Perbandingan uji diagnostik antara nilai leukosit, neutrofil, dan C-Reactive Protein (CRP) pada apendisitis akut sampel dan komplikasi pada pasien dewasa

SOFII, Imam, dr. Agus Barmawi, SpB.SpBD

2006 | Tesis | PPDS I Ilmu Bedah

Latar belakang: Apendisitis akut adalah keadaan akut abdomen yang memerlukan pembedahan segera untuk mencegah komplikasi yang lebih buruk. Jika telah terjadi perforasi, maka komplikasi dapat terjadi seperti peritonitis umum, abses, dan komplikasi pascaoperasi seperti fistula dan infeksi luka operasi. Keterlambatan diagnosis dapat meningkatkan angka mortalitas dan morbiditas. Ada sekitar 11,2%-30% keterlambatan diagnosis ini berakibat perforasi intestinal. Nilai leukosit, presentase neutrofil, dan C-reactive protein (CRP) dapat sebagai informasi yang bermanfaat dalam mendiagnosis apendisitis akut simpel dan komplikasi pada dewasa. Metode: Dilakukan penelitian prospektif cross sectional tes diagnostik dari data pasien dengan apendisitis akut di Sub-bagian Bedah Digesti RSUP Dr Sardjito Yogyakarta dari bulan Desember 2005-Oktober 2006. Data dikelompokkan menurut klasifikasi apendisitis akut simpel dan komplikasi berdasarkan hasil histopatologi. Didapatkan 82 sampel pada kedua kelompok yang memenuhi kriteria inklusi dan eksklusi. Data dilakukan uji tes diagnostik yaitu: sensitivitas, spesifisitas, nilai prediksi positif/Positive Predictive Value (PPV), nilai prediksi negatif/Negative Predictive Value (NPV), rasio kemungkinan positif/Likelihood Ratio (LR+), rasio kemungkinan negatif/ Likelihood Ratio (LR-), akurasi, dan grafik receiver operating characteristics (ROC) dengan daerah di bawah kurva /areauUnder the curve (AUC), nilai leukosit, neutrofil, dan C-reactive protein (CRP) pada masing-masing kelompok dengan hasil histopatologi sebagai nilai baku emas (gold standard). Hasil: nilai leukosit, neutrofil, dan C-reactive protein masing-masing mempunyai nilai sensitivitas 70,07%; 74,54%; 89,09%; spesifisitas 70,37%; 70,37%; 81,48%; Positive Predictive Value (PPV): 82,97%; 83,67%; 90,74%; Negative Predictive Value (NPV): 54,28%; 57,57%; 78,57%; Likelihood Ratio (LR+): 2,36%; 2,51%; 4,56%, Likelihood Ratio (LR-): 0,42%; 0,22%; 0,13%, area under the curve (AUC): 0,797; 0,744; 0,891, dan akurasi: 70,73%; 73,17%; 86,56%. 7 Simpulan: C-reactive protein (CRP) lebih baik dalam diagnosis penunjang untuk membedakan apendisitis akut simpel dan komplikasi pada dewasa dibandingkan nilai leukosit dan neutrofil.

Background: acute appendicitis is one of the acute abdomen conditions that need an emergency surgical procedure to prevent severe complication. If the perforation is present, the complications are general peritonitis, abscess, and postoperative complication such as fistula and operative wound infection. Late diagnosis can increase the mortality and morbidity. There are about 11.2%-30% cases with intestinal perforation caused by late diagnosis. The leukocyte count, percentage of neutrophyl, and C-reactive protein (CRP) are valuable information to diagnose the perforation and nonperforation acute appendicitis in adult patients. Method: a prospective cross sectional study was held on diagnostic test from patient’s database for acute appendicitis cases on Digestive Surgery Subdivision of Dr Sardjito Hospital from December 2005 until October 2006. The data was classified as simple and complication acute appendicitis based on the histopathology result. Eighty two were gained for the two groups which fulfill the inclusion and exclusion criteria. The diagnostic test i.e. sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR+), Likelihood Ratio (LR-), accuracy, and receiver operating characteristics (ROC) with area under the curve (AUC) were done for the leukocyte count, neutrophyl, and C-reactive protein (CRP) in each group with histopathology result as a gold standard. Result: the leukocyte count, neutrophyl, and C-reactive protein (CRP) respectively had a value of sensitivity: 70,07%; 74,54%; 89,09%; specificity: 70,37%; 70,37%; 81,48%; Positive Predictive Value (PPV): 82,97%; 83,67%; 90,74%; Negative Predictive Value (NPV): 54,28%; 57,57%; 78,57%; Likelihood Ratio (LR+): 2,36%; 2,51%; 4,56%, Likelihood Ratio (LR-): 0,42%; 0,22%; 0,13%, area under the curve (AUC): 0,797; 0,744; 0,891, and accuracy 70,73%; 73,17%; 86,56%. Conclusion: C-reactive protein (CRP) is a better diagnostic test to differ between simple and complication acute appendicitis in adult patient compared with leukocyte count and neutrophyl.

Kata Kunci : Apendisitis Akut, Respon Inflamasi, simple and complication acute appendicitis, leukocyte count, neutrophyl, and C - reactive protein (CRP).