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Abstrak :
Latar Belakang : Gangguan fungsi hati pada meningitis tuberkulosis (MTB) dilaporkan sebesar 9,5- 43,3%. Gangguan hati dapat mempengaruhi tata laksana berupa interupsi pemberian obat anti tuberkulosis (OAT) yang dapat menyebabkan perburukan klinis dan meningkatkan risiko kematian terutama pada fase intensif. Metode : Studi kohort retrospektif pada pasien MTB untuk mengetahui karakteristik demografi, laboratorium gangguan fungsi hati dan mortalitas baik pada kelompok dengan dan tanpa interupsi OAT fase intensif. Penelurusan rekam medis pada pasien MTB yang dirawat di RSUPN Cipto Mangunkusumo pada Januari 2019 – April 2023. Hasil : Dari 200 subjek yang memenuhi kriteria, sebanyak 145 subjek (72,5%) mengalami gangguan fungsi hati, terdiri dari 88 subjek (60,7%) derajat ringan, 25 subjek (17,2%) derajat sedang, dan 32 subjek (22,1%) derajat berat. Gangguan fungsi hati banyak terjadi pada lak-laki (59,3%), median usia 37 tahun. Interupsi OAT dilakukan pada 43 subjek (29,7%). Perbedaan karakteristik yang bermakna adalah laki-laki (72,1% vs 53,9%, p=0,04), kadar tertinggi serum glutamic ocaloacetic transaminase (SGOT) (195 (10-2.945) vs 53,5 (14-464), p=<0,001) serum glutamic pyruvic transaminase (SGPT) (128 (10-1.268) vs 50 (10-294), p=<0,001), bilirubin total (1,57 (0,34-8,98) vs 1,08 (0,25-2,43), p=<0,001) dan direk (1,11 (0,19-8,05) vs 0,56 (0,12-2,01), p=<0,001). Gangguan fungsi hati derajat berat lebih banyak pada kelompok dengan interupsi (62,8% vs 4,9%, p=<0,001). Mortalitas lebih banyak pada kelompok dengan gangguan fungsi hati (34,5% vs 16,4%, p=0,012) dan pada kelompok dengan interupsi (55,8% vs 44,2%, p=<0,001). Kesimpulan : Gangguan fungsi hati pada MTB lebih banyak ditemukan pada laki-laki dengan usia dekade ketiga. Perbedaan karakteristik bermakna pada kelompok dengan interupsi OAT adalah kadar fungsi hati dan derajat gangguan fungsi hati yang lebih buruk. Mortalitas lebih banyak pada kelompok dengan gangguan fungsi hati dan kelompok dengan interupsi OAT. ...... Background : Liver dysfunction in tuberculosis meningitis (TBM) has been reported 9,5 – 43,3%. Liver dysfunction could impact to the therapy with interuption of antituberculosis therapy (ATT). That interruption can caused clinical deterioration and increase risk of death, especially in the intensive phase. Methods : Retrospective study on TBM patients to determine the demographic and laboratory characteristics of liver dysfunction and mortality in both groups with and without interruption of intensive phase ATT. Using medical records of TBM patients who admitted at Dr. Cipto Mangunkusumo National General Hospital from January 2019 to April 2023. Results : Total 200 subjects met the criteria, there were 145 subjects (72.5%) had liver dysfunction, the degree were consist of 88 subjects (60.7%) mild, 25 subjects (17.2%) moderate, and 32 subjects (22.1%) severe. Interruption ATT were in 43 subjects (29.7%). Liver dysfunction was common in male and median age were 37 years. Significant characteristics difference were male (72.1% vs 53.9%, p=0.04), peak level of aspartate transaminase (AST) (195 (10-2945) vs 53.5 (14-464), p=<0.001), alanine aminotransferase (ALT) (128 (10-1268) vs 50 (10-294), p=<0.001), total bilirubin (1.57 (0.34-8.98) vs 1.08 (0.25-2.43), p=<0.001) and direct bilirubin (1.11 (0.19-8.05) vs 0.56 (0.12-2.01), p=<0.001). Severe liver dysfunction more common in group with interruption (62.8% vs 4.9%, p=<0.001). Mortality was higher in liver dysfunction group (34.5% vs 16.4%, p=0.012), and in group with interruption (55.8% vs 44.2%, p=<0.001). Conclusion : Liver dysfunction in TBM more common in male in third decade. Significant characteristics difference were male, higher level of liver function test and degree of liver dysfunction. Mortality was higher in liver dysfunction group and group with interruption

Abstrak :
Background: acoustic radiation force impulse (ARFI) is a new proposed noninvasive method for liver fibrosis staging. Integrated with B mode ultrasonography, ARFI can be used to assess liver tissue condition. However its diagnostic accuracy is still being continuously evaluated. Also, there is lack of data regarding the utilization of ARFI in our population. This study aimed to evaluate the diagnostic value of ARFI as an alternative noninvasive modality for fibrosis staging in chronic hepatitis B and hepatitis C patients in our population. Methods: we conducted cross sectional comparison of ARFI imaging and transient elastography on patients who underwent liver biopsy at Cipto Mangunkusumo Hospital. Fibrosis staging using METAVIR scoring system presented as standard reference. A total of 43 patients underwent liver biopsy was evaluated by ARFI imaging and transient elastography. Cut off values were determined using receiver operating characteristic (ROC). Results: both liver stiffness determined by ARFI and transient elastography (TE) were moderately correlated with METAVIR score with value of 0.581 and 0.613, respectively (both P<0.01). Diagnostic accuracy of ARFI predicted significant fibrosis (F>2) with area under receiver operating characteristic curve (AUROC) of 0.773 (95% CI 0.616-0.930) and even better for cirrhosis (F4 fibrosis), expressed as AUROC of 0.856 (95% CI 0.736-0.975). Transient elastography was better for significant fibrosis with AUROC of 0.761 (95% CI 0.601-0.920) and was best for prediction of cirrhosis, expressed as AUROC of 0.845 (95% CI 0.722-0.968). Conclusion: ARFI is provided with more convenient evaluation of liver tissue condition, and its diagnostic accuracy is not significantly different from TE for staging liver fibrosis.