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Abstrak :
Latar belakang. Neutrophil-lymphocyte ratio (NLR) dan platelet-lymphocyte ratio (PLR) merupakan pemeriksaan indikator inflamasi yang sederhana, yaitu hanya membutuhkan pemeriksaan darah perifer lengkap dengan menghitung jenis leukosit absolut. Beberapa studi telah menunjukkan bahwa peningkatan NLR dan PLR berasosiasi dengan keluaran yang lebih buruk pada subjek dengan kanker payudara. Sampai saat ini, studi yang meneliti peran NLR dan PLR sebagai penanda biologis keganasan dan indikator penilaian risiko terhadap kanker payudara masih sangat sedikit, sehingga bukti ilmiah yang ada belum konklusif. Tujuan dari penelitian ini adalah untuk menganalisis hubungan antara NLR dan PLR terhadap risiko kanker payudara di Rumah Sakit dr. Cipto Mangunkusumo. Metode. Studi potong lintang dilakukan di RSCM dengan melibatkan perempuan dewasa dengan atau tanpa diagnosis kanker payudara yang belum pernah menerima kemoterapi, terapi radiasi, dan pembedahan. Usia, stadium kanker payudara, subtipe molekuler kanker payudara, indeks massa tubuh (IMT), komorbiditas, NLR, dan PLR merupakan variabel yang diteliti terhadap kejadian kanker payudara. Hasil. Pada penelitian ini, didapatkan sebanyak 65 subjek dengan kanker payudara dan 70 subjek tanpa kanker payudara. Hasil menunjukkan bahwa terdapat hubungan bermakna antara NLR tinggi dengan risiko kejadian kanker payudara dengan OR(IK95%) = 5,47 (2,39-12,52) dan p <0,001. Selain itu, didapatkan hubungan bermakna antara PLR tinggi dengan peningkatan risiko kejadian kanker payudara dengan OR(IK95%) = 4,67 (2,18-10) dan p <0,001. Dari uji multivariat didapatkan NLR dan PLR merupakan faktor-faktor yang berhubungan bermakna secara statistik (p = 0,001) dengan terjadinya kanker payudara dibandingkan dengan faktor-faktor lain. Kesimpulan. Terdapat asosiasi antara NLR dan PLR tinggi dengan peningkatan risiko kanker payudara. ......Background. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple inflammatory indicator tests, which only require a complete peripheral blood count by calculating the absolute leukocyte type. Several studies have shown that increased NLR and PLR are associated with poorer outcomes in subjects with breast cancer. To date, there have been very few studies examining the role of NLR and PLR as biological markers of malignancy and risk assessment indicators for breast cancer, so that the scientific evidence is not conclusive. The purpose of this study was to analyze the relationship between NLR and PLR on the risk of breast cancer at dr. Cipto Mangunkusumo. Methods. A cross-sectional study was conducted at RSCM involving adult women with or without a diagnosis of breast cancer who had never received any chemotherapy, radiation therapy, and surgery. Age, stage of breast cancer, molecular subtype of breast cancer, body mass index (BMI), comorbidities, NLR, and PLR are the variables studied on the incidence of breast cancer. Results. In this study, there were 65 subjects with breast cancer and 70 subjects without breast cancer. The results showed that there was a significant association between high NLR and the increased risk of breast cancer with OR(95% CI) = 5.47 (2.39-12.52) and p <0.001. In addition, a significant association was found between high PLR and an increased risk of breast cancer with OR (95% CI) = 4.67 (2.18-10) and p <0.001. From the multivariate test, it was found that only increased NLR and increased PLR were independent factors that were statistically significant (p = 0.001) related to the occurrence of breast cancer compared to other factors. Conclusion. High NLR and PLR are associated with an increased risk of breast cancer

Abstrak :
ABSTRAK Latar Belakang: Lesi koroner kompleks berkaitan dengan prognosis buruk SKA. Pentingnya revaskularisasi awal untuk mengurangi angka morbiditas dan mortalitas. PLR berkaitan dengan kompleksitas lesi buruk dan diharapkan menjadi acuan dalam identifikasi dini lesi koroner kompleks. Tujuan: Mengetahui akurasi diagnostik dan nilai titik potong PLR sebagai penapis lesi koroner kompleks baik pada kelompok usia ≤45 tahun dan >45 tahun. Metode: Sebuah studi potong lintang secara retrospektif di ICCU RSUPN-CM. Data diambil dari rekam medis pasien SKA dewasa dan menjalani angiografi koroner dari Januari 2012 ? Juli 2015. Akurasi diagnositik dinilai dengan menghitung sensitivitas dan spesifisitas. Nilai titik potong ditentukan menggunakan kurva ROC. Hasil: Proporsi pasien SKA dengan lesi koroner kompleks 47,2%. Nilai titik potong optimal pada pasien usia ≤45 tahun adalah 111,06 dengan sensivitas 91,3% dan spesifisitas 91,9. Pada kelompok usia >45 tahun nilai titik potong optimal pada angka 104,78 dengan nilai sensivitas 91,7% dan spesifisitas 58,6. Simpulan: Nilai titik potong PLR optimal pada kelompok usia ≤45 adalah 111,06 dan kelompok usia >45 tahun adalah 104,78 dengan akurasi diagnositik masing-masing AUC 93,9% (p <0,001) dan AUC 77,3% (p <0,001).

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ABSTRACT Background: A Complex coronary lesion is related to poor prognosis in ACS patient. The importance of early revascularization is to decrease mortality and complications. Inflammatory marker such as PLR related to complex coronary lesions and expected to be a tool that can assist physicians and cardiologists to stratify patients who have high probability for having a complex coronary lesion. Aim: Evaluate the diagnostic accuracy of PLR in identifying a complex coronary lesion in ACS patient. The other aim was to identify the proportion of complex coronary lesion and cut-off point of PLR between ≤45 years old group and >45 years old group subjects. Method: This is a cross sectional retrospectively study in ACS patients hospitalized in ICCU of RSUPN-CM from January 2012 until July 2015. The inclusion are adult ACS patients and who underwent coronary. The diagnostic accuracy was determined by calculating the sensitivity, specificity, PPV, NPV, Positive LR, and Negative LR. The cut-off point was determined using ROC curve. Results: The proportion of complex coronary lesion was 47,2%. The optimal cut-off point in ≤45 years old group was 111,06 with sensitivity and specificity respectively 91,3% and 91,9%. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity and specificity respectively 91,7% and 58,6%. Conclusion: The optimal cut-off point of ≤45 years old groups is 111,06 and for >45 years old group is 104,78. The diagnostic accuracy of PLR in ≤45 years old groups was very good (AUC 93,9%, p value <0,001), while in >45 years old group was moderate (AUC 77,3%, p value <0,001).

Abstrak :
Latar Belakang : Korioamnionitis  telah dihubungkan dengan kejadian ketuban pecah dini preterm (PPROM),  persalinan preterm dan luaran kehamilan yang buruk salah satunya adalah kejadian sepsis neonatus awitan dini (SNAD). Infeksi ditengarai mempunyai peran penting terhadap kejadian korioamnionitis. Hingga saat ini pemeriksaan histopatologi merupakan standar baku emas untuk menegakkan diagnosis korioamnionitis. C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) dan Platelet to Lymphocyte Ratio (PLR) adalah marker inflamasi dari serum darah maternal, dan menggambarkan keadaan infeksi dan inflamasi. Tujuan penelitian ini adalah untuk mengetahui asosiasi antara kadar CRP, NLR dan PLR serum maternal serta kultur kuman membran amnion dengan kejadian korioamnionitis dan SNAD.Metode: Penelitian potong lintang terhadap 61 orang ibu dengan PPROM usia kehamilan £32 minggu. Kadar NLR dan PLR merupakan rasio neutrofil absolut dan platelet dengan limfosit absolut. Korioamnionitis ditegakkan dengan pemeriksaan histopatologi korioamnion. Dan jenis kuman diketahui dari kultur membran amnion. Hasil: Kejadian korioamnionitis pada pasien PPROM adalah 27,8%. Pada sampel dengan korioamnionitis Median NLR 8,59 (4,20–22,67) ; p = 0,03 , sedangkan PLR dan CRP berturut-turut adalah 166,10 (84,89–396,27) dan 5,80 (0,03–88);  p>0,05. Terdapat 25% sampel dengan korioamnionitis yang luarannya menderita SNAD. Kadar NLR, PLR dan CRP sampel dengan luaran SNAD berturut-turut adalah 7,13(3,03–16,15); 154,30(45,2-444,08); dan 12,40 (2,4 –67,53), semuanya mempunyai nilai p>0,05. Jenis bakteri yang terbanyak berasal dari ordo Enterobacteriales (68%) dan E. Coli (23,4%) merupakan spesies terbanyak. Namun tidak terdapat asosiasi antara jenis bakteri dengan kejadian korioamnionitis dan SNAD (p<0,05) Kesimpulan: Terdapat asosiasi NLR dengan kejadian Korioamnionitis. Namun tidak terdapat marker inflamasi maternal yang berasosiasi dengan kejadian SNAD. Pada penelitian ini tidak terdapat hubungan antara jenis bakteri dengan kejadian korioamnionitis maupun SNAD. ......Background: Chorioamnionitis has been associated with the incidence of preterm premature rupture of membranes (PPROM), preterm labor and poor pregnancy outcomes, one of which is the incidence of early onset neonatal sepsis (EONS). Infection is suspected to have an important role in the occurrence of chorioamnionitis. Until now, histopathological examination is the gold standard for diagnosing chorioamnionitis. C-Reactive Protein (CRP), Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) are inflammatory markers from maternal serum, and can describe the state of infection and inflammation. The purpose of this study was to determine the association between levels of CRP, NLR and PLR in maternal serum and amniotic membrane culture with the incidence of chorioamnionitis and EONS. Methods: A cross-sectional study of 61 mothers with PPROM at ≤32 weeks' gestation. NLR and PLR levels are the ratio of absolute neutrophils and platelets to absolute lymphocytes. Chorioamnionitis is confirmed by histopathological examination of the chorioamnion. And the type of germ is known from amniotic membrane culture. Results:The incidence of chorioamnionitis in PPROM patients was 27.8%. In samples with chorioamnionitis Median NLR 8.59 (4.20–22.67) ; p = 0.03 , while the PLR​​and CRP were 166.10 (84.89–396.27) and 5.80 (0.03–88) respectively; p>0.05. There are 25% of samples with chorioamnionitis whose outcome with EONS. The NLR, PLR and CRP levels of the samples with EONS were 7.13(3.03–16.15); 154.30(45.2-444.08); and 12.40 (2.4 –67.53), all of which have a value of p>0.05. The most types of bacteria come from the order Enterobacteriales (68%) and E. Coli (23.4%) are the most species. However, there was no association between the type of bacteria and the incidence of chorioamnionitis and SNAD (p<0.05). Conclusion: There is an association of NLR with chorioamnionitis. However, there were no maternal inflammatory markers associated with EONS. In this study, there was no relationship between the type of bacteria and the incidence of chorioamnionitis or EONS.

Abstrak :
Kanker kolorektal (KKR) merupakan salah satu jenis keganasan dengan angka morbiditas dan mortalitas yang tinggi di seluruh dunia, termasuk di Indonesia. Kolonoskopi adalah baku emas dalam mendeteksi dan penapisan KKR. Inflamasi kronik dan respons imun pejamu diketahui berperan penting dalam proses tumorigenesis dan progresivitas sel kanker. Proses inflamasi tersebut mempengaruhi hasil pemeriksaan hematologi, sehingga parameter Rasio Hemoglobin-Trombosit (RHT), Rasio Trombosit-Limfosit (RTL), dan Rasio Limfosit-Monosit (RLM) diharapkan dapat memberikan informasi mengenai perkembangan sel tumor. Penelitian ini bertujuan untuk mengevaluasi peran RHT, RTL, dan RLM dalam membedakan kelompok KKR dan non-KKR. Penelitian dilakukan dengan menggunakan desain potong lintang dengan total 80 pasien tersangka KKR, 40 pasien KKR dan 40 pasien non-KKR yang menjalani pemeriksaan kolonoskopi dan histopatologi. Didapatkan perbedaan bermakna RHT, RTL, dan RLM pada kelompok KKR dan non-KKR. Titik potong RHT, RTL, dan RLM untuk membedakan kelompok KKR dan non-KKR adalah 0,26 (sensitivitas 77,5% dan spesifisitas 92,5%), 189,22 (sensitivitas 77,5% dan spesifisitas 72,5%), dan 2,864 (sensitivitas 77,5% dan spesifisitas 77,5%), secara berturut-turut. Berdasarkan analisis regresi logistik, kombinasi nilai RHT dan RLM lebih baik untuk mendeteksi KKR dibandingkan RHT atau RLM secara tunggal. Kombinasi RHT dan RLM dapat digunakan untuk mendeteksi KKR dengan skor 2 untuk RHT < 0,26 dan skor 1 untuk RLM < 2,864 dengan probabilitas 94,81%. ......Colorectal cancer (CRC) is a gastrointestinal malignancy with high morbidity and mortality rates worldwide, including in Indonesia. Colonoscopy remains the gold standard for CRC detection and screening. Chronic inflammation and host immune responses are known to play important roles in tumorigenesis and cancer progression. This inflammation affects the results of hematological examination. Therefore, parameters such as Hemoglobin-Platelet Ratio (HPR), Platelet-Lymphocyte Ratio (PLR), and Lymphocyte-Monocyte Ratio (LMR) are expected to provide information on tumor cell development. This study aims to evaluate the role of HPR, PLR, and LMR in distinguishing CRC and non-CRC. The study was conducted using a cross-sectional design with a total of 80 suspected CRC patients, with 40 CRC patients and 40 non-CRC patients undergoing colonoscopy and histopathology examinations. Significant differences were found in HPR, PLR, and LMR in the CRC and non-CRC groups. The cut-off points of HPR, PLR, and LMR to distinguish the CRC and non-CRC groups were 0.26 (sensitivity 77.5% and specificity 92.5%), 189.22 (sensitivity 77.5% and specificity 72.5%), and 2.864 (sensitivity 77.5% and specificity 77.5%), respectively. Logistic regression analysis showed that the combination of HPR and LMR values is better in detecting CRC compared to HPR or LMR alone. The combination of HPR and LMR can be used to detect CRC with a score of 2 for HPR < 0.26 and a score of 1 for LMR < 2.864 with 94.81% probability.

Abstrak :
ABSTRACT
Background: with the increasing number of patients with acute coronary syndrome (ACS) with complex coronary lesion and the increasing needs of coronary artery bypass grafting (CABG) procedures, there is an increasing need for a tool to perform early stratification in high-risk patients, which can be used in daily clinical practice, even at first-line health care facilities setting in Indonesia. It is expected that early stratification of highrisk patients can reduce morbidity and mortality rate in patients with ACS. This study aimed to identify diagnostic accuracy of platelet/lymphocyte ratio (PLR) and the optimum cut-off point of PLR as a screening tool for identifying a complex coronary lesion in patients ≤45 and >45 years old. Methods: this was a retrospective cross-sectional study, conducted at the ICCU of Cipto Mangunkusumo Hospital. Data was obtained from medical records of adult patients with ACS who underwent coronary angiography between January 2012 - July 2015. The inclusion criteria were adult ACS patients (aged ≥18 years old), diagnosed with ACS and underwent coronary angiography during hospitalization. Diagnostic accuracy was determined by calculating sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-). The cut-off point was determined using ROC curve. Results: the proportion of ACS patients with complex coronary lesion in our study was 47.2%. The optimum cut-off point in patients aged ≤45 years was 111.06 with sensitivity, specificity, LR+ and LR of 91.3%, 91.9%, 11.27 and 0.09, respectively. The optimum cut-off points in patients aged >45 years was 104.78 with sensitivity, specificity, LR+ and LR of 91.7%, 58.6%, 2.21 and 0.14, respectively. Conclusion: the optimum cut-off point for PLR in patients aged ≤ 45 years is 111.06 and for patients with age >45 years is 104.78 with diagnostic accuracy, represented by AUC of 93.9% (p<0.001) and 77.3% (p<0.001), respectively for both age groups.

Abstrak :
Latar Belakang : Kanker paru karsinoma bukan sel kecil (KPKBSK) merupakan jenis kanker paru yang terbanyak. Kesintasan kanker paru terutama ditentukan oleh jenis dan stage kanker. Pada jenis dan stage yang sama masih terdapat perbedaan kesintasan. Inflamasi telah lama diketahui sebagai faktor yang memengaruhi kesintasan pada pasien KPKBSK. Pemeriksaan profil leukosit merupakan pemeriksaan yang murah, cepat dan rutin dikerjakan. Terdapat beberapa penelitian di luar negeri yang meneliti hubungan rasio neutrofil limfosit, rasio trombosit limfosit dan rasio limfosit monosit namun dengan hasil dan titik potong yang beragam. Metode : Penelitian ini menggunakan metode kohort retrospektif pada 148 pasien KPKBSK stage lanjut dengan mutasi epidermal growth factor receptor (EGFR) wild type atau tidak diketahui yang berobat ke RSRRN Persahabatan antara tahun 2018-2019, yang mendapatkan kemoterapi minimal 2 siklus. Dilakukan pencatatan data profil leukosit berupa RNL, RTL dan RLM sebelum menjalani kemoterapi pertama, kemudian diikuti respons klinis berupa kesintasan PFS dan OS. Analisis hubungan antar variabel menggunakan uji korelasi Spearman dan analisis kesintasan menggunakan kurva Kaplan Meier. Hasil : Sampel penelitian 148 pasien KPKBSK stage IIIB-IV dengan proporsi laki-laki 107 orang (72,3%) dan perempuan 41 orang (27,7%). Median usia 57 tahun (16-77 tahun). Didapatkan kanker paru jenis karsinoma sel skuamosa (KSS) sebanyak 83 (56,1%), adenokarsinoma 62 (41,9%) dan adenoskuamosa 3 (2%) dengan performance status (PS) 0-2. Terdapat hubungan yang bermakna antara RNL, RTL dan RLM dengan PFS dan OS. Pasien dengan RNL≥4 memiliki PFS yang lebih rendah (HR=1,689, IK95%:1,189-2,399, p=0,003) dan OS lebih rendah (HR=2,028, IK95%:1,423-2,891, p<0,001). Pasien dengan RTL≥125 memiliki PFS yang lebih rendah (HR=2,229, IK95%:1,226-4,053, p=0,009) dan OS lebih rendah (HR=2,286, IK95%:1,259-4,148, p=0,007). Pasien dengan RLM≥2,5 memiliki PFS yang lebih tinggi (HR=0,464, IK95%:0,316 - 0,682, p<0,001) dan OS lebih tinggi (HR=0,383, IK95%:0,259 - 0,565, p<0,001) Kesimpulan : Nilai RNL, RTL dan RLM memiliki hubungan dengan PFS dan OS pada pasien KPKBSK stage lanjut yang mendapatkan kemoterapi. Baik RNL, RTL maupun RLM dapat digunakan sebagai faktor prognostik pada pasienKPKBSK stage lanjut yang mendapatkan kemoterapi Kata kunci Kemoterapi, KPKBSK, prognosis, rasio neutrofil limfosit (RNL), rasio trombosit limfosit (RTL), rasio limfosit monosit (RLM) ......Background : Non small cell lung cancer (NSCLC) is the most common type of lung cancer. Lung cancer survival is mainly determined by the type and stage of cancer. At the same type and stage, there are still differences in survival. Inflammation has long been recognized as a factor that affects survival in patients with NSCLC. Examination of the leucocyte profile is an inexpensive, fast and routine examination. There are several studies that examine the relationship between the ratio of neutrophil to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR) and the ratio lymphocytes to monocyte (LMR) but with varying results and cut points. Methods : This study used a retrospective cohort method on 148 advanced stage NSCLC patients with wild type or unknown mutations of epidermal growth factor receptor (EGFR) who were treated at RSRRN Persahabatan between 2018-2019, who received at least 2 cycles of chemotherapy. Leukocyte profile data were recorded in the form of NRL, PLR and LMR before undergoing the first chemotherapy, followed by clinical responses in the form of PFS and OS survival. Analysis of the relationship between variables using the Spearman correlation test and survival analysis using the Kaplan Meier curve. Results : Total sample was 148 NSCLC patients IIIB-IV with the proportion of 107 men (72,3%) and 41 women (27,7%). The median age was 57 years (16-77 years). There were 83 (56,1%) squamous cell carcinoma (SCC) cases, 62 (41,9%) adenocarcinoma cases and 3 (2%) adenosquamous cases with performance status (PS) of 0-2. There is a significant relationship between NLR, PLR and LMR with PFS and OS. Patients with NLR≥4 had lower PFS (HR=1,689, 95% CI:1,189-2,399, p=0,003) and lower OS (HR=2,028, 95% CI:1,423-2,891, p<0,001). Patients with PLR≥125 had lower PFS (HR=2,229, 95% CI:1,226-4,053, p=0,009) and lower OS (HR=2,286, 95% CI:1,259-4,148, p=0,007). Patients with LMR≥2,5 had higher PFS (HR=0,464, 95% CI: 0,316-0.682, p<0,001) and higher OS (HR=0,383, 95% CI: 0,259-0,565, p<0,001) Conclusion : NLR, PLR and LMR values ​​were associated with PFS and OS in advanced stage NSCLC patients receiving chemotherapy. Both NLR, PLR and LMR could be used as prognostic factors in advanced stage NSCLC patients receiving chemotherapy