RASIO PREVALENSI CEDERA GINJAL AKUT PADA PASIEN RAWAT INTENSIVE DENGAN PENINGKATAN KADAR NEUTROPHIL GELATINASE ASSOCIATED LIPOCALIN (NGAL) URIN

CHANDRA TRIANNA DEWI, dr. Ira Puspitawati,M. Kes, Sp.PK(K)

2021 | Tesis-Spesialis | PATOLOGI KLINIK

Latar belakang: Cedera ginjal akut atau Acute kidney injury (AKI) merupakan suatu kumpulan gejala klinis akibat adanya gangguan fungsi ginjal yang terjadi secara mendadak dan merupakan komplikasi yang sering dijumpai pada pasien dengan kondisi kritis. Biomarker deteksi AKI yang digunakan saat ini masih kurang reliabel. Neutrophil Gelatinase Assosiated Lipocalin (NGAL) merupakan penanda cedera tubular dapat digunakan sebagai penanda dini untuk memprediksi kejadian AKI. Tujuan penelitian ini untuk mengetahui rasio prevalensi kejadian Cedera Ginjal Akut pada pasien rawat Intensive dengan peningkatan kadar Neutrophil Gelatinase-Assosiated Lipocalin (NGAL) urin. Metode: Penelitian observasional analitik dengan desain penelitian cross sectional. Subjek penelitian adalah pasien yang dirawat ICU RSUP Dr. Sardjito yang memenuhi kriteria inklusi dan eksklusi. NGAL urin diperiksa menggunakan Architect dengan metode Chemiluminecent Microparticle Immunoassay (CMIA). Kriteria AKI menggunakan kriteria KDIGO. Analisis data dasar secara deskriptif, disajikan dengan median (minimal-maksimal), chi-square test dan Mann Whitney u-test. Perhitungan rasio prevalensi (RP) disajikan dengan tabel 2x2 serta beda proporsi diuji dengan chi-square test. Hasil : Total subjek penelitian ini adalah 77 orang, sebagian besar subjek penelitian laki-laki (51,9%). Total subjek yang berkembang kearah AKI 16 orang (19,5%). Median usia subjek 48 (18 - 92) tahun. Kriteria usia <60 tahun dan >=60 tahun didapatkan perbedaan bermakna pada kelompok AKI dan non-AKI (p=0,0359). Kadar NGAL urin pada dua kelompok penelitian didapatkan perbedaan bermakna [112,1(8,5-1500) vs 53,1 (0,3-1500) p=0,0413]. Peningkatan kadar NGAL urin >34,32 ng/ml memiliki rasio prevalensi sebesar 2,29 dengan CI 95%: 0,776-11,668 dibandingkan kadar NGAL urin <=34,32 ng/ml dan secara statistik tidak bermakna (p= 0,1021). Peningkatan NGAL urin berdasarkan cut off ROC populasi sebesar >46,5 ng/mL memiliki rasio prevalensi sebesar 3,08 dengan 95% CI (1,016-15,182) mengalami cedera ginjal akut dan hal ini signifikan secara statistik (p= 0,0388). Simpulan: Berdasarkan perhitungan Rasio Prevalensi (RP) yaitu sebesar 2,29 mengalami cedera ginjal akut dan secara statistik tidak bermakna, akan tetapi berdasarkan cut off pada populasi penelitian ini didapatkan RP sebesar 3,08 mengalami cedera ginjal akut dan hal ini signifikan secara statistik.

Background: Acute Kidney Injury (AKI) is a clinical syndrome of symptoms due to a sudden disruption of kidney function and is a complication that is often found in patients with critical ill. The current of AKI detection biomarker is not reliabel enough. Neutrophil Gelatinase Associated Lipocalin (NGAL) is a biomarker that can be used as an early biomarker to predict the incidence of AKI. The aim of the study was to determine prevalence rasio of Acute Kidney Injury in intensive care unit with urinary NGAL increased levels. Method: This is an analytical observational study with cross sectional method. The subjects were the patients who were admitted to the ICU in RSUP Dr. Sardjito that met the inclusion and exclusion criteria. Urinary NGAL was examined using Architect with Chemiluminescent Microparticle Immunoassay (CMIA) method. Criteria for acute kidney injury were assessed using KDIGO criteria. Baseline descriptive baseline data analysis presented with median (minimum-maximum), chi-square test, and Mann Whitney u test. Determination cut off NGAL urine level analized by ROC curve, the prevalence ratio (PR) is presented in 2x2 table and different proportions analized by chi-square test. Result : The total subject of this study was 77 people, most of the subject were male (51,9%). The total subjects who developed AKI were 16 subjects (19,5%). Median age of subjects was 48 (18-92) years. There were significant differences in the criteria for age <60 years old and >= 60 years in the AKI and non-AKI groups (p=0,0359). Urinary NGAL levels in two gourps were statistically significant [112,1(8,5-1500) vs 53,1 (0,3-1500) p=0,0413]. Elevated urine NGAL level >34,32 ng/mL had prevalence ratio of 2,29 (CI 95% 0,776-11,668) compare to urinary NGAL level <=34,32 ng/ml and statistically not significant (p= 0,1021). Elevated urinary NGAL cut off based on ROC curve >46,5 ng/mL had prevalence ratio 3,08 with 95% CI (1,016-15,182) to have acute kidney injury and it was statistically significant (p= 0,0388). Conclusion : Based on calculation of Prevalence Ratio (PR), it was 2,29 had acute kidney injury and it was not statistically significant. However, based on the cut off in this study population, it wa obtained PR of 3.08 had Acute Kidney Injury and it was statistically significant.

Kata Kunci : Acute Kidney Injury, urinary NGAL, intensive care unit