan Ht yang optimal untuk menghindari morbiditas dan mortalitas pascaoperasi. Metode: Dilakukan suatu studi retrospektif kohort pada pasien yang menjalani operasi reparasi TOF di Pusat Jantung Nasional Harapan Kita dalam periode 1 Januari 2015 hingga 30 Juni 2020. Analisis statistik dilakukan pada kadar Hb dan Ht praoperasi TOF dengan luaran mortalitas, kejadian perdarahan, transfusi darah, reoperasi, dan defisit neurologis pascaoperasi untuk menilai titik potong Hb dan Ht optimal serta pengaruh pada masing-masing luaran operasi tersebut.Hasil: Sebanyak 806 pasien dilibatkan sebagai sampel penelitian dengan median usia 53 bulan dan SpO2 80%. Terdapat pengaruh bermakna usia, berat badan, dan SpO2 terhadap Hb dan Ht (p<0,05). Terjadinya peningkatan risiko perawatan >72 jam sebesar 1,5 kali lipat pada Hb yang tinggi serta risiko sebesar 1,6 kali lipat pada Ht yang tinggi. Terdapat peningkatan risiko perdarahan pascaoperasi >10mL/Kg sebesar 4,6 kali lipat pada Hb yang tinggi serta peningkatan risiko sebesar 5,4 kali lipat pada Ht yang tinggi. Tidak terdapat pengaruh bermakna Hb dan Ht terhadap kematian intraperawatan, kejadian reoperasi, dan defisit neurologis pascaoperasi. Diperoleh titik potong (nilai optimal) Hb 16,75 gr/dL dan Ht 51,20% dengan kemampuan prediktor yang cukup baik (AUC Hb = 0,71; AUC Ht = 0,72).Simpulan: Peningkatan hemoglobin dan hematokrit secara bermakna mempengaruhi durasi ICU, perdarahan pascaoperasi, dan banyaknya transfusi pascaoperasi. Untuk praoperasi TOF, diperoleh kadar optimal Hb di bawah 16,75gr/dL dan Ht di bawah 51,20%.

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Introduction: Increase of hemoglobin (Hb) and hematocrit (Ht) occurs in children with cyanotic heart disease. These conditions will lead some hemodynamic and coagulation changes that can increase patient mortality and morbidity. Tetralogy of Fallot (TOF) repair surgery in Indonesia mostly in late condition, where the patient suffers from chronic hypoxemia. Aim of this study are to determine the impact of high Hb and Ht on TOF repair surgery outcome as well as to determine the optimal value of Hb and Ht to avoid postoperative morbidity and mortality.

Method: A retrospective cohort study was conducted on patients undergoing TOF repair surgery Pusat Jantung Nasional Harapan Kita from January 1, 2015 until June 30, 2020. Statistical analysis was carried out on the preoperative TOF Hb and Ht levels with mortality, bleeding incidence, blood transfusion, reoperation, and postoperative neurological deficits to find the optimal Hb and Ht cutoff point and the effect on each of these operative outcomes.

Results: A total of 806 patients were included in the study sample with median age of 53 months and an SpO2 of 80%. There was a significant effect of age, body weight, and SpO2 on Hb and Ht (p <0.05). There was an increased risk of treatment > 72 hours by 1.5 times for high Hb and a risk of 1.6 times for high Ht. There an increased risk of postoperative bleeding> 10mL / Kg by 4.6 times in high Hb and an increased risk of 5.4 times in high Ht. Transfusions> 15mL / Kg were found to increase by 1.5 times at high Hb levels and 1.7 times at high Ht levels. There was no significant effect of Hb and Ht on inhospital mortality, reoperative incidence, and postoperative neurological deficits. The cut points obtained in this study were Hb 16.75 gr / dL and Ht 51.20% with a fairly good predictor ability (AUC Hb = 0.71; AUC Ht = 0.72) on postoperative bleeding.

Conclusion: High hemoglobin and hematocrit is significantly affected the ICU duration, postoperative bleeding, and the number of transfusions. The cut-off point taken from the relationship between hemoglobin and hematocrit on postoperative bleeding has a fairly good predictor ability. Optimal hemoglobin is below 16.75 gr/dL and optimal hematocrit is below 51.20%."

"Penyakit Jantung Bawaaan (PJB) Tetralogy of Fallot (TOF) merupakan PJB sianotik (biru) terbanyak. Tatalaksana definitif operasi sedini mungkin. Hampir semua pembiayaan menggunakan BPJS Kesehatan berdasarkan tarif INA-CBG. Adanya selisih negatif tarif INA-CBG tahun 2016 dengan tagihan perawatan operasi TOF menyebabkan banyak rumah sakit tidak mengoperasi dan merujuk ke RSJPD Harapan Kita. Dengan adanya tarif INA-CBG terbaru tahun 2023 yang mengalami kenaikan, diperlukan penelitian apakah terdapat selisih negatif. Perlu dianalisa faktor yang berhubungan dengan tagihan perawatan serta kepatuhan Clinical Pathway (CP) TOF. Penelitian observasional deskriptif cross sectional mengambil sampel pasien perawatan operasi total koreksi TOF tahun 2022 sejumlah 82 pasien. Hasil penelitian didapatkan sebagian besar usia ≥1 tahun, perempuan, status gizi normal, ada diagnosa sekunder, severitas PPK I (ringan) dan INA-CBG II (sedang), tidak ada komplikasi, kelas III, median lama CPB 103,5 menit dan AoX 55 menit, lama rawat post operasi 6 hari dan total 8 hari. Faktor yang berhubungan dengan tagihan perawatan adalah komplikasi, kelas rawat dan lama rawat CP. Hal yang belum sesuai dengan CP TOF yaitu lama rawat, pemeriksaan laboratorium, radiologi, pemakaian obat, alkes dan BMHP. Masih terdapat selisih negatif antara total tagihan perawatan pasien operasi total koreksi TOF tahun 2022 dengan total tarif INA-CBG terbaru tahun 2023.

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Tetralogy of Fallot (TOF) is the most common cyanotic Congenital Heart Disease (CHD). Definitive management is surgery earliest as possible. Almost all financing uses BPJS Kesehatan based on INA-CBG rate. Negative difference between the 2016 INA-CBG rates and TOF surgery treatment bill make many hospitals not operating and refering to Harapan Kita Hospital. With increasing in the latest 2023 INA-CBG rates, research for negative difference is needed. Analyzing factors related to care bills and adherence to TOF Clinical Pathway (CP) is studied too. This cross-sectional descriptive observational study took a sample of 82 patients undergoing TOF total  correction in 2022. Results showed that most were aged ≥1 year, female, normal nutritional status, had secondary diagnoses, severity of PPK I (mild) and INA-CBG II (moderate), no complications, class III, median duration of CPB 103.5 minutes and AoX 55 minutes, length of postoperative care 6 days and total of 8 days. Factors related to treatment bills are complications, class of care and CP length of care. Things not in accordance with the TOF CP are length of stay, laboratory, radiology, drug, medical equipment and BMHP use. There is still negative difference between the 2022 TOF total correction treatment patient bills and the latest 2023 INA-CBG rate."

"Latar belakang: Gagal ginjal akut (GGA) menjadi salah satu komplikasi serius yang dapat terjadi setelah prosedur bedah pintas arteri koroner (BPAK). GGA paskaoperasi jantung secara independen berhubungan dengan peningkatan 3-8 kali lipat angka morbiditas dan mortalitas serta memperpanjang durasi perawatan (hospitalisasi) sehingga dapat meningkatkan biaya kesehatan. Untuk menurunkan insidensi GGA ini, dibutuhkan modalitas pemeriksaan sebelum operasi yang berhubungan dengan kejadian GGA paska BPAK sehingga dapat digunakan sebagai prediktor nantinya untuk tindakan pencegahan. Indeks resistif renal (IRR) diketahui dapat menggambarkan kondisi resistensi dan komplians pembuluh darah yang berhubungan dengan patofisiologi GGA paska BPAK. Namun hingga saat ini belum ada penelitian yang menilai hubungan langsung antara nilai IRR dan kejadian GGA paska BPAK. Tujuan: Mengetahui hubungan nilai IRR terhadap kejadian GGA paska BPAK Metode: Pasien yang akan dilakukan prosedur BPAK akan menjalani pemeriksaan dupleks renalis untuk mendapatkan nilai IRR. Luaran gagal ginjal akut dinilai dengan pemeriksaan kadar kreatinin darah selama 48 jam paska BPAK Hasil: Terdapat 96 pasien yang menjadi subjek penelitian. Median nilai IRR pada subjek penelitian ini ialah 0.71 (0.57-0.87). Terdapat perbedaan median nilai IRR antara kelompok GGA dan non GGA (0.73, rentang 0.57-0.87 dan 0.65, rentang 0.58-0.72). Nilai IRR memiliki korelasi yang cukup baik terhadap kejadian GGA paska BPAK (nilai koefisien korelasi r = 0.66, p < 0,001) dengan titik potong padanilai IRR 0.685 (sensitivitas 82.40%, spesifisitas 73.30%). Faktor-faktor lain seperti usia, diabetes melitus, hipertensi, nilai kreatinin serum pre operatif, klirens kreatinin pre operatif, fraksi ejeksi, durasi mesin pintas kardiopulmonal dan durasi klem silang aorta secara statistika berbeda bermakna berhubungan terhadap kejadian GGA paska BPAK. Namun dari analisis multivariat, hanya faktor fraksi ejeksi, durasi mesin pintas kardiopulmonal, nilai IRR, dan diabetes mellitus terbukti bermakna Kesimpulan: Terdapat hubungan antara IRR dengan kejadian gagal ginjal akut paska BPAK. Nilai IRR 0.685 merupakan titik potong optimal (sensitivitas 82,40% dan spesifisitas 73.30%)

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Background: Acute kidney injury (AKI) still become one of the serious complications that can occur after a coronary artery bypass graft (CABG) procedure. Post-operative AKI is independently associated with a 3-8 fold increase in morbidity and mortality and extending the duration of treatment (hospitalization) thereby increasing health costs. To reduce the incidence of AKI, a modality of examination prior surgery which is related to the incidence of post-operative AKI is needed so that it can be used as a predictor later for preventive action. The renal resistive index (RRI) is known to be able to describe the condition of resistance and vascular compliance which are related to the pathophysiology of post-operative AKI. However, there has been no research that assesses the direct relationship between RRI values and the incidence of post-operative AKI Objectives: To investigate the relationship between RRI value and incidence of post-operative AKI in patients underwent CABG procedure. Methods: CABG candidates patients will undergo duplex renalis examination to obtain an RRI score. Outcome of renal impairment was assessed by blood creatinine examination within 48 hours after CABG procedure. Results: There were 96 patients who became the subject of the study. The median of RRI value in this study subjects was 0.71 (0.57-0.87). There were differences in median of RRI values between groups with post-operative AKI and those not (0.73, range 0.57-0.87 dan 0.65, range 0.58-0.72). There was quite good correlation between RRI and post-operative AKI (p < 0.001 with correlation coefficient r = 0.66) with cut off point of IRR value was 0.685 (sensitivity 82.40%, specificity 73.30%). Other factors such as age, diabetes mellitus, hypertension, ejection fraction, CPB duration, and aortic cross clamp duration are associated with incidence of post-operative AKI. However, multivariat analysis showed only ejection fraction, cardiopulmonary bypass duration, RRI, and diabetes mellitus significantly related to post-operative AKI Conclusion: RRI values has relationship with post-operative AKI. The optimal cut off value of RRI retrieved by this study is 0.685 (sensitivity 82.40%, specificity 73.30%)"

"Latar Belakang: Acute Kidney Injury pada COVID-19 merupakan komplikasi penting dan dikaitkan dengan peningkatan risiko kematian diduga diperantarai kondisi inflamasi dan disregulasi imun, baik di awal maupun selama perawatan. Tujuan: Untuk mengetahui hubungan antara IL-6, IL-10, TNF-" dengan AKI dan memprediksi perburukan hematuria, dan kejadian AKI Metode: Studi potong lintang dan prospektif kohort melibatkan 43 pasien COVID-19 derajad sedang dan berat yang dirawat di Rumah Sakit Pertamina Pusat di Jakarta, Indonesia dari bulan November 2020 hingga Januari 2021. Selama observasi dilakukan pemeriksaan darah lengkap, serum kreatinin, urinalisis, kadar IL-6, IL-10, TNF-" pada hari pertama dan hari ketujuh pengobatan atau sebelum hari ketujuh jika pasien meninggal atau dipulangkan, dan perubahannya di analisis. Insiden AKI ditentukan ketika perubahan serum kreatinin dan urin output memenuhi kriteria pedoman Kidney Disease Improving Global Outcomes. Uji korelasi dilakukan terhadap peningkatan sitokin dengan perubahan hematuria dan kreatinin. Uji Wilcoxon dilakukan untuk mengetahui perbedaan kadar sitokin diantara status albuminuria. Selanjutnya dilakukan uji Receiver Operator Characteristic untuk melihat kemampuan prediksi IL-6, IL-10, TNF-" terhadap perburukan hematuria dan kejadian AKI, menggunakan AUC minimal 0,7 dengan batas bawah IK 95% lebih dari 0,5 dan nilai p <0,05 Hasil: Terdapat korelasi antara peningkatan kadar serum IL-10 dengan perubahan serum kreatinin (r= -0,343; p 0,024) tetapi tidak pada perubahan IL-6 dan TNF-a. Perubahan hematuria tidak berkorelasi dengan peningkatan ketiga kadar sitokin. Juga tidak ada perbedaan dalam kadar sitokin di antara kelompok albuminuria. Kadar serum TNF-" dihari pertama perawatan dapat memprediksi AKI pada hari ke tujuh, AUC 85%; p=0,045 (IK 0,737-0,963), tetapi tidak dapat memprediksi perburukan hematuria Kesimpulan: Terdapat korelasi antara peningkatan IL-10 dengan perubahan serum kreatinin. TNF-! pada hari pertama perawatan dapat memprediksi kejadian AKI di hari ketujuh perawatan pasien COVID-19 derajat sedang dan berat.

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Background: Acute Kidney Injury is an important complication and is associated with increased risk of death in COVID-19 due to inflammatory conditions and immune dysregulation, both at the beginning and during treatment. Aim: To determine the relationship between IL-6, IL-10, TNF-α with AKI and their ability to predict the worsening of hematuria, and the incidence of AKI. Methods: 43 moderate and severe COVID-19 patients treated from November 2020 to January 2021 at Pertamina Central Hospital in Jakarta, Indonesia were included in this cross-sectional and prospective cohort study. During observation, tests including complete blood count, serum creatinine, urinalysis, levels of IL-6, IL-10 and TNF-α were performed on the first and seventh day of treatment, or before day 7 if the patient died or was discharged, and the changes were analyzed. The incidence of AKI is determined when changes in serum creatinine and urine output meet the criteria in the Kidney Disease Improving Global Outcomes guidelines. Correlation test was performed on increased cytokines with changes in hematuria and creatinine. Wilcoxon test was performed to obtain differences in cytokine levels among albuminuria status. Receiver Operator Characteristic test was then carried out to see the predictive ability of IL-6, IL-10, TNF- α on the worsening of hematuria and the incidence of AKI. Results: There was a correlation between increased serum IL-10 levels with changes in serum creatinine (r= -0.343; p 0.024), but not in IL-6 and TNF-a levels. On the other hand, changes in hematuria did not correlate with an increase in the levels of the three cytokines. There was also no significant difference in the levels of cytokines among albuminuria groups. Serum TNF-! levels on the first day of treatment were able to predict AKI on the seventh day (AUC 85%; p=0.045; 95%CI 0.737-0.963), but did not predict the worsening of hematuria. Conclusion: There was a correlation between increased serum IL-10 with changes in serum creatinine. TNF-! on the first day of treatment can predict the incidence of AKI on the seventh day of treatment for moderate and severe COVID-19 patients."

"Kejadian yang berhubungan dengan reaksi obat sangat sulit dikenali, karena seringkali tampak seperti penyakit lain dan banyak gejala reaksi obat yang muncul, terutama untuk paparan obat yang singkat. AKI adalah salah satu dari kondisi yang mempengaruhi struktur dan fungsi ginjal, keadaan ini ditandai dengan penurunan fungsi ginjal secara tiba-tiba yang menyebabkan nekrosis pada tubulus, pedoman Kidney Disease Improving Global Outcomes (KDIGO) 2012. Di Indonesia, perawatan penyakit ginjal merupakan ranking kedua pembiayaan terbesar dari BPJS kesehatan setelah penyakit jantung. Tujuan penelitian ini mengetahui prevalensi kejadian D-AKI dan menentukan faktor risiko utama serta data obat-obatan yang dapat mempengaruhi peningkatan kadar kreatinin serum selama dirawat. Dalam penelitian ini, metode penelitian yang digunakan observasional retrospektif dengan menggunakan desain cross sectional. Tempat pengambilan sampel berada dibagian Rekam Medis RSPAD Gatot Soebroto. Data pasien rawat inap yang diambil periode Januari – Desember 2021 dicatat berdasarkan kriteria inklusi dan eksklusi. Jumlah sampel yang diambil sebanyak 56 orang pasien yang diidentifikasi dengan menggunakan kriteria Kidney Disease Improving Global Outcomes (KDIGO) dan menggunakan trigger tool, pengambilan sampel ditentukan dengan simple random sampling. Izin Ethical Approval diperoleh dari tim kaji etik RSPAD Gatot Soebroto dan informasi pasien dikumpulkan atas izin Kepala RSPAD Gatot Soebroto. Prevalensi angka kejadian D-AKI diruang rawat inap RSPAD Gatot Soebroto adalah 82,1%. Faktor-faktor terjadinya DAKI di ruang rawat inap adalah Interaksi obat nefrotoksik (OR = 8,926, 95% CI: 1,557-51,179 p value = 0,014) dan Lama penggunaan obat >=7 hari (OR = 5,303, 95% CI: 1,057-177,26,62) p value = 0,043. Secara umum obat nefrotoksik yang paling banyak digunakan adalah kombinasi obat nefrotoksik > 3 macam, obat diuretik, NSAID, Sefalosporin, ARB, ACEi dan obat kemoterapi. Dalam penelitian ini terdapat hubungan antara pemakaian obat nefrotoksik dengan faktor-faktor risiko yang dialami pasien di ruang rawat inap RSPAD Gatot Soebroto, dengan nilai p value ≤ 0,05. Dimana faktor-faktor yang diketahui sangat mempengaruhi secara sifnifikan.

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Events related to drug reactions are very difficult to identify, because they often look like other diseases and many symptoms of drug reactions occur, especially for short drug exposures. AKI is one of the conditions that affect the structure and function of the kidney, this condition is characterized by a sudden decrease in kidney function that causes necrosis of the tubules, the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guideline. In Indonesia, kidney disease treatment is ranked second the largest financing from BPJS health after heart disease. Analyzing the prevalence of D-AKI and determining the main risk factors and drug data that can affect the increase in serum creatinine levels during hospitalization. The research method used was retrospective observation using a cross sectional design. The sampling location is in the Medical Record section of the Gatot Soebroto Army Hospital. Inpatient data for the period January – December 2021, recorded based on inclusion and exclusion criteria. The number of samples is 56 patients who were identified using the criteria of Kidney Disease Improving Global Outcomes (KDIGO) and using trigger tool, sampling with simple random sampling. Ethical approval permission was obtained from the ethics review team of Gatot Soebroto RSPAD and patient information was collected with the permission of the Head of Gatot Soebroto RSPAD. The prevalence of the incidence of D-AKI in the inpatient room of the Gatot Soebroto Hospital is 82,1%. The factors for the occurrence of DAKI in the inpatient ward were nephrotoxic drug interaction (OR = 8,926, 95% CI; 1,557-51,179) p Value =0,014 and duration of drug use > = 7 days (OR = 5,303, 95% CI: 1,057-177,26,62) p value = 0,043. In general, the most widely used nephrotoxic drugs are a combination of > 3 kinds of nephrotoxic drugs, diuretic drugs, NSAIDs, cephalosporins, ARBs, ACEi and chemotherapy drugs. In this study, there was a relationship between the use of nephrotoxic drugs and the risk factors experienced by patients in the inpatient room of the Gatot Soebroto Hospital, with a p value of 0.05. Where the factors that are known to have a significant influence. "

"AKI disebabkan oleh pengaruh gangguan sistemik atau lokal hemodinamik yang menyebabkan terjadinya stres atau kerusakan pada sel tubular yang dapat berlanjut menjadi gagal ginjal kronik. Pasien yang mengalami malnutrisi dengan peningkatan prevalensi kejadian AKI sebanyak 2,25 kali. Skrining pasien malnutrisi dilakukan dalam 24 hingga 48 jam pertama saat pasien masuk ke rumah sakit menggunakan alat skrining, salah satunya adalah NRS-2002. Penelitian menggunakan desain kohort prospektif pada subjek berusia ≥18 tahun yang dirawat di RSUPN dr. CIpto Mangunkusumo dan RSUI. Diperoleh 64 subjek dengan kelompok skor NRS-2002 ≥ 3 sebanyak 36 subjek dan kelompok skor NRS < 3 sebanyak 28 subjek. Jumlah pasien laki-laki sebanyak 40 (62,5%) subjek, dan perempuan sebanyak 24 (37,5%) subjek, dengan usia rerata 50,95 tahun. Berdasarkan indeks massa tubuh, kelompok IMT dengan malnutrisi adalah kelompok terbanyak dengan jumlah 21 (32,8%) subjek. Pasien dengan faktor risiko hipertensi sebanyak 18 (28,1%) subjek. Subjek dengan Skor NRS ≥ 3 didapatkan 36 subjek dengan 10 orang yang mengalami AKI. Subjek dengan skor NRS <3 didapatkan sebanyak 28 orang dengan 1 orang mengalami AKI. Hasil uji statistik menggunakan uji fischer’s exact test diperoleh nilai p 0,017 ( RR 7,78, CI 95% 1,06-57,20). Hal ini menyatakan bahwa didapatkan hubungan bermakna antara skor Nutritional Risk Screening – 2002 dengan kejadian acute kidney injury pada pasien sakit kritis

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AKI is caused by systemic or local hemodynamic disturbances that result in stress or damage to tubular cells, which can progress to chronic kidney failure. Patients experiencing malnutrition have a 2.25 times higher prevalence of AKI. Screening for malnutrition is conducted within the first 24 to 48 hours of hospital admission using screening tools such as the NRS-2002. This study used a prospective cohort design on subjects aged ≥18 years who were treated at RSUPN dr. Cipto Mangunkusumo and RSUI. A total of 64 subjects were obtained, with 36 subjects having an NRS-2002 score ≥ 3 and 28 subjects having an NRS score < 3. There were 40 male subjects (62.5%) and 24 female subjects (37.5%), with an average age of 50.95 years. Based on body mass index, the group with malnutrition was the largest group, with 21 subjects (32.8%). There were 18 subjects (28.1%) with hypertension as a risk factor. Subjects with an NRS score ≥ 3 included 36 subjects, with 10 of them experiencing AKI. Subjects with an NRS score <3 included 28 people, with 1 person experiencing AKI. The results of the statistical test using Fischer's exact test obtained a p-value of 0.017 (RR 7.78, CI 95% 1.06-57.20). This indicates a significant relationship between the Nutritional Risk Screening - 2002 score and the incidence of acute kidney injury in critically ill patients."