RasioPrevalensi Kadar Cystatin C serum pada Kejadian Acute Kidney Injury (AKI) Pasien yang dirawat di Ruang Intensif RSUP Dr Sardjito

ISNIYANTI CHASANAH, Prof. dr. Budi Mulyono, Sp.PK (K) MM ; dr. Ira Puspitawati, M.Kes, Sp.PK (K)

2020 | Tesis-Spesialis | PATOLOGI KLINIK

INTISARI Latar belakang: Acute Kidney Injury (AKI) sering dikaitkan dengan morbiditas dan mortalitas yang tinggi di seluruh dunia. Kejadian AKI diruang rawat intensif (ICU) menunjukkan antara 6-70% dengan klinis yang bervariasi. Temuan ini menunjukkan pasien yang dirawat di ICU rentan terjadinya AKI. Serum kreatinin yang telah banyak digunakan secara luas untuk mendeteksi AKI memiliki keterbatasan seperti spesifisitas rendah pada azotemia pre renal, perubahan asupan makanan, drug induced yang merubah sekresi kreatinin di tubular dan dipengaruhi oleh umur, jenis kelamin, massa otot, kehamilan, diet dan latihan berat. Cystatin C adalah salah satu pemeriksaan untuk memprediksi AKI lebih awal dibanding serum kreatinin. Cystatin C diketahui lebih baik dibandingkan serum kreatinin karena konsentrasinya tidak dipengaruhi oleh usia, jenis kelamin, massa otot, infeksi, penyakit radang atau hati sehingga penelitian ini menggunakan Cystatin C yang diharapkan mampu memprediksi gangguan fungsi ginjal dini secara dini pada pasien yang dirawat di ruang rawat intensif. Tujuan : Untuk mengetahui rasio prevalensi kadar Cystatin C serum pada kejadian AKI pada pasien di ruang rawat intensif RSUP Dr Sardjito. Metode: Penelitian ini merupakan studi cross sectional dengan subjek peenelitian pasien yang dirawat di ICU. Pemeriksaan kreatinin dan Cystatin C dilakukan untuk menentukan status AKI. Analisis data dasar secara deskriptif, ditunjukkan dengan rerata dan standar deviasi. Uji normalitas data kontinyu menggunakan uji Kolmogorov Smirnov. Uji beda antar dua kelompok dilakukan dengan independent t-test dan Mann Whitney U-test. Data kategorikal disajikan dalam proporsi. Analisis beda proporsi dikerjakan dengan chi-square dan dihitung Rasio Prevalensi (RP) dengan 95% CI, p<0,05. Hasil: Subjek penelitian ini sebanyak 77 orang. Berdasarkan kriteria KDIGO didapatkan 16 pasien AKI dan 61 pasien non-AKI. Proporsi usia > 60 tahun pada AKI lebih tinggi dibanding non-AKI. Didapatkan jumlah Cystatin C � 0,95mg/l lebih tinggi daripada � 0,95mg/l pada kelompok AKI. Rasio prevalensi kadar Cystatin C � 0,95mg/l sebesar 1,25 secara statistik tidak bermakna. Hasil ini belum menunjukkan hubungan antara kenaikan kadar Cystatin C �0,95 mg/l terhadap risiko terjadinya AKI. Simpulan: Rasio prevalensi adanya AKI sebesar 1,25 pada kadar Cystatin C � 0,95 mg/L secara statistik tidak bermakna pada pasien yang dirawat di ruang Intensif RSUP Dr Sardjito Kata kunci: Acute Kidney Injury, marker AKI Cystatin C, Cystatin s as predictor AKI

ABSTRACT Background: Acute Kidney Injury (AKI) is often associated with high morbidity and mortality affecting many patients worldwide. The incidences of AKI in the Intensive Care Unit (ICU) are between 6-70% with various clinical symptoms. These findings suggest that patients admitted to the ICU are prone to suffer AKI. Serum creatinine is a widely used marker for AKI, although its few limitations have been pointed out, such as low specificity for pre-renal azotemia, altered dietary intake, drug-induced changes in tubular creatinine secretion, and affected by age, sex, muscle mass, pregnancy, diet, and strenuous exercise. Cystatin C is another biomarker known to be useful in predicting AKI earlier than serum creatinine. Cystatin is also considered better than serum creatinine because it�s concentration is not influenced by age, gender, muscle mass, infection, inflammatory disease, or liver, therefore this study used Cystatin C as a marker to predict early renal dysfunction in patients treated in the ICU Objective: To determine the prevalence ratio of serum Cystatin C levels to the risk of AKI incidence in patients in the intensive care unit of Dr. Sardjito Hospital Methods: This study was a cross-sectional study of patients who were admitted to the ICU. Serum creatinine and Cystatin C tests were performed to determine the AKI status of the patients. Basic demographic characteristics were presented as descriptive data (mean and standard deviation). Continuous data normality was analyzed using Kolmogorov Smirnov. The differences between the two groups were assessed with the independent t-test and the Mann-Whitney U-test. Categorical data were expressed as proportions. Analysis of different proportions was performed using chi-square and prevalence ratio (RP) was calculated with 95% CI, and p <0.05 was considered significant. Result: The subjects of this study were 77 patients. Based on KDIGO criteria, there were 16 patients with AKI, and 61 were non-AKI patients. In the AKI group, patients were mostly elderly (>60 years). It was also found that Cystatin C� 0.95 mg/l was higher than � 0.95 mg/l in the AKI group. Ratio prevalence cystatin c level � 0.95 mg/l is 1.25 and it was not statistically significant. This result did not show yet any correlation between increasing Cystatin C �0.95 mg/l with the risk of AKI. Conclusion: The AKI prevalence ratio of 1.25 at the level of Cystatin C � 0.95 mg/L was statistically insignificant in patients treated in the Intensive Care Room Dr. Sardjito. Keywords: Acute Kidney Injury, AKI Cystatin Cmarker, Cystatin as a predictor of AKI

Kata Kunci : : Acute Kidney Injury, AKI Cystatin Cmarker, Cystatin as a predictor of AKI