Skoring Diagnostik Berbasis Klinis Dan Laboratorium Sebagai Prediktor Awal Untuk Membedakan Meningitis Tuberkulosa Dan Meningitis Viral Pada Pasien Usia Dewasa Di Rs Saiful Anwar Malang

Handoko, Eko Aprilianto (2019) Skoring Diagnostik Berbasis Klinis Dan Laboratorium Sebagai Prediktor Awal Untuk Membedakan Meningitis Tuberkulosa Dan Meningitis Viral Pada Pasien Usia Dewasa Di Rs Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.

Abstract

Latar Belakang: Diagnosis Meningitis tuberkulosis (MTB) dan meningitis viral di daerah dengan fasilitas terbatas, ditegakkan secara empiris berdasarkan klinis, epidemiologi dan temuan laboratorium. Keterlambatan dan kesalahan diagnosis meningkatkan angka mortalitas dan morbiditas pasien MTB dan meningitis viral. Penegakan diagnosis MTB dan meningitis viral menantang karena klinis dan nilai laboratorium serupa, Sehingga dibutuhkan alat diagnostik tambahan berupa skoring sederhana untuk membedakan diagnosis MTB dengan meningitis viral. Beberapa skoring telah diteliti namun belum digunakan secara luas sehingga diperlukan skor pembanding terutama di negara asia tenggara. Tujuan: Untuk menemukan model skoring baru yang memiliki nilai diagnostik cukup baik dalam membedakan MTB dan meningitis viral. Metode : Penelitian menggunakan retrospektif kohort. Sampel penelitian adalah pasien MTB dan meningitis viral di RSSA bulan januari 2016 - Desember 2018. Kriteria Diagnosis untuk MTB berdasarkan kriteria Lancet Scoring System dan diagnosis meningitis viral ditegakkan apabila tidak ditemukan penyebab lain meningitis dan perbaikan klinis dengan terapi konservatif. Manifestasi klinis dan nilai laboratorium dibandingkan antara pasien MTB dan Meningitis Viral. Hasil : Penelitian melibatkan 86 pasien MTB dan 40 meningitis viral. Berdasarkan analisa regresi logistik beberapa faktor prediktif signifikan untuk diikutkan model skoring : kejang, grade meningitis, LED, natrium, leukosit darah, Protein LCS, LDH LCS. Kami menyusun 3 model skoring yaitu : Brawijaya Meningitis Skor 1 (BMS1) (Klinis dan laboratorium darah), BMS2 (Klinis dan Analisa LCS), BMS3 (Klinis, laboratorium darah dan analisa LCS). Titik potong skor ditentukan menggunakan analisa kurva ROC. Ketiga model skoring tersebut memiliki memiliki nilai diagnostik cukup baik. Kesimpulan : Terdapat 3 model skoring BMS untuk membedakan MTB dan menigitis viral berdasarkan klinis dan nilai laboratorium. Skoring BMS mudah diaplikasikan dan memiliki nilai diagnostik cukup baik, terutama pada daerah dengan fasilitas diagnostik terbatas

English Abstract

Background : The diagnosis of tuberculous meningitis (TBM) and viral meningitis, at region with limited health facilities, enforced empirically based on clinical findings, epidemiological, and laboratory result. The Delay and misdiagnosis of TBM and viral meningitis can increase mortality and morbidity. The diagnosis of TBM and viral meningitis was challenging because of similar clinical and laboratory values, so the novel simple scoring to distinguish the diagnosis is needed. Several scoring systems have been studied, but have not been widely applied, so comparative scores are needed especially in Southeast Asian countries. Objective : The study aims to find a novel scoring system that has good diagnostic's value for distinguishing TBM and viral meningitis. Methods : The study used a retrospective cohort. The study sample was TBM patients and viral meningitis in RSSA in January 2016 - December 2018. Diagnosis criteria for TBM based on the Lancet Scoring System and diagnosis of viral meningitis are established if no other etiology is found and there are clinical improvements with conservative therapy. Clinical manifestations and laboratory values were compared between TBM and Viral Meningitis group. Results : The study involved 86 TBM and 40 viral meningitis patients. Significant predictive factors (P <0.05) included a scoring model, based on logistic regression analysis: seizures, meningitis grade, LED, sodium, blood leukocytes, CSF protein, CSF LDH. We compiled 3 novel scoring models : Brawijaya Meningitis Score 1 (BMS1) (Clinical and blood laboratory), BMS2 (Clinical and CSF Analysis), BMS3 (Clinical, blood laboratory and CSF analysis). The BMS cutoff value is determined using the ROC curve analysis. The scoring models have good diagnostic values. Conclusion : There are 3 novel scoring of BMS to differentiate TBM and viral menigitis. BMS is easy to apply and has good diagnostic value, especially in regions with limited diagnostic facilities

Other obstract

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Item Type:	Thesis (Magister)
Identification Number:	TES/616.995/HAN/s/2019/041901659
Uncontrolled Keywords:	Meningitis Tuberkulosis, Meningitis Viral, Brawijaya Meningitis Skor
Subjects:	600 Technology (Applied sciences) > 616 Diseases > 616.9 Other disease > 616.99 Tumors and miscellaneous communicable diseases > 616.995 Tuberculosis
Divisions:	Profesi Kedokteran > Spesialis Neurologi, Fakultas Kedokteran
Depositing User:	Endang Susworini
Date Deposited:	18 Jul 2022 04:45
Last Modified:	18 Jul 2022 04:45
URI:	http://repository.ub.ac.id/id/eprint/192196

Text Eko Aprilianto Handoko.pdf Download (5MB)

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