Paramita, Dyah (2016) Kadar Dna Sirkulasi Sebagai Biomarker Survival Pada Multitrauma Di Rumah Sakit Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.
Abstract
Multi trauma merupakan trauma yang secara simultan terjadi pada 2 organ atau lebih dan minimal salah satu trauma mengancam jiwa. Salah satu penyebab kematian pada trauma adalah komplikasi. Deteksi awal adanya komplikasi trauma adalah melalui aplikasi biomarker sehingga dapat meningkatkan outcome pada trauma yang parah. Salah satu biomarker untuk mendeteksi adanya reaksi inflamasi pada multitrauma adalah kadar DNA sirkulasi. Kadar DNA sirkulasi berikatan dengan molekul protein yang berbentuk nukleosom. Pada penelitian ini, akan menganalisis peranan kadar sirkulasi DNA sebagai biomarker penentu kerusakan organ dan survival pada pasien multitrauma. Penelitian ini merupakan penelitian cohort dengan subyek penelitian merupakan pasien multitrauma yang datang di IGD Rumah Sakit Saiful Anwar Malang yang memenuhi dengan criteria inklusi. Kadar nukleosom sirkulasi, ISS, RTS, PS, GCS, kadar leukosit akan diukur ketika subyek berada di Instalasi Gawat Darurat. Selanjutnya, subyek akan diikuti hingga hari ke-7 untuk menentukan status survival. Pemeriksaan kadar nukleosom darah menggunakan Nucleosome Kit ELISA (Abnova Corporation) dan dilakukan di Laboratorium Sentral Ilmu Hayati Universitas Brawijaya. Analisa data menggunakan uji korelasi Pearson, Korelasi Spearman, dan Uji t tidak berpasangan (independent sample t-test) dan chi square. Penelitian dilakukan selama 6 bulan dan didapatkan 86 pasien trauma dengan evaluasi pada hari ketujuh perawatan didapatkan 74 pasien hidup dan 12 pasien meninggal. Jumlah pasien laki-laki 59 orang (68,6%) dan 27 pasien perempuan (31,4%). Nilai skoring GCS, RTS, PS lebih tinggi secara bermakna pada kelompok hidup dibandingkan kelompok meninggal (p < 0,001). Nilai skoring ISS dan MOF lebih rendah secara bermakna pada kelompok hidup dibandingkan kelompok meninggal (p < 0,001). Kadar nukleosom sirkulasi tidak berbeda bermakna antara kelompok hidup dibandingkan kelompok meninggal (p > 0,05). Untuk jumlah leukosit, pada kelompok meninggal lebih tinggi secara bermakna dibandingkan kelompok hidup (p < 0,05). Nilai korelasi kadar nukleosom sirkulasi dengan usia, GCS, ISS, RTS, PS, dan leukosit pada semua sampel penelitian menunjukkan adanya korelasi negatif dengan nilai yang bermakna antara kadar nukleosom sirkulasi dengan usia (p = 0,05;r = -0,341). Berdasar status survival, tidak didapatkan korelasi secara bermakna antara kadar nukleosom sirkulasi dengan usia, GCS, ISS, RTS, PS, dan leukosit (p > 0,05). Selain itu, tidak terdapat hubungan yang bermakna antara kadar nukleosom sirkulasi dengan Skor MOF. Kesimpulan dari penelitian ini adalah tidak terdapat hubungan antara kadar nukleosom sirkulasi dengan status survival pasien multitrauma. Kadar nukleosom sirkulasi tidak berhubungan dengan MOF, GCS, ISS, RTS, PS, dan leukosit pada pasien multitrauma. Namun, berhubungan dengan usia pada semua subyek. Kadar nukleosom belum dapat digunakan sebagai prediktor survival pada pasien multitrauma.
English Abstract
Multi trauma is trauma that occurs simultaneously in two or more organs and at least one life-threatening trauma. One of the causes of death in trauma is a complication. Early detection of complications of trauma is through the application of biomarkers that can improve outcome in severe trauma. One biomarker to detect the presence of inflammatory reaction in multitrauma is circulating DNA levels. Levels of circulating DNA binds to protein molecules that form nucleosomes. In this study, will analyze the role of the circulating levels of DNA as a biomarker determinants of organ damage and survival in patients multitrauma This study is a cohort study with research subjects are mulitrauma patients who arrive in the Emergency Room of Saiful Anwar Hospital in Malang who meet the inclusion criteria. Levels of circulating nucleosomes, ISS, RTS, PS, GCS, leukocyte levels will be measured when the subject is in the ER. Furthermore, subjects will be followed until day 7 to determine the survival status. The necleosome level of blood was analized using Nucleosome nucleosome ELISA Kit (Abnova Corporation) and was conducted at the Central Laboratory of Biological Sciences University of Brawijaya. Data were analyzed using Pearson correlation test, Spearman Correlation, and unpaired t test (independent sample t-test) and chi square. The study was conducted for 6 months and gained 86 trauma patients with an evaluation on the seventh day treatment there were 74 patients survive and 12 patients died. There were 59 male (68.6%) and 27 female patients (31.4%). GCS, RTS, PS was significantly higher in the survive group than died group (p <0.001). ISS and MOF scoring was significantly lower in the survive group than died group (p <0.001). Circulating nucleosomes levels were not significantly different between survive groups than died group (p> 0.05). For leukocyte, the died group was significantly higher than the survive group (p <0.05). The correlation of circulating nucleosomes with age, GCS, ISS, RTS, PS, and leukocytes in all samples showed that there was a negative correlation with significant corelation between the levels of circulating nucleosomes with age (p = 0.05, r = -0.341). Based on survival status, no significant correlation between circulating nucleosomes levels with age, GCS, ISS, RTS, PS, and leukocytes (p> 0.05). In addition, there is no significant relationship between levels of circulating nucleosomes with MOF Score. The conclusion of this study there was no association between levels of circulating nucleosomes with patient survival status multitrauma. Levels of circulating nucleosomes are not related to MOF, GCS, ISS, RTS, PS, and leukocytes in patients multitrauma. However, dealing with age in all subjects. Nucleosome levels can not be used as a predictor of survival in patients multitrauma.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/617.1/PAR/k/2017/041707889 |
| Uncontrolled Keywords: | PSYCHIC TRAUMA, DNA, SURVIVAL |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran |
| Depositing User: | Nur Cholis |
| Date Deposited: | 14 Sep 2017 06:12 |
| Last Modified: | 14 Sep 2017 06:12 |
| URI: | http://repository.ub.ac.id/id/eprint/2521 |
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