PREDIKTOR KEMATIAN ANAK DENGAN ENSEFALOPATI DENGUE

AFIARINA DHEVIANTY, dr. Eggi Arguni, Msc, PhD, SpA; dr. Agung Triono, SpA

2017 | Tesis | S2 Ilmu Kedokteran Klinik

Ensefalopati dengue merupakan manifestasi infeksi dengue yang sering berakibat fatal. Belum banyak penelitian yang menjelaskan tentang faktor yang mempengaruhi prognosis ensefalopati dengue pada anak. Tujuan. Mengetahui prediktor kematian ensefalopati dengue pada anak. Metode. Penelitian menggunakan metode retrospektif case control. Data diambil dari rekam medis anak (1-18 tahun) dengan ensefalopati dengue yang dirawat di RSUP Dr. Sardjito sejak Januari 2010 hingga Desember 2016. Prediktor kematian yang diteliti adalah jenis kelamin, usia, status nutrisi, kejang, syok, hepatitis akut berat, gagal ginjal akut, gagal nafas akut, pemanjangan prothrombin time (PT), activated partial thromboplastin time (APTT), hematokrit, leukosit, dan trombosit. Luaran dibagi menjadi hidup dan meninggal. Rekam medis anak dengan riwayat gangguan fungsi ginjal, hati, dan koagulasi serta rekam medis yang tidak lengkap dieksklusi. Analisis data dengan uji chi square dilanjutkan dengan regresi logistik. Hasil. Terdapat 81 anak dengan ensefalopati dengue dan 25 di antaranya meninggal. Angka kematian sebesar 30,86%. Median usia pasien adalah 5 tahun, sedangkan median onset terjadinya ensefalopati dengue adalah hari ke-5 demam. Analisis multivariat menunjukkan bahwa gagal nafas akut merupakan prediktor independen kematian anak dengan ensefalopati dengue (p 0,00; OR 8,2; IK 95% 2,3-29,15). Kesimpulan. Gagal nafas akut merupakan prediktor independen kematian anak dengan ensefalopati dengue.

Dengue encephalopathy is unusual manifestation of dengue infection. Eventhough rare, this lead to mortality. There was limited study about factor that influence this prognosis, especially mortality in children. Objective. To investigate predictors of mortality in children with dengue encephalopathy. Methods. Retrospective, case control study. Data were collected from medical records of children (1-18 years old) who hospitalized at Sardjito Hospital Yogyakarta during Januari 2010-Desember 2016. Sex, age, nutritional state, seizure, shock, severe acute hepatitis, acute kidney injury, acute respiratory failure, hematocrite, thrombocyte, leukocyte, prolonged prothrombine time and activated partial thromboplastin time were studied as predictors of mortality. Outcome were classified as survive and death. The exclusion criteria were children with underlying kidney diseases, liver diseases, bleeding/coagulation disorders and incomplete medical records. Statistical analysis used chi square test which were continued with logistic regression. Results. There were 81 children with encepalopathy dengue, 25 among them were died. Mortality rate during this period was 30,86%. Median age were 5 years old, while onset of dengue encephalopathy was 5th day of fever. Acute respiratory failure was the independent factor of mortality predictor in children with dengue encephalopathy (p 0,00; OR 8,2; IK 95% 2,3-29,15). Conclusion. Acute respiratory failure was independent predictor of mortality in children with dengue encephalopathy.

Kata Kunci : ensefalopati, dengue, anak, prediktor, kematian