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Abstrak :
Latar belakang: Rekomendasi Centers for Disease Control and Prevention (CDC) 2010 (revisi 2002) tidak spesifik memberi panduan dalam pencegahan sekunder sepsis awitan dini (SAD) pada neonatus cukup bulan (NCB), asimtomatik lahir dari ibu yang mengalami KPD < 18 jam. Tujuan: Didapatnya model determinan SAD pada NCB sesuai masa kehamilan (SMK), asimtomatik lahir dari ibu yang mengalami KPD lebih dari 12 jam. Metodologi: penelitian observasional potong lintang untuk mendapatkan model determinan sepsis neonatorum awitan dini (SNAD) yang dilakukan dari Februari 2013 sampai bulan Mei 2014 di RSAB Harapan Kita, RSUD Tarakan, RSIA Budi Kemuliaan. Determinan yang diteliti adalah jenis persalinan, petanda infeksi saluran kemih (ISK) pada ibu, petanda infeksi intra amnion (IIA) seperti demam intrapartum, ibu takikardia, janin takikardia, adanya perubahan warna dan bau cairan ketuban, leukosit darah ibu, dan petanda infeksi darah tali pusat (peningkatan jumlah total leukosit, neutrofil, peningkatan rasio I/T, hs-CRP dan IL-6). Diagnosis sepsis ditegakkan berdasarkan catatan medis bayi yang dipastikan berdasarkan hasil positif biakan darah tali pusat. Model determinan SNAD yang dihasilkan adalah suatu persamaan regresi logistik yang digunakan untuk menentukan probabilitas terjadinya SNAD sebagai acuan terapi antibiotik. Hasil: model determinan SAD pada NCB SMK, asimtomatik lahir dari ibu KPD > 12 jam berupa kalkulator dan sistem skor yang dibentuk dari determinan persalinan per vaginam, perubahan warna dan bau cairan ketuban, leukosit darah ibu, leukosit darah tali pusat, kadar hs-CRP darah tali pusat dan kadar IL-6 darah tali pusat. Model determinan SNAD memiliki dua varian, varian lengkap digunakan untuk fasilitas pelayanan neonatus subspesialistik dan varian alternatif digunakan untuk fasilitas pelayanan spesialistik. Titik potong ideal penentuan probabilitas terjadinya SNAD memiliki sensitivitas di antara 24,2 – 40,3 % dan spesifisitas 87,1 - 94,5 %. Nilai diskriminasi dengan nilai AUC berkisar di antara 0,743 – 0,816 dengan kalibrasi baik berdasarkan uji Hosmer-Lemeshow. Simpulan: Hasil penelitian ini adalah model determinan SAD pada NCB SMK asimtomatik lahir dari ibu yang mengalami KPD > 12 jam, berbentuk kalkulator dan sistem skor yang memiliki varian lengkap dan alternatif untuk menentukan probabilitas terjadinya SNAD sebagai dasar pemberian terapi antibiotik empiris secara rasional. ......Background: Centers for Disease Control and Prevention (CDC) 2010 (revised 2002) recommendations does not specifically provide guidance in secondary prevention of asymptomatic early-onset sepsis (EOS) on term infant born to mother experiencing PROM < 18 hours. Objective: to develop early-onset neonatal sepsis (EONS) determinant model as a rational basis for determining the empirical antibiotic therapy in asymptomatic, term infant born to mother with PROM > 12 hours. Method: A cross-sectional observational study to obtain an EONS determinant model which was conducted from February 2013 to May 2014 in RSAB Harapan Kita, Tarakan Hospital, RSIA Budi Kemuliaan. The determinant factor is the type of delivery, marker of maternal urinary tract infection (UTI), intra-amniotic infection markers (intrapartum fever, maternal tachycardia, fetal tachycardia, change in the color and odor of amniotic fluid, maternal blood leukocytes), and umbilical cord blood infection marker (increased the total number of leukocytes, neutrophils, an increase in the ratio of I / T, hs-CRP and IL-6). Early-onset neonatal sepsis was diagnosed base on infant medical record on 72 hours afeter birth and confirmed by the positive results of umbilical cord blood cultures. The resulting of EONS determinants model is a logistic regression equation used to determine the probability of the occurrence of EONS as reference rational basis empirical antibiotic therapy. Results: The EOS determinants model on asymptomatic term infant born to mothers with PROM> 12 hours is a calculator and scoring system that is formed from the determinant of vaginal delivery, change the color and odor of amniotic fluid, maternal blood leukocytes, cord blood leukocytes, the levels of hs-CRP and IL-6 umbilical cord blood level. Early-onset neonatal sepsis determinant model has two variants, the full variant used for subspecialty neonatal care facilities and alternative variant is used for specialty neonatal care facilities. Ideal cutoff point probability of occurrence SNAD has sensitivity range of 24.2 to 40.3% and specificity of 87.1 to 94.5%. The model performe is good based on Hosmer-Lemeshow test anda discrimination value AUC in in range of 0.743 to 0.816. Conclusion: The EOS determinant model of asymptomatic term infant born to mothers with PROM > 12 hours is a calculator and scoring system that is used to determine the probability of EONS occurrence as the basis of determining the rational empirical antibiotic therapy.

Abstrak :
Sepsis merupakan kondisi yang sulit untuk didiagnosis. Definisi sepsis berdasarkan International Consensus Conference on Pediatric Sepsis 2005 terlalu sensitif dan tidak spesifik. Akibatnya sering terjadi underdiagnosed/overdiagnosis terhadap sepsis. Sampai saat ini tidak ada data tentang karakteristik pasien sepsis, kepatuhan diagnosis berdasarkan konsensus yang disepakati, dan luaran sepsis pasien di PICU. Penelitian ini bertujuan untuk mengetahui gambaran karakteristik sepsis di PICU RS dr. Cipto Mangunkusumo. Metode penelitian ini adalah deskriptif retrospektif dari data rekam medis pasien sepsis di PICU periode Januari 2012 sampai April 2016. Didapatkan 85 pasien yang didiagnosis dokter dengan sepsis, 7 pasien diantaranya tidak memenuhi kriteria konsensus. Hanya 1 pasien yang didiagnosis sepsis berat oleh dokter, sedangkan berdasarkan konsensus didapatkan 66 pasien sepsis berat. Infeksi respiratorik adalah penyakit primer penyebab sepsis di PICU (51,3%). Angka kejadian sepsis berat di PICU sebesar 85% dan syok septik 70%. Klebsiella pneumonia kuman gram negatif terbanyak penyebab sepsis (22%). Angka kematian sepsis sebesar 29%, pada sepsis berat 32% dan meningkat pada syok septik 37%. Penelitian ini menunjukkan kepatuhan diagnosis sepsis oleh dokter berdasarkan konsensus masih kurang. Diagnosis sepsis pasien di PICU berdasarkan kadar prokalsitonin yang meningkat. ...... Sepsis is a condition that is difficult to diagnose. Definition of sepsis based on the International Consensus Conference on Pediatric Sepsis 2005 is too sensitive and not specific. As a result underdiagnosed/overdiagnosis often occurs in sepsis. Until now there are no data on the characteristics of sepsis patients, compliance to diagnosis based on consensus, and the outcome of sepsis patients in PICU. The aim of this study is to determine the characteristic features of sepsis in PICU of dr. Cipto Mangunkusumo hospital. The methods is descriptive retrospective study from medical records of sepsis patients in PICU from January 2012 until April 2016. There were 85 patients diagnosed with sepsis by physicians, 7 of them did not meet the criteria of consensus. Only one severe sepsis patients diagnosed by a doctor, but based on the consensus, there are 66 patients with severe sepsis. Respiratory infections are the primary cause of sepsis (51.3%). The incidence of severe sepsis in PICU is 85% and of septic shock is 70%. Klebsiella pneumonia, Gram negative bacteria, is the most common cause of sepsis (22%). Sepsis mortality rate is 29%, severe sepsis is 32% and increased in septic shock by 37%. This study describes compliance of diagnosis of sepsis by doctor based on consensus is still lacking. The diagnosis of sepsis patients in PICU based on increased levels of procalcitonin.

Abstrak :

Prevalensi sepsis neonatorum diantara bayi baru lahir cukup tinggi. Oleh karena itu, dibutuhkan diagnosis yang akurat. Namun, gejala klinis sepsis tidak cukup spesifik untuk menegakkan diagnosa, dan ini merupakan tantangan bagi para dokter. Penelitian ini bertujuan untuk mempelajari hubungan antara enam faktor resiko terhadap prevalensi sepsis neonatorum awitan dini (SNAD). Terdapat 67 pasien yang lahir dan dirawat di Rumah Sakit Cipto Mangunkusumo pada tahun 2018 dan diikutsertakan dalam penelitian ini, dan data yang digunakan didapatkan dari rekam medis. Subjek dibagi menjadi dua kelompok berdasarkan durasi pengobatan antibiotik: sepsis (pengobatan >5 hari) dan non-sepsis (pengobatan ≤5 hari). Penelitian ini cross-sectional, dan menggunakan analisis univariat dan bivariat. 52 (77.6%) dari 67 pasien memiliki SNAD. Melalui analisis bivariat, faktor resiko yang diteliti tidak signifikan secara statistik (nilai p> 0.05) terhadap sepsis maupun non-sepsis, dengan pengecualian untuk demam pada ibu dengan nilai p yang tidak ada. Ketuban pecah dini (KPD) ≥18 jam, nilai APGAR rendah, usia gestasi <37 minggu, dan berat badan lahir (BBL) < 2500 gram memiliki OR>1, Sedangkan leukosit ibu ≥18000 sel/ µL memiliki OR <1. Untuk demam ibu dan nilai APGAR rendah OR tidak dapat dihitung. Pada kesimpulannya, KPD ≥18 jam, usia gestasi <37 minggu, BBL < 2500 gram, leukosit ibu ≥ 18000 sel/ µL, dan nilai APGAR rendah tidak berhubungan dengan prevalensi SNAD. Tidak ada faktor resiko yang paling berpengaruh.

 

Kata kunci: Faktor resiko sepsis, sepsis neonatorum awitan dini

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The prevalence of sepsis among neonates are high. Hence, accurate diagnosis is required. However, diagnosis through clinical signs and symptoms are still vague, which remains a challenge for physicians. This research aims to study the association of six risk factors towards the prevalence of neonatal Early Onset Sepsis (EOS). A total of 67 patients that were born and treated in Ciptomangunkusumo Hospital in 2018 were used in this research, obtained from medical record. The subjects were divided into two groups based on the duration of treatment using antibiotics: sepsis (treatment >5 days) and non-sepsis (treatment ≤ 5 days). This study is cross-sectional, and uses univariate and bivariate analysis. 52 (77.6%) out of 67 patients have EOS. From bivariate analysis, the risk factors that were examined did not show a statistical significance (p-value > 0.05) towards sepsis and non-sepsis, except for maternal fever which p-value has no result.  Prolonged rupture of membranes, low APGAR score, gestational age <37 weeks, and birth weight <2500 grams had an OR>1. On the other hand, high maternal leukocyte count has an OR< 1. The OR of maternal fever and low APGAR score was not able to be calculated. In conclusion, prolonged rupture of membrane, premature infant, birth weight <2500 grams, maternal leukocyte counts of ≥ 18000 cells/ µL, and low APGAR score has no relation with the prevalence of EOS. There are no most influential risk factors.

 

Keywords: Risk factors of sepsis, early onset sepsis

Abstrak :
Tuberkulosis merupakan penyakit menular yang disebabkan oleh bakteri mycobacterium tuberculosis. Salah satu penyebab perburukan dan kematian pada pasien dengan tuberkulosis paru adalah adanya sepsis. Sepsis merupakan disfungsi organ mengancam nyawa yang disebabkan oleh disregulasi respon host terhadap infeksi. Syok sepsis akibat tuberkulosis dapat menyebabkan beberapa gejala yang umum pada tuberkulosis, seperti demam dan sesak napas hingga disfungsi multiorgan. Angka kematian yang tinggi dan kesalahan diagnosis sepsis pada tuberkulosis masih umum terjadi. Oleh karena itu, perawat berperan penting dalam pengenalan dini dan perawatan pada pasien dengan sepsis. Penulisan karya ilmiah ini bertujuan untuk memaparkan hasil praktik mengenai pemberian asuhan keperawatan pada pasien tuberkulosis paru dengan sepsis. Analisis asuhan keperawatan dilakukan pada pasien laki-laki berusia 49 tahun yang mengalami tuberkulosis paru disertai dengan sepsis di ruang rawat inap. Masalah keperawatan yang dapat diangkat pada kasus pasien dengan sepsis, antara lain bersihan jalan napas tidak efektif, ketidakseimbangan nutrisi: kurang dari kebutuhan tubuh, dan risiko syok. Penerapan intervensi pada karya ilmiah ini khususnya berfokus untuk menangani risiko syok dengan menggunakan bundel yang disertai dengan perawatan terperinci pada pasien. Intervensi diberikan selama empat hari kepada pasien. Intervensi yang diterapkan efektif dalam meningkatkan kondisi klinis pasien ketika dilakukan penerapan, namun tidak berdampak signifikan pada peningkatan kondisi klinis pasien secara kumulatif. ......Tuberculosis is an infectious disease caused by the bacteria mycobacterium tuberculosis. One of the causes of deterioration and death in patients with pulmonary tuberculosis is sepsis. Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Septic shock due to tuberculosis can cause several symptoms common to tuberculosis, such as fever and shortness of breath to multiorgan dysfunction. The high mortality rate and misdiagnosis of sepsis in tuberculosis are still common. Therefore, nurses play an important role in early recognition and treatment of patients with sepsis. The aim of writing this scientific work is to present practical results regarding the provision of nursing care to pulmonary tuberculosis patients with sepsis. Analysis of nursing care was carried out on a 49 year old male patient who experienced pulmonary tuberculosis accompanied by sepsis in the inpatient room. Nursing problems that can be raised in cases of patients with sepsis include ineffective airway clearance, imbalanced nutrition: less than body requirements, and risk of shock. The implementation of interventions in this scientific work specifically focuses on managing the risk of shock using a bundle accompanied by detailed patient care. The intervention was given for four days to the patient. The intervention implemented was effective in improving the patient's clinical condition when implemented, but did not have a significant impact on improving the patient's clinical condition cumulatively.

Abstrak :
Sepsis masih menjadi masalah kesehatan dunia dengan angka kematian yang cukup tinggi berkisar 20 – 50%. Penggunaan terapi antibiotik yang rasional dengan segera dapat menurunkan angka kematian. Sebaliknya, penggunaan terapi antibiotik tidak rasional akan meningkatkan terjadinya resistensi yang berdampak pada tingginya morbiditas, mortalitas dan biaya kesehatan. Penelitian ini bertujuan untuk mengevaluasi kualitas penggunaan antibiotik dengan metode gyssens pada pasien sepsis. Penelitian ini merupakan penelitian observasional dengan metode cross-sectional yang dilakukan di RSUP Fatmawati Jakarta. Subyek penelitian adalah 110 pasien sepsis pada periode Januari hingga Desember 2020 yang memenuhi kriteria inklusi yaitu pasien usia > 18 tahun dan mendapatkan terapi antibiotik. Pasien sepsis umumnya berusia ≤ 65 tahun (66,4%) dengan rerata usia 60,60±13,88, berjenis kelamin perempuan (52,7%), termasuk dalam kategori sepsis (53,6%), memiliki > 1 penyakit penyerta (86,4%), mengalami infeksi paru (66,4%), dan lama rawat ≤ 14 hari (85,5%). Berdasarkan distribusi penggunaan antibiotik, sebagian besar (93,66%) pasien menggunakan antibiotik empiris. Antibiotik tunggal digunakan pada 46,37% pasien dengan presentase terbanyak adalah meropenem (14,55%). Sedangkan 53,63% pasien menggunakan antibiotik kombinasi dengan presentase terbanyak adalah kombinasi ceftriaxon+levofloxacin (19,09%). Sejumlah 92,73% pasien menggunakan antibiotik selama ≤ 14 hari. Berdasarkan evaluasi kualitas antibiotik menggunakan metode gyssens diperoleh hasil 49,09% pasien menggunakan antibiotik yang rasional dan 50,91% pasien menggunakan antibiotik yang tidak rasional dan tersebar dalam kategori VI (0,91%), V (17,28%), IV a (3,63%), IV b (0,91%), IV c (0,91%), III a (3,63%), III b (20%), II a (0,91%) dan II b (2,73%). ......Sepsis is still a global health problem with a fairly high mortality rate ranging from 20-50%. Rational use of antibiotic therapy immediately can reduce mortality. Conversely, irrational use of antibiotic therapy will increase the occurrence of resistance which has an impact on high morbidity, mortality and health costs. This study aims to evaluate the quality of antibiotics use with the Gyssens method in sepsis patients. This study was an observational study with a cross-sectional method conducted at Fatmawati Hospital, Jakarta. The subjects were 110 septic patients from January to December 2020 who met the inclusion criteria, namely aged > 18 years and received antibiotic therapy. Sepsis patients were generally aged 65 years (66.4%) with a mean age of 60.60 ± 13.88, female (52.7%), included in the category of sepsis (53.6%), had >1 comorbidities (86,4%), had lung infection (66.4%), and length of stay ≤ 14 days (85.5%). Based on the pattern of antibiotic use, most (93.66%) patients used empiric antibiotics. A single antibiotic used in 46.37% of patients with the highest percentage was meropenem (14.55%). Meanwhile, 53.63% of patients used combination antibiotics with the highest percentage were combination of ceftriaxone+levofloxacin (19.09%). A total of 92.73% of patients used antibiotics for ≤ 14 days. Based on the evaluation of the quality of antibiotics using the Gyssens method, the study found the result that 49.09% of patients using rational antibiotics and 50.91% of patients using irrational antibiotics and were spread in category VI (0.91%), V (17.28%), IV a (3.63%), IV b (0.91%), IV c (0.91%), III a (3.63%), III b (20%) , II a (0.91%) and II b (2.73%).

Abstrak :
Sepsis merupakan suatu disfungsi organ yang bersifat mengancam jiwa yang disebabkan oleh infeksi, sedangkan syok septik adalah sekumpulan tanda-tanda sepsis dengan resiko mortalitas yang lebih tinggi. Penatalaksanaan pasien bergantung pada pemberian antibiotik empiris yang sesuai untuk mencegah resistensi bakteri terhadap antibiotik yang diberikan. Tujuan penelitian ini yaitu untuk melihat pola antibiotik yang diberikan kepada pasien sepsis dan menilai kesesuaian penggunaan antibiotik pada pasien sepsis di Instalasi Gawat Darurat RSUP Fatmawati periode Oktober-Desember 2016. Penelitian ini dilakukan dengan desain cross sectional dan bersifat deskriptif secara retrospektif dengan mengevaluasi catatan rekam medis dari 99 pasien sepsis. Pengambilan sampel penelitian dilakukan dengan teknik total sampling. Hasil analisis pada 99 pasien sepsis, didapatkan jumlah penderita laki-laki lebih tinggi daripada perempuan, yaitu sebesar 56.57 dan paling banyak diderita oleh pasien lansia akhir >55-65 tahun sebesar 34.34. Kriteria pasien sepsis didapatkan bahwa pasien sepsis sebesar 73.74 dan syok septik sebesar 26.26. Antibiotik tunggal yang paling sering digunakan adalah seftriakson, sedangkan antibiotik yang paling sering dikombinasi adalah levofloksasin seftriakson. Penggunaan antibiotik yang memenuhi kriteria tepat pasien sebanyak 49.49 , tepat indikasi sebanyak 70.71 , dan tepat dosis sebanyak 34.34. ...... Sepsis is defined as life threatening organ dysfunction caused by infection, whereas septic shock is a subset of sepsis in which substantially increase mortality. The management of the patient depends on treating septic patient especially with appropriate empirical antibiotics to prevent bacterial resistance. The purpose of this study was to perceive of the antibiotic prescription patterns given to sepsis patients and assess the accuracy of antibiotic usage in sepsis patients in the Emergency Department of Fatmawati Central General Hospital October to December 2016 period. The design of this study was cross sectional and this sudy was descriptive with retrospective data collection by evaluated medical records from 99 patients. This sudy used the total sampling technique. Based on analysis of 99 sepsis patients, the number of men was higher than women, which was 56.57 and the most suffered by the elderly 55 65 years old patients was 34.34. This study showed that sepsis patients were 73.74 and septic shock were 26.26. The single most antibiotic commonly used was ceftriaxone and the most combined antibiotic was levofloxacin ceftriaxone. The administration of antibiotics which patient 39 s properly criteria was 49.49 , appropriate indication was 70.71 , and appropriate dosage was 34.34.

Abstrak :
ABSTRAK
Latar Belakang: Pengaruh metastasis sebagai penyebab peningkatan procalcitonin (PCT) pada pasien tumor padat nonsepsis masih belum jelas. Studi-studi sebelumnya memberikan hasil yang tidak konklusif. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis juga belum diketahui. Tujuan: Mengetahui peran PCT dalam diagnosis sepsis pada pasien tumor padat dengan metastasis. Metode: Studi potong lintang terhadap pasien tumor padat yang berobat di RSCM September-Desember 2015. Pada pasien ditentukan ada tidaknya sepsis menggunakan kriteria sepsis ACCP/SCCM 2001, dilakukan pemeriksaan darah perifer, serta PCT. Dilakukan analisis untuk mengetahui perbedaan kadar PCT pasien tumor padat metastasis dan tanpa metastasis yang tidak sepsis. Selain itu, dilakukan pula pencarian nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis dengan menggunakan ROC. Hasil dan Pembahasan: Didapatkan 112 pasien tumor padat, pria sebanyak 51%, dengan rerata usia 47,9 ±12,47 tahun. Sebanyak 71 (63,4%) pasien sudah didapatkan metastasis, 36 (32,1%) diantaranya sepsis, dan 6 (5,3%) mengalami SIRS. Dari 41 (36,6%) pasien tanpa metastasis, 9 (8%) mengalami sepsis, dan 5 (4,4%) SIRS. Terdapat perbedaan bermakna kadar PCT pada pasien tumor padat metastasis dibandingkan tanpa metastasis pada kondisi nonsepsis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Pasien tumor padat metastasis yang mengalami sepsis memiliki kadar PCT lebih tinggi dibandingkan nonsepsis [3,5 ng/mL (0,66-189,4) vs. 0,25 ng/mL (0,07-1,76); p<0,001]. Dari kurva ROC kadar PCT pada tumor padat metastasis, didapatkan AUC [0,956, IK 0,916-0,996] untuk mendiagnosis sepsis. Nilai titik potong PCT untuk diagnosis sepsis pada pasien tumor padat metastasis adalah 1,14 ng/mL dengan sensitivitas 86% dan spesifisitas 88%. Kesimpulan: Pada kondisi nonsepsis, kadar PCT pasien tumor padat metastasis lebih tinggi dibandingkan pasien tanpa metastasis. Nilai titik potong PCT untuk diagnosis sepsis pada tumor padat metastasis adalah 1,14 ng/mL. ABSTRACT
Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL. ;Background: The effect of metastasis as a cause of increased procalcitonin (PCT) in patients with solid tumors without sepsis remains unclear. Previous studies did not provide conclusive results. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors is also unknown. Objective: To determine the role of PCT in the diagnosis of sepsis toward metastatic solid tumors patients. Methods: A cross sectional study was conducted in solid tumor patients who were admitted to Cipto Mangunkusumo, Jakarta between September 2015 and December 2015. The ACCP/SCCM 2001 criteria was used to identify sepsis or SIRS in patients. Procalcitonin level, as well as routine blood examination, was performed to determine the differences of PCT level among solid tumor patients with and without metastasis. Cut off point of PCT for diagnosing sepsis in patients with metastatic solid tumors was determined using ROC curve. Results and Discussion: There were 112 patients with solid tumors, 51% male, with mean of age 47,9 ± 12,47 years. A total of 71 (63,4%) patients had metastasis, while 36 (32,1%) of them had sepsis and 6 (5,3%) experienced SIRS. Among 41 (36,6%) patients without metastasis, 9 (8%) had sepsis and 5 (4,4%) had SIRS. In the absence of sepsis, the PCT level was significantly higher in patients with metastatic solid tumors compared those without metastasis [0,25 ng/mL (0,07-1,76) vs. 0,09 ng/mL (0,03-0,54); p<0,001]. Metastatic solid tumor patients with sepsis had PCT levels higher than those without sepsis [3,5 ng / mL (0,66 to 189,4) vs. 0,25 ng / mL (0,07-1,76); p <0,001]. ROC curve showed that level of PCT for sepsis in metastatic solid tumors was AUC [0,956, IK 0,916-0,996]. Cut off point of PCT for sepsis in patients with metastatic solid tumors was 1.14 ng / mL with a sensitivity of 86% and specificity of 88%. Conclusion: In the absence of sepsis, PCT levels of patients with metastatic solid tumors is higher than patients without metastasis. Cut off point of PCT for sepsis diagnosis in metastatic solid tumors was 1,14 ng / mL.

Abstrak :
ABSTRAK
Latar Belakang : Sepsis memiliki mortalitas yang tinggi, dengan insiden yang semakin meningkat. Jenis mikroorganisme etiologi sepsis berhubungan dengan keparahan dan mortalitas pasien sepsis, dimana sepsis Gram negatif merupakan kelompok dengan keparahan dan mortalitas tertinggi. Kultur darah merupakan baku standar diagnosis etiologi sepsis dan dasar pemberian antimikroba definit, namun angka keberhasilannya rendah dan membutuhkan waktu beberapa hari. Pemeriksaan prokalsitonin (PCT) memiliki sensitivitas tinggi terhadap infeksi bakteri dan nilainya berbeda pada berbagai hasil kultur darah pasien sepsis. Belum ada data profil PCT pada pasien sepsis di Indonesia dan belum ada studi profil PCT pada sepsis non-bakteremia dengan fokus infeksi Gram negatif. Tujuan : Mendapatkan data profil PCT pada berbagai kelompok pasien sepsis. Metode : Penelitian ini merupakan studi potong lintang retrospektif terhadap data sekunder rekam medis dan laboratorium pasien sepsis yang dirawat di RSCM selama Januari 2013 ? Desember 2015. Dengan metode konsekutif subyek penelitian dikelompokkan berdasarkan etiologi sepsis. Hasil : Nilai median PCT pada sepsis bakteremia Gram negatif, bakteremia Gram positif, fungemia, dan sepsis non bakteremia dengan fokus infeksi Gram negatif berturut-turut 13,9 ng/mL, 2,73 ng/mL, 2,56 ng/mL, dan 5,25 ng/mL. Berdasarkan derajat keparahan sepsis, nilai median PCT tertinggi didapatkan pada syok sepsis pada kelompok bakteremia Gram negatif (65,16 ng/mL).

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ABSTRACT
Background : Sepsis has high mortality rate, and its incidence has been increasing recently. Microbes types as sepsis etiology are related to severity and mortality of septic patients. Gram-negative sepsis is the highest severity and mortality group of septic patients. Blood culture is gold standard to confirm etiology of sepsis and guidance for administration of definit antimicrobes, but its success rate is low and needs some days for the results Procalcitonin (PCT) has high sensitivity for bacterial infection, and it has different levels due to various results of blood cultures of septic patients. There are no datas about PCT profile in septic patients in Indonesia, and no studies before about PCT profile in non-bacteremia sepsis with Gram-negative focal infection. Aim: To obtain PCT profile in various groups of septic patients. Method: A cross-sectional retrospective study was conducted to collect medical records and laboratory datas of septic patients at RSCM during January 2013 until December 2015. By consecutive sampling subjects were grouping base on sepsis etiology. Result : PCT median values of Gram-negative bacteremia, Gram-positive bacteremia, fungemia, and non-bacteremia sepsis with Gram-negative focal infection are 13.9 ng/mL, 2.73 ng/mL, 2.56 ng/mL, and 5.25 ng/mL. Base on severity of sepsis, the highest level of PCT median (65.16 ng/mL) is found in septic shock in Gram-negative bacteremia group. Conclusion: Gram-negative bacteremia sepsis has the highest level of PCT median.