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Abstrak :
Latar belakang. Sepsis merupakan salah satu penyebab utama kematian anak di seluruh dunia. Penilaian SEPSIS-3 merekomendasikan sistem skoring SOFA sebagai alat untuk mendeteksi sepsis dan memrediksi kematian. Hingga saat ini masih digunakan PELOD-2 dalam mendeteksi sepsis dan memrediksi kematian walaupun sudah dikeluarkan adaptasi SOFA pada populasi anak berupa pSOFA. Tujuan. Mengetahui prevalensi sepsis anak di RSCM dan faktor yang berpengaruh terhadap kematian akibat sepsis berdasarkan skoring PELOD-2 dan pSOFA. Mengetahui sensitivitas, spesifisitas, positive predictive value, dan negative predictive value PELOD-2 dan pSOFA. Mengetahui batas nilai (cut-off) perubahan pSOFA dalam 7 hari perawatan sebagai prediktor mortalitas hari ke-28. Mengetahui sensitivitas, spesifisitas, positive predictive value, dan negative predictive value batas nilai (cut-off) perubahan pSOFA dalam 7 hari perawatan sebagai prediktor mortalitas ke-28 pada anak sepsis di PICU. Metode. Penelitian uji prognostik dengan desain kohort prospektif pada pasien anak yang dirawat di PICU RSCM Jakarta dengan diagnosis sepsis. Hasil. Prevalensi sepsis sebesar 20,4%. Dari 45 subyek penelitian, rerata usia adalah 73,24 bulan (SD 66,9). Status gizi yang paling banyak adalah status gizi buruk (35,6%) dan gizi kurang (28,9%). Sumber infeksi yang paling banyak adalah infeksi saluran pernapasan. Diagnosis saat masuk yang paling banyak adalah syok sepsis, pneumonia, COVID-19, dan gastroenteritis. Jumlah pasien yang meninggal adalah 15 subyek (33,3%). Kriteria skoring yang bermakna secara statistik (p<0,05) dalam memprediksi kematian adalah status gizi buruk, SpO2:FiO2, trombosit, blirubin dan penggunaan ventilasi invasif. Sensitivitas pSOFA lebih baik dibandingkan dengan PELOD-2 (93,75% vs. 25%), sedangkan spesifisitas PELOD-2 lebih baik dibandingkan dengan pSOFA (96,6% vs. 10,34%). Nilai batas (cut-off) perubahan pSOFA dalam 7 hari perawatan sebagai prediktor mortalitas hari ke-28 adalah 47,7%. Nilai cut-off 47,7% mempunyai sensitivitas 61,9%, spesifisitas 77,7%, nilai prediksi positif 81,2%, dan nilai prediksi negatif 46,6% dengan nilai RR 5,6875. Kesimpulan. Faktor yang berperan terhadap kematian akibat sepsis adalah PaO2:FiO2, SpO2:FiO2, kadar trombosit, kadar bilirubin, GCS, PaCO2, dan ventilasi invasive. Untuk mendiagnosis sepsis, PELOD-2 lebih baik dibandingkan pSOFA, sedangkan untuk menyaring (uji tapis) sepsis, pSOFA dinilai lebih unggul dan dapat melihat progresifitas penyakit. Nilai batas (cut off) perubahan pSOFA dalam 7 hari perawatan sebagai prediktor mortalitas hari ke-28 adalah 47,7% Nilai cut-off 47,7% mempunyai sensitivitas 61,9%, spesifisitas 77,7%, nilai prediksi positif 81,2%, dan nilai prediksi negatif 46,6% dengan nilai OR 5,6875. Background. Sepsis is one of the leading causes of childhood mortality worldwide. The SEPSIS-3 assessment recommends the SOFA scoring system as a tool for detecting sepsis and predicting mortality. Until now, PELOD-2 is still being used to detect sepsis and predict mortality even though pSOFA has been promoted as the pediatric adaptation of SOFA scoring.  Objectives. To determine the prevalence of sepsis in children at RSCM and the factors that influence mortality from sepsis based on PELOD-2 and pSOFA scoring. Determine the sensitivity, specificity, positive predictive value, and negative predictive value of PELOD-2 and pSOFA. Determine the cut-off value for pSOFA changes in 7 days as a predictor of mortality on day 28; and to determine the sensitivity, specificity, positive predictive value, and negative predictive value of this cut-off value as predictors of mortality in the 28th day of hospital stay in septic children in the PICU. Methods. A prognostic study with a prospective cohort design in pediatric patients admitted to the PICU of RSCM Jakarta with a diagnosis of sepsis. Results. Sepsis prevalence was 20,4%. Of the 45 study subjects, the mean age was 73.24 months (SD 66.9). The most common nutritional status was severe malnutrition (35.6%) and undernutrition (28.9%). The most common source of infection was respiratory tract infection. The most common diagnoses at admission were septic shock, pneumonia, COVID-19, and gastroenteritis. Mortality rate was 33.3%. The scoring criteria that were statistically significant (p<0.05) in predicting mortality were severe and undernutrition, SpO2:FiO2, platelet level, bilirubin level, and the use of invasive ventilation. Sensitivity of pSOFA was better than that of PELOD-2 (93.75% vs. 25%), while specificity of PELOD-2 was better than that of pSOFA (96.6% vs. 10.34%). The cut-off value for pSOFA changes in 7 days of treatment as a predictor of mortality on day 28 was 47.7%. The cut-off value of 47.7% had a sensitivity of 61.9%, a specificity of 77.7%, a positive predictive value of 81.2%. , and a negative predictive value of 46.6% with an OR value of 5.6875. Conclusions. Factors that contribute to sepsis mortality were SpO2:FiO2, platelet levels, bilirubin levels, and invasive ventilation. For diagnosing sepsis, PELOD-2 was better than pSOFA. Meanwhile, to screen for sepsis, pSOFA was considered superior and is able to see disease progression. The cut-off value for pSOFA changes in 7 days of treatment as a predictor of mortality on day 28 was 47.7%. The cut-off value of 47.7% had a sensitivity of 61.9%, a specificity of 77.7%, a positive predictive value of 81.2%. , and a negative predictive value of 46.6% with an OR value of 5.6875.

Abstrak :
Latar belakang: Sepsis merupakan salah satu penyebab morbiditas dan mortalitas pada anak. Untuk optimalisasi tatalaksana sepsis diperlukan penanda yang dapat memprediksi kejadian sepsis, derajat keparahan dan luaran sepsis klinis. Tujuan penelitian: Mengetahui kadar plasma Cit H3 sepsis klinis pada anak dan menganalisa hubungannya terhadap derajat keparahan penyakit dan prognostik survivalnya. Metode penelitian: Penelitian observasional pendekatan kohort prospektif dilakukan pada anak usia satu bulan sampai 18 tahun dengan diagnosis sepsis klinis sejak Pebruari - Mei 2018 di RSUPN Cipto Mangunkusumo, Jakarta. Penilaian skor PELOD-2, pSOFA dan Cit H3 dilakukan saat diagnosis ditegakkan dan 48 jam kemudian. Mortalitas dipantau selama tujuh hari. Hasil: Diperoleh 67 anak memenuhi kriteria dengan median kadar plasma Cit H3 1.210 800-32.160 ng/mL. Berdasarkan sepsis-3, kadar plasma Cit H3 pasien sepsis lebih tinggi dibandingkan curiga sepsis. Sensitivitas dan spesifisitas kadar plasma Cit H3 ge; 1.200 ng/mL sebagai penanda kejadian sepsis adalah 83,3 dan 75,7. Perubahan kadar plasma Cit H3 dalam 48 jam berhubungan dengan progresifitas sepsis klinis. Citrullinated histone H3 berkorelasi dengan skor PELOD-2 r=0,338;P

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Background: Sepsis is a life threatening organ dysfunction causing high morbidity and mortality in children thus, a highly predictive septic marker to forecast its severity and predict mortality is needed. Aim: To determine plasma Cit H3 levels in clinically sepsis children and analyze its correlation with disease severity and survival rate. Method: A prospective observational study was conducted in one month ndash 18 years old children with diagnosed clinically sepsis during February ndash April 2018 in Cipto Mangunkusumo Hospital, Jakarta. Evaluation of PELOD 2, pSOFA score, and Cit H3 were done when diagnosis initially made and 48 hours after. Patient rsquo s survival was observed for 7 days. Results: Sixty seven children with clinically sepsis had median plasma Cit H3 level 1,210 800 ndash 32,160 ng mL. The plasma Cit H3 level in patients who diagnosed with sepsis sepsis 3 was higher than suspected sepsis. As marker sepsis event, plasma Cit H3 level with cut off point ge 1,200 ng mL has sensitivity 83,3 and specificity 75.5. Changes in plasma Cit H3 level in the first 48 hours was significantly correlated with changes in clinical outcome. Plasma Cit H3 level also correlated with PELOD 2 and pSOFA score. Using survival analysis, plasma Cit H3 level ge 1,200 ng mL significantly increased mortality rate. Conclusion: Plasma Cit H3 level correlates with severity and survival rate of clinically diagnosed sepsis.