HUBUNGAN ANTARA JUMLAH KETERLIBATAN ORGAN MAYOR DENGAN RESPON TERAPI METILPREDNISOLON DOSIS PULSE PADA PASIEN LUPUS ERITEMATOSUS SISTEMIK

ADHITA KARTYANTO, dr. Ayu Paramaiswari, SpPD-KR.; Prof. Dr. dr. Nyoman Kertia, Sp.PD, KR

2021 | Tesis-Spesialis | ILMU PENYAKIT DALAM

Latar Belakang: Lupus Eritematosus Sistemik (LES) memerlukan penanganan yang komprehensif dan terintegrasi karena dapat bermanifestasi pada berbagai sistem organ baik itu organ non mayor maupun organ mayor. Metilprednisolon merupakan salah satu terapi LES, dimana pada dosis pulse digunakan sebagai terapi induksi dalam mengatasi kekambuhan aktifitas penyakit dan memberikan perbaikan prognosis yang dramatis pada lupus berat melalui efek nongenomik nya. Tidak semua pasien LES yang mendapatkan terapi metilprednisolon dosis pulse mengalami respon komplit, beberapa faktor mungkin mempengaruhi respon terapi tersebut, salah satu yang diduga mempengaruhi perbedaan respon terapi tersebut adalah jumlah keterlibatan organ mayor Tujuan Penelitian: Mengetahui hubungan antara jumlah keterlibatan organ mayor dengan keberhasilan terapi metilprednisolon dosis pulse pada pasien LES di RSUP dr. Sardjito Yogyakarta. Metode Penelitian: Penelitian ini menggunakan metode potong lintang (cross sectional study) retrospektif, Subjek penelitian ini yaitu pasien dewasa penderita LES yang dirawat di ruang rawat inap penyakit dalam di RSUP Dr. Sardjito Yogyakarta serta memenuhi kriteria inklusi dan eksklusi. sejak 1 Januari 2016 sampai 31 Desember 2019. data karakteristik subyek penelitian diambil dari data catatan medis pasien dan data hasil laboratorium sebelum dilakukan pemberian pulse metilprednisolon. Hasil Penelitian: Sejumlah 88 subyek penelitian diambil dari catatan medik. Pasien dengan jumlah keterlibatan organ mayor 1 lebih banyak mengalami respon komplit (53,8%), keterlibatan organ mayor 2 sebagian besar respon parsial (66,7%), keterlibatan organ mayor 3 (48,6%) dan keterlibatan organ mayor 4 (53,8%) tidak respon, dan keterlibatan organ mayor 5 (75%) respon parsial. Ada hubungan yang bermakna jumlah keterlibatan organ mayor dengan respon terapi p<0,001. Koefisien korelasi r=0,382 artinya semakin banyak keterlibatan organ mayor semakin tidak respon terhadap terapi. Hasil analisis multivariat diketahui hanya jumlah keterlibatan organ mayor yang berpengaruh dominan terhadap respon terapi p=0,001. Koefisien regresi 0,797 Kesimpulan: Jumlah keterlibatan organ mayor secara bermakna mempengaruhi keberhasilan terapi metilprednisolon dosis pulse pada pasien LES dengan semakin banyak organ mayor yang terlibat semakin tidak respon terhadap terapi

Background: Systemic Lupus Erythematosus (SLE) requires comprehensive and integrated treatment because it can manifest in various organ systems, both non-major and major organs. Pulse doses Methylprednisolone used as induction therapy, it provides dramatic improvement in prognosis in severe lupus through its nongenomic effects. Not all SLE patients who received pulse dose methylprednisolone therapy gives complete response, several factors may influence the therapeutic response, one of which is thought to influence the difference in therapeutic response is the number of major organ involvement. Research Objectives: To determine the relationship between the number of major organ involvement and therapeutic response of pulse dose methylprednisolone therapy in SLE patients at Sardjito Hospital Yogyakarta. Research Methods: This study used a retrospective cross-sectional study. The subjects of this study were adult patients with SLE treated in the internal medicine ward at Sardjito Hospital Yogyakarta and met the inclusion and exclusion criteria from January 1, 2016 to December 31, 2019. The data on the characteristics of the research subjects were taken from the patients medical records and laboratory data before giving pulse methylprednisolone. Research Results: A total of 88 research subjects were taken from medical records. Patients with major organ involvement 1 experienced more complete response (53.8%), major organ involvement 2 mostly partial response (66.7%), major organ involvement 3 (48.6%) and major organ involvement 4 ( 53.8%) no response, and major organ involvement 5 (75%) partial response. There is a significant relationship with the number of major organ involvement with response to therapy p<0.001. The correlation coefficient r=0.382 means that the more major organ involvement the less response to therapy. The results of multivariate analysis showed that only the number of major organ involvement had a dominant effect on the response to therapy, p=0.001. Regression coefficient 0.797 Conclusion: The number of major organ involvement significantly affects the success of pulse dose methylprednisolone therapy in SLE patients with the more major organs involved the less response to therapy.

Kata Kunci : LES, Metilprednisolon dosis pulse, Jumlah Keterlibatan Organ Mayor, Respon Terapi, SLE, pulse dose Methylprednisolone, Major Organ Involvement Number, Therapeutic Response