Kadar albumin serum sebagai prediktor terhadap luaran klinis myasthenia gravis (MG) yang mendapatkan plasma exchange di RSUP DR Sardjito Yogyakarta

FAUZYA MARLINDA AMRIE, dr. Indra Sari Kusuma Harahap, Ph.D., Sp.S(K) ; DR. dr. Paryono, Sp.S(K)

2024 | Tesis-Spesialis | S2 Ilmu Penyakit Saraf

Latar belakang: Myasthenia gravis (MG) adalah penyakit autoimun yang disebabkan oleh antibodi yang menyerang reseptor asetilkolin postsinaptik dan menyebabkan kelemahan yang berfluktuasi, terkadang mengancam jiwa. Angka kejadian tahunan myasthenia gravis adalah 8-10 kasus per satu juta penduduk dengan prevalensi 150-250 kasus per 1 juta penduduk, 15-20?rkembang menjadi krisis myasthenia dengan mortalitas krisis myasthenia gravis sebesar 3-8%. Pada penyakit autoimun, stres oksidatif dan status antioksidan yang rendah memainkan peran penting untuk menentukan luarannya. Albumin diketahui sebagai marker peradangan dan umum digunakan untuk penilaian kondisi inflamasi. Semakin banyak bukti keterlibatan inflamasi dan stres oksidatif dalam imunopatogenesis myasthenia gravis, albumin mungkin berhubungan dengan luaran myasthenia gravis.

Metode: Desain penelitian adalah kohort retrospektif dengan 78 responden. Responden mendapat terapi plasma exchange dan dinilai kadar albumin saat admisi sebagai prediktor luaran klinis myasthenia gravis. Data diambil dari rekam medis. Analisis data menggunakan bivariat dan multivariat.

Hasil: Subjek dengan Myasthenia Gravis Foundation America (MGFA) kelas I sebanyak 2 subjek (2.6%), kelas II sebanyak 14 subjek (17.9%), kelas III sebanyak 23 subjek (29.5%), kelas IV sebanyak 22 subjek (28.2%) dan kelas V sebanyak 17 subjek (21.8%). Pada penelitian ini, subjek penelitian mendapatkan plasma exchange yang dilakukan selama rerata 3,5(1-23) hari dengan rerata pemberian 3(2-6) kali. Pada hasil analisa bivariat didapatkan hasil bahwa pasien dengan albumin rendah (<3 p=0,001. RR =12,46).>

Kesimpulan: Kadar albumin rendah saat admisi rumah sakit merupakan prediktor  luaran buruk pasien myasthenia gravis dengan terapi plasma exchange.

Background: Myasthenia gravis (MG) is an autoimmune disease caused by antibodies that attack postsynaptic acetylcholine receptors and cause fluctuating, sometimes life-threatening weakness. The annual incidence of myasthenia gravis is 8-10 cases per one million population with a prevalence of 150-250 cases per 1 million population, 15-20% progress to myasthenia crisis with a myasthenia gravis crisis mortality of 3-8%. In autoimmune diseases, oxidative stress and low antioxidant status play an important role in determining the outcome. Albumin is a known marker of inflammation and is commonly used for the assessment of inflammatory conditions. With increasing evidence of the involvement of inflammation and oxidative stress in the immunopathogenesis of myasthenia gravis, albumin may be associated with myasthenia gravis outcomes.

Methodology: The study design was a retrospective cohort with 78 respondents. Respondents received plasma exchange therapy and were assessed for albumin levels at admission as a predictor of myasthenia gravis clinical outcomes. Data were collected from medical records. Data analysis uses bivariate and multivariate.

Results: Subjects with MGFA class I were 2 subjects (2.6%), class II were 14 subjects (17.9%), class III were 23 subjects (29.5%), class IV were 22 subjects (28.2%) and class V were 17 subjects (21.8%). In this study, the research subjects received plasma exchange which was carried out for an average of 3.5 (1-23) days with an average administration of 3 (2-6) times. In the bivariate analysis, it was found that patients with low albumin (<3 p=0.001. RR =12.46).>

Conclusion: Low albumin level at hospital admission is a predictor of poor outcome of myasthenia gravis patients with plasma exchange therapy.

Kata Kunci : myasthenia gravis, albumin, prediktor klinis, plasma exchange