Wikanadi, Sinung (2016) Peningkatan Kadar Procalcitonin Pasien Trauma Tumpul Thoracoabdominal Dengan Iss ≥ 16 Dan Sirs Di Rsud Dr. Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Multitrauma dengan ISS ≥ 16, menjadi penyebab kematian terbanyak pada manusia usia produktif dan berlanjut menjadi penyebab hilangnya tahun-tahun kehidupan yang berharga dibandingkan kanker, penyakit jantung, dan stroke secara kombinasi. Trauma thoracoabdominal, sebagai mulitrauma, memberikan kontribusi yang tinggi terhadap kematian seorang pasien dikarenakan posisi anatominya, mengandung organ-organ vital tubuh, lokasi terbanyak benturan, dan sering tanpa perlukaan. Evaluasi awal prognosis pasien multitrauma merupakan hal yang sulit. Diperlukan parameter klinik yang mencerminkan kondisi aktual pasien. Procalcitonin (PCT) mempunyai kadar yang sangat kecil pada orang sehat. PCT selama ini diketahui sebagai biomarker yang dapat dipercaya pada kasus sepsis dan infeksi & mempunyai keakuratan dan nilai klinis untuk menentukan diagnosis sepsis pada pasien dengan penyakit kritis. PCT sebagai petanda SIRS pada trauma thoracoabdominal dan morbiditas akibat SIRS belum pernah diamati. Penelitian cohort dilakukan selama 4 bulan. Sampel darah diambil pada hari pertama dan hari ketiga pasca trauma. Didapatkan 53 orang subyek penelitian, 46 orang laki-laki dan 7 perempuan. 3 orang dropped out karena meninggal sebelum hari ketiga. Dari 50 orang subyek, 25 orang mengalami SIRS dengan 5 orang di antaranya meninggal, dan 25 orang tidak mengalami SIRS. Pasien yang mengalami SIRS dimasukkan dalam pengujian statistik. Hasil penelitian didapatkan rata-rata kadar PCT pada hari pertama adalah 11.178 ± SD 11.568 meningkat secara signifikan pada hari ketiga 13.998 ± SD 14.496, dengan nilai t -4.012 dengan signifikansi 0.001. Nilai rata-rata PCT pasien yang meninggal adalah 25.98±13.47 berbeda bermakna dengan sampel hari ketiga 34.02±16.74, dengan nilai t -4.119 dengan signifikansi 0.05. Hasil uji korelasi Pearson antara peningkatan kadar PCT dan SIRS diperoleh nilai r hitung sebesar 0.708 dengan nilai signifikansi 0.000, yang berarti semakin besar peningkatan procalcitonin, maka peluang untuk terjadinya SIRS akan meningkat. Kadar PCT yang didapatkan selama penelitian, mencerminkan tingginya tingkat inflamasi pada pasien. Semakin tinggi kadar PCT, diasosiasikan dengan banyaknya sitokin keradangan yang direlease oleh tubuh. Sitokin keradangan ini menunjukkan luasnya kerusakan jaringan akibat trauma. Peningkatan kadar PCT pada hari ketiga menunjukkan perluasan kerusakan jaringan akibat trauma, yang berujung pada peningkatan release sitokin pro inflamasi yang semakin hebat, yang tercermin pada tingginya kadar PCT pada hari ketiga. Dapat disimpulkan bahwa pasien-pasien trauma tumpul thoracoabdominal yang mengalami SIRS, didapatkan peningkatan kadar PCT.
English Abstract
Multitrauma with ISS ≥ 16, is the leading cause of death among productive age men and continue to be the cause of years of valuable life lost compared with cancer, heart disease, and stroke in combination. Thoracoabdominal trauma has great contribution to mortality of patient due to its anatomical position, contain vital body organs, the most body impact, and oftenly without any skin injury. Early prognosis evaluation of multitrauma patient is difficult. Clinical parameters which reflect patient’s actual condition is required. Procalcitonin (PCT) has a very low level among healty individuals. PCT is known to be reliable biomarker in septic and infection cases dan has accuracy and clinical value to determine diagnosis of sepsis among critically ill patients. PCT as biomarker of SIRS in thoracoabdominal trauma and morbidity caused by SIRS has never been observed. The research was done in 4 months. Blood sampel was taken within the first day and third day after trauma. 53 subjects were collected, 46 male and 7 female. 3 patients were dropped out becaused they died before the third day. Among 50 subjects, 25 subjects suffered from SIRS with 5 deaths, and 25 subjects were free from SIRS. Patients suffered from SIRS were included in statistical analysis. The result was mean value of PCT level in the first day was 11.178± SD 11.568, which was significantly increased in the third day 13.998 ± SD 14.496 with t value of -4.012, with level of significancy 0.001. The mean PCT level of deceased patients from the first day was 25.98 ± SD 13.47 which was significantly increased in the third day 25.98 ± SD 16.74, with t value of -4.119, with level of significancy 0.05. Pearson correlation test towards increasing levef of PCT and SIRS revealed rcounting was 0.708 with level of significancy 0.000, which means that, the more increasing level of PCT, the chance of SIRS event will also increasing. PCT levels obtained during research reflect high level of inflammation over patients. The higher level of PCT level was associated with the amount of pro inflammatory cytokines relased by the body. This amount of cytokines revealed the extensive tissue damage resulted from trauma. The increasing level of PCT on the third day showed the extension of tissue damage resulted from trauma, which effected in the increasing release of pro inflammatory cytokines. It was concluded that blunt thoracoabdominal trauma patients suffered from SIRS, had increasing level of PCT.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/61721/WIK/p/2016/041707888 |
| Uncontrolled Keywords: | ABDOMEN - WOUNDS AND INJURIES, CHEST - WOUNDS AND INJURIES, BACTERIAL DISEASE - DIAGNOSIS, TRAUMATIC CHOCK |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran |
| Depositing User: | Nur Cholis |
| Date Deposited: | 18 Sep 2017 06:20 |
| Last Modified: | 18 Sep 2017 06:20 |
| URI: | http://repository.ub.ac.id/id/eprint/2634 |
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