PERAN NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL) URIN SEBAGAI PREDIKSI KEMATIAN SELAMA RAWAT INAP PASCA TINDAKAN INTERVENSI KORONER PERKUTAN PRIMER DI RSUP DR. SARDJITO

DANDY FIRMANSYAH, dr. Heru Prasanto, Sp.PD, KGH.; dr. Iri Kuswadi, Sp.PD, KGH

2021 | Tesis-Spesialis | ILMU PENYAKIT DALAM

Latar Belakang: Neutrophil gelatinase-associated lipocalin (NGAL) merupakan salah satu protein di dalam kelompok besar lipocalins. NGAL berperan dalam inflamasi, apoptosis dan remodeling matriks ekstraselular kardiomiosit pada pasien dengan masalah jantung. Dalam konteks STEMI (ST-Elevation Myocardial Infarction), kadar NGAL urin dapat meningkat akibat inflamasi sistemik maupun kerusakan ginjal. Oleh karena itu, NGAL urin diharapkan dapat sebagai parameter laboratorium untuk memprediksi kematian selama rawat inap pasca tindakan intervensi koroner perkutan primer. Tujuan Penelitian: Mengetahui peran NGAL urin sebagai prediksi kematian selama rawat inap pasca tindakan intervensi koroner perkutan primer di RSUP dr. Sardjito. Metode Penelitian: Penelitian ini menggunakan metode potong lintang (cross sectionalstudy), berlangsung pada bulan Juli sampai dengan November 2020 di Unit Gawat Darurat (UGD), Instalasi Laboratorium Terpadu (ILT) dan Cardiovascular Care Unit (CVCU) RSUP dr. Sardjito Yogyakarta. Subjek penelitian ini yaitu pasien STEMI yang menjalani intervensi koroner perkutan primer dan memenuhi kriteria inklusi maupun eksklusi. Dilakukan pengambilan data berupa kadar NGAL urin dua belas jam pasca tindakan intervensi koroner perkutan primer sebagai variabel bebas. Follow up dilakukan terhadap subyek penelitian untuk melihat ada tidaknya kematian selama rawat inap sebagai variabel terikat. Analisis multivariat digunakan untuk mengetahui hubungan variabel bebas dan terikat dengan mempertimbangkan adanya variabel pengganggu potensial. Hasil Penelitian: Sejumlah 98 subyek penelitian dibagi menjadi 2 kelompok yaitu kelompok dengan NGAL urin < nilai cutoff dan NGAL urin >= nilai cutoff. Berdasarkan area under the receiver operating characteristic (AUROC), nilai cutoff NGAL urin yaitu 39,25 ng/ml dengan sensitivitas 84,6% dan spesifisitas 56,5%. Selanjutnya dilakukan follow up untuk mengetahui ada tidaknya kematian selama rawat inap. Kematian terjadi pada 13 (13,3%) subyek, dimana 2 subyek memiliki NGAL urin < nilai cutoff dan 11 subyek memiliki NGAL urin >= nilai cutoff. Analisis mantel haenszel menunjukkan variabel pengganggu potensial yang secara bermakna berpengaruh terhadap hubungan NGAL urin terhadap kematian yaitu usia, DM, hipertensi, dislipidemia, CHF, kreatinin, eGFR, merokok, BMI, status infeksi, anemia, derajat gagal jantung, jumlah koroner terlibat dan LVEF. Analisis multivariat menunjukkan bahwa NGAL urin >=39,25 ng/ml tidak bermakna secara independen sebagai prediksi kematian selama rawat inap pada pasien pasca tindakan intervensi koroner perkutan primer (p 0,075; OR 13,653; CI 0,772-241,535) Kesimpulan: NGAL urin >=39,25 ng/ml tidak bermakna secara independen sebagai prediksi kematian selama rawat inap pada pasien pasca tindakan intervensi koroner perkutan primer.

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is one of the proteins in the large group of lipocalins. NGAL plays a role in inflammation, apoptosis and remodeling of the extracellular matrix of cardiomyocytes in patients with heart disease. In the context of STEMI (ST-Elevation Myocardial Infarction), urinary NGAL levels may increase due to systemic inflammation or kidney damage. Therefore, urinary NGAL is expected to be a laboratory parameter to predict hospital mortality after primary percutaneous coronary intervention. Objective: To determine the role of urinary NGAL as a predictor of hospital mortality after primary percutaneous coronary intervention in RSUP dr. Sardjito. Methods: This research used cross sectional method, taking place from July to November 2020 in the Emergency Unit (ER), Integrated Laboratory Installation (ILT) and Cardiovascular Care Unit (CVCU) RSUP dr. Sardjito Yogyakarta. The subjects of this research were STEMI patients who underwent primary percutaneous coronary intervention and met the inclusion and exclusion criteria. Data in the form of urinary NGAL levels twelve hours after primary percutaneous coronary intervention was collected as an independent variable. Follow-up was carried out on research subjects to see whether there was hospital mortality as the dependent variable. Multivariate analysis was used to determine the relationship between independent and dependent variables by considering the existence of potential confounding variables. Results: A total of 98 research subjects were divided into 2 groups (urinary NGAL < cutoff value and urinary NGAL >= cutoff value). Based on the area under the receiver operating characteristic (AUROC), the cutoff value of urinary NGAL was 39.25 ng/ml with sensitivity of 84.6% and specificity of 56.5%. Furthermore, follow-up was carried out to determine whether there was hospital mortality. Mortality occurred in 13 (13.3%) subjects, of which 2 subjects had urinary NGAL < cutoff value and 11 subjects had urinary >= cutoff value. Mantel haenszel analysis showed potential confounding variables that significantly influenced the relationship of urinary NGAL to mortality. The variables are age, diabetes mellitus, hypertension, dyslipidemia, CHF, creatinine, eGFR, smoking, BMI, infection status, anemia, degree of heart failure, number of coronary involvement and LVEF. Multivariate analysis showed that urinary NGAL >=39.25 ng/ml was not independently significant as a predictor of hospital mortality after primary percutaneous coronary intervention (p 0.075; OR 13.653; CI 0.772-241.535). Conclusion: Urinary NGAL >=39.25 ng/ml was not independently significant as a predictor of hospital mortality after primary percutaneous coronary intervention.

Kata Kunci : Neutrophil gelatinase-associated lipocalin (NGAL) urin, kematian, STEMI (ST-Elevation Myocardial Infarction), intervensi koroner perkutan primer, Urinary neutrophil gelatinase-associated lipocalin (NGAL), mortality, STEMI (ST-Elevation Myocardial Infarcti