Pengaruh Tindakan Bronchoalveolar Lavage Terhadap Penurunan Angka Mortalitas, Lama Rawat Inap, Prokalsitonin, Neutrofil to Limfosit Ratio, Indeks Rox dan Skor Apache II pada Pasien Pneumonia Berat di RSUP Dr. Sardjito

Refi Yulistian, dr Sumardi, SpPD,KPMK.; dr. Ika Trisnawati, MSc, SpPD, KPMK

2025 | Tesis-Subspesialis | SUBSPESIALIS ILMU PENYAKIT DALAM

Latar Belakang: Pneumonia berat memiliki morbiditas dan mortalitas yang tinggi di perawatan intensif. Tindakan Bronchoalveolar lavage (BAL) sebagai terapeutik memiliki efektivitas baik pada pasien pneumonia berat di studi sebelumnya. Penelitian komprehensif menilai efektifitas BAL pada mortalitas, lama rawat inap, prokalsitonin, neutrofil to limfosit ratio, indeks ROX dan skor APACHE II pada pneumoni berat masih terbatas di Indonesia.

Tujuan: Pengaruh tindakan BAL terhadap mortalitas, lama rawat inap, prokalsitonin, neutrofil to limfosit ratio, indeks ROX dan skor APACHE II pada pasien pneumonia berat di RSUP Dr. Sardjito.

Metode: Penelitian kohort retrospektif pada pasien pneumonia berat periode Januari 2021 –Desember 2024. Subjek dipilih dengan consecutive sampling. Data diperoleh dari rekam medis elektronik dan dianalisis untuk mengetahui mortalitas, lama rawat inap, prokalsitonin, neutrofil to limfosit ratio, indeks ROX dan skor APACHE II. 

Hasil: Sebanyak 147 pasien (tindakan BAL : 73, tanpa BAL : 74). Tidak ditemukan perbedaan signifikan kejadian mortalitas pada kelompok tindakan BAL (41%) vs tanpa BAL (31%), (p = 0.2). Ditemukan perbedaan signifikan lama rawat inap kelompok tindakan BAL median LOS (11.0 hari) vs tanpa BAL (12.0 hari) (p < 0 xss=removed xss=removed xss=removed xss=removed>

Kesimpulan: Tindakan BAL tidak menunjukkan perbedaan signifikan terjadinya mortalitas dan parameter lainnya, sedangkan pada lama rawat inap didapatkan lebih singkat dibanding tanpa BALsecara signifikan.

Background : Severe pneumonia has high morbidity and mortality in intensive care. Bronchoalveolar lavage (BAL) as a therapeutic procedure has been shown to be effective in patients with severe pneumonia in previous studies. Comprehensive studies assessing the effectiveness of BAL on mortality, length of hospital stay, procalcitonin, neutrophil-to-lymphocyte ratio, ROX index, and APACHE II score in severe pneumonia are still limited in Indonesia.

Objective: To determine the effect of BAL on mortality, length of hospital stay, procalcitonin, neutrophil-to-lymphocyte ratio, ROX index, and APACHE II score in patients with severe pneumonia at Dr. Sardjito General Hospital.

Methods: This was a retrospective cohort study of patients with severe pneumonia from January 2021 to December 2024. Subjects were selected using consecutive sampling. Data were obtained from electronic medical records and analyzed to determine mortality, length of hospital stay, procalcitonin, neutrophil-to- lymphocyte ratio, ROX index, and APACHE II score.

Results: A total of 147 patients (BAL: 73, without BAL: 74) were included. No significant difference in mortality was found in the BAL group (41%) versus the group without BAL (31%) (p = 0.2). A significant difference in median length of stay (LOS) was found in the BAL group (11.0 days) versus the group without BAL (12.0 days) (p < 0 xss=removed xss=removed xss=removed xss=removed>

Conclusion: BAL did not significantly affect mortality and other parameters, but the length of hospital stay was significantly shorter compared to those without BAL. 

Kata Kunci : Bronchoalveolar lavage, pneumonia berat, mortalitas, lama perawatan, Prokalsitonin