Hasanah, Dian (2018) Kesintasan, Faktor-faktor Prognostik, dan Skor Mortalitas Pasien Systemic Lupus Erythematosus di RSUD Dr. Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang. Kesintasan pasien dan kondisi berat sebagai penyumbang mortalitas SLE belum pernah dievaluasi di RSUD Dr. Saiful Anwar. Demikian pula sedikit informasi yang tersedia tentang morbiditas dan dampak penyakit pada kualitas hidup. Mengingat SLE adalah penyakit dengan hasil klinis yang seringkali berat, dan berkaitan dengan mortalitas dan morbiditas tinggi, maka analisis kesintasan penyakit ini sangat penting untuk mengevaluasi keberhasilan terapi selama ini. Pembuatan skor prognosis yang murah dan terjangkau dengan tetap memperhatikan tingginya sensitivitas dan spesifisitas, tentunya sangat bermanfaat untuk praktek klinis di negara berkembang. Metode. Semua data rekam medis pasien yang pernah dirawat di Poli Reumatologi maupun Instalasi Rawat Inap RSUD Dr. Saiful Anwar tahun 2013-2017 dicatat. Kami mendapatkan total 373 pasien SLE. Kami juga melakukan wawancara pasien SLE di Poli Reumatologi RSUD Dr. Saiful Anwar untuk melengkapi data yang tidak ditemukan dalam rekam medis. Analisis kesintasan dilakukan dengan metode Kaplan-Meier dan Life Table. Analisis prognosis dilakukan dengan analisis bivariat dan dilanjutkan dengan analisis multivariat. Setelah itu dilanjutkan dengan pembentukan rumus prognosis dan pembuatan skor prognosis. Hasil. Median usia saat pasien terdiagnosis adalah 28 tahun. Median selisih antara usia saat pasien mengalami onset hingga terdiagnosis adalah < 1 tahun dan 30% pasien terlambat dikonsulkan. Sebagian besar pasien didiagnosis SLE oleh Dokter Konsultan Reumatologi (79,1%). Terdapat 24,1% pasien yang pernah mengalami remisi, dengan median jangka waktu tercapainya remisi pertama adalah 20 bulan (1,7 tahun). Gangguan dalam kehidupan sehari-hari yang diderita pasien akibat SLE berupa kelelahan (fatigue) 82%, cuti dari sekolah/kerja 43%, dan berhenti dari pekerjaan 32,5%. Sejumlah 50% pasien pernah mengeluhkan gejala dan tanda depresi dan/atau kecemasan akibat penyakit SLE yang dideritanya. Kesintasan pasien SLE di RSUD Dr. Saiful Anwar Malang untuk 1 tahun adalah 88%, untuk 5 tahun adalah 80%, dan untuk 10 tahun adalah 75%. Sebanyak 16,3% kasus rawat inap berakhir dengan kematian, di mana sebab kematian meliputi: akibat aktivitas SLE (39,2%), akibat infeksi (23,5%), serta akibat kombinasi aktivitas SLE dan infeksi (37,3%). Faktor-faktor yang menjadi risiko untuk mortalitas adalah: neuropsikiatri lupus, nefritis lupus, trombositopenia, hipertransaminase, hiperbilirubinemia, hipoalbuminemia, hiponatremia, dan perawatan di ruang intensif atas indikasi apapun. Kesimpulan. Kami telah membuat kartu skor prognosis mortalitas dan menetapkan kesintasan berdasarkan faktor-faktor prognosis tersebut.
English Abstract
Background. Survival of patients and severe conditions as a contributor to SLE mortality has never been evaluated in Dr. Saiful Anwar General Hospital. Similarly, only little information is available about the morbidity and impact of disease on quality of life. Considering that SLE can cause severe clinical outcomes, and is associated with high mortality and morbidity, then the survival analysis of the disease is essential to evaluate the success of therapy. Making a good and affordable prognostic score is certainly useful for clinical practice in developing countries. Method. All medical records of outpatients and inpatients who had been treated by Rheumatology Department of Dr. Saiful Anwar General Hospital from year 2013 to 2017 were recorded. We collected 640 medical records and got 373 names of SLE patients. We also conducted interviews to them to got information which were not found in the medical record. We conducted survival analysis with Kaplan-Meier and Life Table methods. Prognostic analysis was conducted with multivariate analysis and proceeded with prognosis formulation and prognosis score generation. Results. The median age at the time the patient was diagnosed is 28 years. The median difference between the of age of onset and diagnosis was < 1 year. About 30% of patients were late to be counselled to Rheumatologist. Most patients were diagnosed by Rheumatologist (79.1%). There were 24.1% of patients who had disease remission, with the median period of first remission was 20 months (1.7 years). Disease burden experienced by the patients were: fatigue (82%), leaving school/work (43%), and quit from work (32,5%). About 50% of patients complained symptoms and signs of depression and/or anxiety due to their disease. Most patients had lymphopenia (79.6%) and 38.9% had lymphopenia and leukopenia. Lupus nephritis is a common disorder, followed by haemolytic anemia, thrombocytopenia, lupus neuropsychiatric and serositis. Survival of SLE patients in Saiful Anwar General Hospital for 1 year is 88%, for 5 years is 80%, and for 10 years is 75%. There were 16.3% of inpatient cases ended with death, which was due to death from SLE activity (39.2%), infection (23.5%), and combination of SLE and infection (37.3%). Factors that are at risk for mortality are: lupus neuropsychiatric, lupus nephritis, serositis, thrombocytopenia, hypertransaminase, hyperbilirubinemia, hypoalbuminemia, hyponatremia, vascular disorders and hospitalization at intensive care units. Conclusion. We have created a mortality score card based on significant prognostic factors and created survival curve for SLE patients in Dr. Saiful Anwar General Hospital.
Other obstract
-
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.772/HAS/k/2018/041802334 |
| Uncontrolled Keywords: | LUPUS ERYTHEMATOSUS |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.7 Diseases of musculoskeletal system > 616.77 Diseases of connectives tissues > 616.772 Systemic lupus erythematosus |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Penyakit Dalam, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 28 Jan 2020 04:30 |
| Last Modified: | 28 Jan 2020 04:30 |
| URI: | http://repository.ub.ac.id/id/eprint/178413 |
Actions (login required)
 |
View Item |