FAKTOR RISIKO MORTALITAS PASIEN GERIATRI YANG DIRAWAT DI ICU RSUP SARDJITO YOGYAKARTA

MAIJONI HENDRA, dr. Akhmad Yun Jufan SpAn, M.Sc, KIC; Dr. Med. dr. Untung Widodo, SpAn, KIC

2022 | Tesis-Spesialis | ANESTESIOLOGI DAN TERAPI INTENSIF

Latar Belakang : Pasien geriatri semakin banyak yang membutuhkan pelayanan terapi intensif. Pada perawatan intensif pasien geriatri akan menunjukkan sindrom geriatri seperti delirium, gangguan sensoris dan frailty yang erat kaitannya dengan morbiditas dan mortalitas. Sampai saat ini di Indonesia belum ada penelitian khusus yang meneliti tentang risiko mortalitas pasien geriatri yang dirawat di ICU. Tujuan : Mengidentifikasi faktor-faktor risiko yang berpengaruh terhadap mortalitas pasien geriatri di ICU, sebagai bahan acuan dalam tatalaksana pasien geriatri di ICU. Metode : Penelitian ini merupakan penelitian observasional kohort retrospektif. Sampel penelitian sebanyak 162 pasien yang dirawat di ICU RSUP Dr Sardjito dalam kurun waktu 1 Januari 2020 hingga 31 Desember 2020. Faktor risiko yang telah diidentifikasi tersebut kemudian dianalisis dan diuji dengan uji student�s t-test untuk data numerik dan chi square test untuk data kategorikal. Hasil analisis dengan p<0.25 selanjutnya dilakukan uji regresi logistik. Variabel dengan nilai p<0.05 pada analisis multivariat dianggap bermakna. Data dianalisis secara statistik dengan aplikasi SPSS 25.0. Hasil: Faktor yang teridentifikasi sebagai faktor risiko mortalitas pasien geriatri di ICU RSUP Dr.Sardjito adalah komorbid ginjal berupa acute kidney injury dan chronic kidney disease (p=0.019, OR 0.364), penggunaan obat inotropik vasopresor yaitu dopamin, dobutamin, norepinefrin, epinefrin, vasopresin baik salah satu ataupun kombinasi (p=0.003, OR 0.277) dan mendapat bantuan ventilasi mekanis (p=0.004, OR 0.890) merupakan variabel yang memiliki pengaruh paling signifikan secara simultan terhadap mortalitas pasien geriatri di ICU. Kesimpulan: Pasien geriatri yang memiliki komorbid ginjal, ventilasi mekanis invasif dan penggunaan obat-obat inotropik vasopresor merupakan faktor risiko mortalitas pasien geriatri di ICU RSUP Dr.Sardjito.

Background : More geriatric patients require intensive therapy services. In intensive care, geriatric patients generally show geriatric syndromes such as delirium, sensory disturbances and frailty, closely related to patient morbidity and mortality. However, until now in Indonesia there has been no specific study that examines the risk of mortality in geriatric patients treated in the ICU. Objective : Identify the risk factors that influence the mortality of geriatric patients in the ICU which can be used as reference material in the management of geriatric patients in the ICU. Methods : This study was a retrospective cohort observational study. The study sample consisted of 162 patients who were treated in the ICU of Dr Sardjito Hospital in the period January 1, 2020 to December 31, 2020. The identified risk factors were then analyzed and tested with the student's t-test for numerical data and the chi-square test for categorical data. The results of the analysis with p<0.25 were then carried out with logistic regression test. Variables with p<0.05 in multivariate analysis were considered significant. The data were analyzed statistically with the SPSS 25.0 application. Results : Factors identified as risk factors for mortality in geriatric patients in the ICU Dr.Sardjito Hospital are kidney comorbidities either acute kidney injury and chronic kidney disease (p=0.019, OR 0.364), used of vasopressor inotropic drugs, namely dopamine, dobutamine, norepinephrine, epinephrine, vasopressin either one or a combination (p=0.003, OR 0.277) and received mechanical ventilation assistance (p=0.004, OR 0.890) considered the most significant effect on the mortality of geriatric patients in the ICU. Conclusion : Geriatric patients with renal comorbidities, either acute kidney injury or chronic kidney disease, prolonged invasive mechanical ventilation and used of vasopressor inotropic drugs are risk factors for mortality in geriatric patients in the ICU Dr.Sardjito Hospital.

Kata Kunci : geriatri, ICU, mortalitas, faktor risiko, geriatrics, ICU, mortality, risk factors