Hubungan Antara Kadar Free Hemoglobin Plasma Perioperatif Dengan Kejadian Acute Kidney Injury Pascaoperasi Bedah Jantung Ddi RSUP Dr. Sardjito

Rifdhani Fakhrudin Nur, dr. Bhirowo Yudo Pratomo, Sp. An-TI, Subsp. An.Kv. (K)., Dr. dr. Djayanti Sari, M.Kes, Sp. An-TI, Subsp. An.Ped. (K)

2024 | Tesis-Subspesialis | SUBSPESIALIS ANESTESIOLOGI DAN TERAPI INTENSIF

Latar Belakang: Acute Kidney Injury (AKI) merupakan komplikasi pascaoperasi bedah jantung yang penting dan paling umum terjadi. Salah satu patofisiologi AKI pascaoperasi bedah jantung adalah penggunaan mesin Cardiopulmonary Bypass (CPB) yang dapat menyebabkan hemolisis dan diikuti oleh pelepasan free Hemoglobin (fHb) ke plasma. Meskipun mekanisme dan hubungan antara kadar fHb plasma dengan kejadian AKI telah diketahui pada pasien sepsis dan pasien dengan sirkulasi ekstra-korporeal, masih belum banyak diteliti hubungan antara kadar fHb plasma dengan kejadian AKI pada pasien pascaoperasi bedah jantung. Tujuan: Mengetahui hubungan antara kadar fHb plasma perioperatif dengan kejadian AKI pascaoperasi bedah jantung di RSUP Dr. Sardjito Yogyakarta. Metode: Penelitian observasional rancangan kohort prospektif dilakukan di RSUP Dr. Sardjito. Variabel bebas adalah kadar fHb plasma perioperatif dan rasio fHb pasca/pra-CPB. Variabel terikat adalah kejadian AKI pascaoperasi berdasarkan kriteria KDIGO 2012. Analisis komparatif dilakukan dengan uji Independent T- test. Rasio fHb pasca/pra-CPB ditentukan keakuratan diagnostik dan nilai cut-off optimalnya dengan kurva Receiver Operating Characteristic (ROC) untuk menghitung Area Under Curve (AUC) dan sensitivitas-spesifisitas. Analisis bivariat dan multivariat dilakukan untuk mengetahui penyebab independen kejadian AKI pascaoperasi. Perbedaan dianggap bermakna secara statistik apabila nilai p < 0>

Hasil: Sebanyak 21% (10/47) subjek mengalami AKI pascaoperasi. Rerata kadar fHb plasma perioperatif lebih tinggi secara bermakna pada subjek kelompok AKI dibandingkan non-AKI pada periode CPB menit ke-60 (p<0 p=0,002), p=0,003). p=0,027) p=0,016 p=0,010), p=0,032), p=0,025), p=0,043), p=0,004), p=0,007), p=0,037) p=0,014, OR=1,06) p=0,007, OR=1,45)>

Kesimpulan: Terdapat hubungan positif antara kadar fHb plasma perioperatif dengan kejadian AKI pascaoperasi bedah jantung di RSUP Dr. Sardjito Yogyakarta. Kadar fHb plasma perioperatif pada periode CPB menit ke-60, menit ke-90, pasca-CPB menit ke-30, dan rasio fHb pasca/pra-CPB lebih tinggi pada subjek kelompok AKI dibandingkan non-AKI.

Background: Acute Kidney Injury (AKI) is an important and most common postoperative complication of cardiac surgery. One of the pathophysiology of AKI post-cardiac surgery is the use of Cardiopulmonary Bypass (CPB) machine which can cause hemolysis and is followed by the release of free hemoglobin (fHb) into plasma. Although the mechanism and relationship between plasma fHb levels and the incidence of AKI has been known in sepsis patients and patients with extra- corporeal circulation, the relationship between plasma fHb levels and the incidence of AKI in post-cardiac surgery patients has not yet been studied.

Objective: To determine the relationship between perioperative plasma fHb levels and the incidence of AKI post-cardiac surgery at RSUP Dr. Sardjito Yogyakarta. Methods: A prospective cohort design observational study was conducted at RSUP Dr. Sardjito. Independent variables were perioperative plasma fHb levels and post/pre-CPB fHb ratio. The dependent variable was the incidence of postoperative AKI based on the KDIGO 2012 criteria. Comparative analysis was carried out using the Independent T-test. The post/pre-CPB fHb ratio was determined for diagnostic accuracy and optimal cut-off values using Receiver Operating Characteristic (ROC) curves to calculate Area Under Curve (AUC) and sensitivity- specificity. Bivariate and multivariate analyzes were performed to determine the independent causes of postoperative AKI. Differences were considered statistically significant if the p value <0>

Results: A total of 21% (10/47) of subjects experienced postoperative AKI. The mean plasma fHb level was significantly higher in AKI group compared to non-AKI at the 60th (p<0 p=0.002), p=0.003). p=0.027) p=0.016 p=0.010), p=0.032), p=0.025), p=0.043), xss=removed p=0.007), p=0.037) p=0.014, OR=1.06) p=0.007, OR=1.45)>

Conclusion: There is a positive relationship between perioperative plasma fHb levels and the incidence of AKI after cardiac surgery at RSUP. Dr. Sardjito Yogyakarta. Plasma fHb levels at 60 minutes, 90 minutes, 30 minutes post-CPB, and post/pre-CPB fHb ratio were higher in AKI group compared to non-AKI. 

Kata Kunci : acute kidney injury, Cardiopulmonary Bypass, free Hemoglobin plasma, hemolisis, pascaoperasi bedah jantung, hemolysis, plasma free- hemoglobin, post-cardiac surgery