Florentia, Shinta Wulandari and dr. Neila Raisa, Sp.S (K), M. Biomed and dr. S. B. Rianawati, Sp.S (K) and Dr. dr. Nanik Setijowati, M. Kes (2023) Pengaruh Kadar Fibrinogen dan D-Dimer terhadap Gangguan Kognitif Vaskular pada Pasien Stroke Iskemik Akut di RSUD Dr. Saiful Anwar Jawa Timur. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang: Stroke iskemik adalah suatu kondisi penurunan aliran darah ke bagian otak secara akut yang menyebabkan kerusakan jaringan otak. Biomarker Fibrinogen dan D-Dimer pada kasus stroke iskemik akut memiliki peranan dalam terjadinya neurodegeneratif yaitu berupa gangguan kognitif vaskular yang dapat berakhir dengan suatu kondisi demensia vaskular sehingga dalam jangka panjang mengganggu kualitas hidup pasien dan menimbulkan masalah sosial baik bagi pasien maupun keluarga, namun hingga saat ini belum ada penelitian di Indonesia secara umum maupun secara khusus di RSUD Dr. Saiful Anwar Jawa Timur terkait hal tersebut. Tujuan: Untuk mengetahui pengaruh kadar Fibrinogen dan D-Dimer terhadap gangguan kognitif vaskular pada pasien stroke iskemik akut di RSUD Dr. Saiful Anwar Jawa Timur. Metode: Penelitian ini menggunakan studi cross sectional pada 23 pasien stroke iskemik akut yang dirawat Januari 2022 sampai dengan Januari 2023 di RSUD Dr. Saiful Anwar Jawa Timur. Teknik pengambilan sampel dengan consecutive sampling yang memenuhi kriteria inklusi dan eksklusi. Hasil: Dari keseluruhan sampel penelitian didapatkan pasien dengan usia ratarata 60.87 tahun, dengan jenis kelamin pria 13 orang dan wanita 10 orang. Riwayat penyakit dahulu dominan Hipertensi pada 18 orang, Diabetes mellitus type 2 sebanyak 7 orang dan obesitas 2 orang. Terdapat 10 orang (43.5%) dengan peningkatan D-Dimer dan 5 orang (21.7%) dengan peningkatan kadar Fibrinogen. Pada uji regresi linier berganda hasil kadar Fibrinogen dan D-Dimer berpengaruh sebesar 64.8% terhadap skor MoCA-INA jika dilakukan analisis secara bersamaan (Fibrinogen, p=0.000 dan D-Dimer, p=0.022) dengan sumbangan efektif dipengaruhi oleh Fibrinogen yaitu 52.43%. Untuk memenuhi aplikasi praktik klinis pada penelitian ini didapatkan secondary outcome dengan uji regresi linier sederhana yaitu Fibrinogen dan D-Dimer dianalisis secara terpisah didapatkan hanya Fibrinogen berpengaruh signifikan (p=0.000), sedangkan D-Dimer tidak berpengaruh signifikan (p=0.079) terhadap skor MoCA-INA. Titik potong Fibrinogen sebesar 329.25 sehingga pada kadar Fibrinogen >329.25 maka pasien kemungkinan mempunyai resiko mengalami gangguan kognitif sebesar 12 kali (OR=12.0, CI=95%, 1.103-130.58 kali). Kesimpulan: Terdapat pengaruh kadar Fibrinogen dan D-Dimer terhadap gangguan kognitif vaskular pada pasien stroke iskemik akut. Pada aplikasi klinis pasien stroke iskemik akut dengan biomarker tunggal Fibrinogen >329.25 didapatkan kemungkinan mempunyai resiko mengalami gangguan kognitif sebesar 12 kali (OR=12.0, CI=95%, 1.103-130.58 kali).
English Abstract
Background: Ischemic stroke is a condition of acutely decreasing blood flow to a part of the brain which causes damage to brain tissue. Fibrinogen and D-Dimer biomarkers in cases of acute ischemic stroke have a role in neurodegenerative events, vascular cognitive impairment can causes a condition of vascular dementia so that it disrupts the patient's quality of life and causes social problems for both the patient and their family, but there has been no research in Indonesia or specifically at Saiful Anwar General Hospital of East Java relating to this matter. Objective: To determine the effect of Fibrinogen and D-Dimer plasma levels on vascular cognitive impairment in acute ischemic stroke patients at General Hospital of East Java. Method: This study used a cross-sectional study on 23 acute ischemic stroke patients who were treated from January 2022 to January 2023 at Dr. Saiful Anwar East Java. Sampling technique with consecutive sampling that meets the inclusion and exclusion criteria. Results: Of the total study sample, the average age of patients was 60.87 years, with 13 male and 10 female patients. The leading pre-existing conditions were hypertension, affecting 18 people, type 2 diabetes in seven people, and obesity in two people. Out of the sample, 10 people (43.5%) had an elevated D-dimer level and five people (21.7%) had an elevated fibrinogen level. In the multiple linear regression analysis, Fibrinogen and D-Dimer levels contributed 64.8% to MoCAINA scores when analyzed together (Fibrinogen, p=0.000 and D-Dimer, p=0.022), with the effective contribution influenced mainly by Fibrinogen (52.43%). To meet clinical practice applications in this study, a simple linear regression analysis was conducted, showing that only Fibrinogen levels significantly affected MoCA-INA scores (p=0.000), while D-Dimer did not show a significant correlation (p=0.079). The cut-off point for Fibrinogen was 329.25, so with Fibrinogen levels >329.25, patients are likely to have a 12-times risk of experiencing cognitive impairment (OR=12.0, CI=95%, 1.103-130.58 times) Conclusion: There is an effect of Fibrinogen and D-Dimer levels on vascular cognitive impairment in acute ischemic stroke patients. In clinical applications, acute ischemic stroke patients with a single biomarker Fibrinogen >329.25 have a 12-times risk of experiencing cognitive impairment (OR=12.0, CI=95%, 1.103- 130.58 times).
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0423060107 |
| Uncontrolled Keywords: | Fibrinogen, D-Dimer, Gangguan Kognitif Vaskular, Stroke Iskemik Akut |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.8 Diseases of nervous system and mental disorders |
| Divisions: | Profesi Kedokteran > Spesialis Neurologi, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 13 Dec 2023 03:05 |
| Last Modified: | 13 Dec 2023 03:05 |
| URI: | http://repository.ub.ac.id/id/eprint/205343 |
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