Performa Nilai Diagnostik Peritoneal Neutrophil Gelatinase-Associated Lipocalin, Jumlah Lekosit, Dan Nilai Polimorfonuklear Cairan Continuous Ambulatory Peritoneal Dialysis Pada Pasien Peritonitis.

Tangdililing, Marianne Lukytha and DR.dr.Hani Susianti,, Sp.PK(K), and Siti Fatonah,, Sp.PK (2019) Performa Nilai Diagnostik Peritoneal Neutrophil Gelatinase-Associated Lipocalin, Jumlah Lekosit, Dan Nilai Polimorfonuklear Cairan Continuous Ambulatory Peritoneal Dialysis Pada Pasien Peritonitis. Magister thesis, Universitas Brawijaya.

Abstract

Peritonitis merupakan komplikasi yang serius dan paling sering terjadi pada pasien dialisis peritoneal. Penegakan diagnosis peritonitis CAPD juga sering ditemukan hambatan. Pemeriksaan lekosit khususnya polimorfonuklear (PMN) dapat memberikan hasil positif dan negatif palsu. Kultur memerlukan waktu yang lama dan sulit memberikan ketepatan evaluasi sehingga diperlukan biomarker baru. Neutrophil gelatinase-associated lipocalin (NGAL) merupakan suatu protein yang telah lama digunakan sebagai penanda inflamasi. NGAL dapat disekresikan oleh granulosit melalui kontak langsung terhadap mikroba maupun melalui sitokin inflamasi pada human peritoneal mesotelial cell (HPMC). Penelitian ini bertujuan mengetahui perbedaan dan korelasi antara kadar peritoneal NGAL (pNGAL), jumlah lekosit, dan nilai PMN serta menentukan nilai diagnostik dari pNGAL, lekosit, dan PMN pada penderita peritonitis. Penelitian cross sectional dilakukan di RSSA pada pasien yang dicurigai peritonitis dan memenuhi kriteria inklusi. Pemeriksaan jumlah lekosit dan persentase PMN dengan metode Flow Cytometry (Sysmex UF-500I), pewarnaan Gram, dan kultur. Kadar pNGAL diukur dengan metode ELISA (Enzyme linked immunoassay). Hasil penelitan ini didapatkan total subyek penelitian 76 orang dengan 57 peritonitis dan 19 non peritonitis. Uji beda Mann-Whitney didapatkan perbedaan bermakna (p<0,05) jumlah lekosit dan nilai PMN pada kedua kelompok. Tidak didapatkan perbedaan bermakna pNGAL pada kedua kelompok. Tidak didapatkan korelasi bermakna antara peningkatan jumlah lekosit dan kadar pNGAL (p=0,095, r=0,41). Nilai cut off pNGAL, jumlah lekosit, dan nilai PMN masing-masing adalah ≥4,87 pg/mL, ≥84,45/μL, dan ≥52,5%. Uji diagnostik didapatkan sensitivitas pNGAL 70,2%, jumlah lekosit 91,2%, dan PMN 91,2%. Spesifisitas 36,8%, jumlah lekosit 73,3%, dan PMN 68,4%. Kesimpulan penelitian ini tidak ditemukan perbedaan bermakna kadar pNGAL pada kelompok peritonitis dan non peritonitis; jumlah lekosit, nilai PMN dan kadar pNGAL menunjukkan korelasi yang tidak bermakna; dan nilai diagnostik optimal adalah jumlah lekosit dan nilai PMN dengan metode Flow Cytometry.

English Abstract

Peritonitis is a serious and most common complication that occurs in peritoneal dialysis patients. Determination of the diagnosis has a obstacles. Examination of leukocytes especially polymorphonuclear (PMN) can give positive and false negative results. Culture requires a long time and it is difficult to provide an accurate evaluation so new biomarker is needed. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein that has long been used as a marker of inflammation. NGAL can be secreted by granulocytes through direct contact with microbes or through inflammatory cytokines in the human peritoneal mesothelial cell (HPMC). This study aims to determine the differences and correlation between peritoneal NGAL levels (pNGAL), leukocyte count, and PMN values and determine the diagnostic value of pNGAL, leukocytes, and PMN in patients with peritonitis. The cross sectional study was carried out in RSSA, in patients suspected of peritonitis and who met the inclusion criteria. Examination of leukocytes and PMN values using Flow Cytometry (Sysmex UF-500i), Gram staining, and culture. pNGAL levels were measured by the ELISA (Enzyme linked immunoassay) method. The results of this study found a total of 76 study subjects with 57 peritonitis and 19 non peritonitis. Mann-Whitney difference test found significant differences (p <0.05) on the number of leukocytes and PMN values in both groups. There were no significant differences in pNGAL in the two groups. There was no significant correlation between increased leukocyte count and pNGAL level (p = 0.095, r = 0.41). The cut off value of pNGAL, leukocytes count, and PMN percentage were ≥4.87 pg/mL, ≥84.45/μL, and ≥52.5% respectively. The diagnostic test found pNGAL sensitivity of 70.2%, leukocyte count of 91.2%, and PMN 91.2%. Specificity pNGAL of 36.8%, leukocyte count of 73.3%, and PMN 68.4%. The conclusion of this study is that no significant differences were found in pNGAL levels in the peritonitis and non-peritonitis groups; the number of leukocytes, PMN values and pNGAL levels showed an insignificant correlation; and the optimal diagnostic value is the number of leukocytes and the value of PMN with Flow Cytometry.

Item Type:	Thesis (Magister)
Identification Number:	TES/617.558/TAN/p/2019/041901662
Uncontrolled Keywords:	Peritonitis, leukocyte count, PMN value, peritoneal dialysis,Peritonitis, Jumlah Lekosit, Nilai PMN, Cairan CAPD
Subjects:	600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology
Divisions:	Profesi Kedokteran > Spesialis Patologi Klinik, Fakultas Kedokteran
Depositing User:	Sugeng Moelyono
Date Deposited:	18 Aug 2022 02:35
Last Modified:	18 Aug 2022 02:35
URI:	http://repository.ub.ac.id/id/eprint/193288

Text Marianne Lukytha Tangdililing.pdf Download (4MB)

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