Prognostic Nutritional Index (PNI) Sebagai Faktor Prognosis Mortalitas Pada Adenokarsinoma Paru Stadium IV

SUBROTO, dr. Eko Budiono, SpPD-KP;dr. Sumardi, SpPD-KP

2020 | Tesis-Spesialis | ILMU PENYAKIT DALAM

INTISARI PROGNOSTIC NUTRITIONAL INDEX (PNI) SEBAGAI FAKTOR PROGNOSIS MORTALITAS PADA ADENOKARSINOMA PARU STADIUM IV Subroto1, Eko Budiono2, Sumardi2 1Peserta Program Pendidikan Dokter Spesialis, Ilmu Penyakit Dalam FKKMK Universitas Gadjah Mada 2Subdivisi Pulmonologi Ilmu Penyakit Dalam FKKMK Universitas Gadjah Mada Latar Belakang. Penelitian mengenai biomarker prognosis pada kanker paru terus dilakukan. Beberapa indikator nutrisional dan imunologis, seperti Prognostic Nutritional Index (PNI), Platelet-to-Lymphocyte Ratio (PLR), dan Glasgow Prognostic Score (GPS), telah digunakan sebagai penilaian prognosis pasien kanker paru dan untuk menentukan terapi yang optimal. Dari sejumlah indeks nutrisional dan imunologis ini, PNI adalah yang sering digunakan. Tujuan Penelitian. Penelitian ini bertujuan untuk menganalisis hubungan antara nilai PNI yang rendah (PNI<40) dengan peningkatan risiko mortalitas pasien kanker paru Adenokarsinoma stadium IV Metode. Penelitian ini dilakukan dengan metode kohort-retrospektif, dengan melihat data status Prognostic Nustritional Index (PNI) di catatan medis dan kemudian menghitung mortalitas pasien kanker paru Adenokarsinoma stadium IV. Jumlah sampel penelitian ini sebanyak 265 yang telah memenuhi kriteria inklusi dan eksklusi, diambil dari catatan medis pasien Adenokarsinoma paru stadium IV yang dirawat di RSUP dr. Sardjito Yogyakarta kurun waktu 1 Januari 2016 – 1 Juli 2019. Nilai PNI dihitung dengan rumus 10 x serum albumin (g/dl) + 0,005 x lymphocyte count (per mm3). Data mortalitas dihitung 6 bulan sejak tegak diagnosis. Uji statistik dengan chi square digunakan untuk menganalisis beda proporsi mortalitas dan variabel pengganggu. Uji regresi logistik multipel digunakan untuk menganalisis keeratan hubungan antara prognostic nutritional index (PNI) dengan mortalitas. Hasil. Subyek yang memiliki skor PNI < 40 berisiko mengalami kematian 3 kali dari subjek yang memiliki skor PNI ≥40 (adjusted OR 3,356, 95% CI 1,165-9,670, nilai p = 0,025). Kesimpulan. Skor PNI terbukti berpengaruh secara bermakna terhadap prognosis mortalitas pada pasien kanker paru jenis adenokarsinoma stadium IV Kata Kunci. PNI (Prognostic Nutritional Index), Adenokarsinoma paru, mortalitas

ABSTRACT PROGNOSTIC NUTRITIONAL INDEX (PNI) AS A PROGNOSTIC FACTOR IN STAGE IV LUNG ADENOCARCINOMA Subroto 1, Eko Budiono 2, Sumardi 2 1Resident of Internal Medicine, Department of Internal Medicine Faculty of Medicine Public Health and Nursing Gadjah Mada University/Dr. Sardjito Hospital Yogyakarta 2Division of Pulmonology, Department of Internal Medicine Faculty of Medicine Public Health and Nursing Gadjah Mada University/Dr .Sardjito Hospital Yogyakarta Background. Studies of biomarkers for prognostic prediction in lung cancer is an ongoing effort. Several nutritional and immunological indicators, such as Prognostic Nutritional Index (PNI), Platelet-to-Lymphocyte Ratio (PLR), and Glasgow Prognostic Score (GPS), have been used to assess the outcome of lung cancer patients and to determine optimal treatments. Of all potential nutritional and immunological indices, PNI is the frequently used. Objectives. To analyze the association between low PNI score (PNI <40) and increased risk of mortality among stage IV pulmonary adenocarcinoma patients Methods. A cohort-retrospective study was performed by extracting prognostic Nustritional Index (PNI) data from medical records and the mortality of patients with stage IV pulmonary adenocarcinoma. A Total of 265 patients met the inclusion and exclusion ciriteria, based on the medical records of patients with stage IV pulmonary adenocarcinoma who were hospitalized at dr. Sardjito hospital Yogyakarta between January 1st, 2016 and July 1st, 2019. PNI score were calculated as follows:10 x serum albumin (g/dl) + 0.005 x lymphocyte count (per mm3). Mortality was considered six months since the diagnosis. Chi square tests were used to analyze the proportions of mortality and confounders. Multiple logistic regression tests were used to analyze the association between prognostic nutritional index (PNI) and mortality. Results. Subjects who had PNI score <40 were at risk of mortality three times higher than subjects with PNI score ≥40 (adjusted OR 3.356, 95% CI 1.165 - 9.670, p = 0.025). Conclusion. PNI score had a significant effect on the mortality in patients with stage IV pulmonary adenocarcinoma. Keywords. PNI (Prognostic Nutritional Index), Pulmonary adenocarcinoma, mortality

Kata Kunci : PNI (Prognostic Nutritional Index), Adenokarsinoma paru, mortalitas