DERAJAT KESADARAN RENDAH SEBAGAI FAKTOR PROGNOSIS MORTALITAS PASIEN STROKE AKUT

dr. Kusbiantoro, dr. H. Moh. Was’an, Sp.S (K) QIA

2011 | Tesis | S2 Ked.Klinik/MS-PPDS

Pendahuluan : Stroke menempati urutan kedua sebagai penyebab kematian di seluruh dunia. Banyak faktor yang diduga berpengaruh terhadap tingkat kematian pasien stroke akut, salah satunya adalah derajat kesadaran. Tujuan : Mengetahui peran derajat kesadaran rendah sebagai prediktor kematian pasien stroke akut. Metode penelitian : Penelitian ini menggunakan rancangan kohort prospektif. Subjek dimasukkan ke dalam penelitian melalui consecutive sampling pasien stroke akut yang dirawat di unit stroke dengan diagnosis stroke berdasarkan CT scan. pasien yang memenuhi kriteria penelitian dilakukan anamnesis dan pemeriksaan fisik dan laboratorium. Kelompok derajat kesadran rendah (GCS ≤ 7) dibandingkan dengan kelompok derajat kesadran tidak rendah (GCS > 7) dalam outcome mortalitas selama 7 hari. Hasil : Total sebanyak 99 pasien (56 laki-laki dan 43 perempuan, rerata usia 62 ± 12,5 tahun). 43 pasien (43,4%) memiliki stroke perdarahan. Derajat kesadran rendah (GCS < 7) (RR = 6,249, 95%CI 3,260-11,979), suhu ≥ 37,5 o C (RR = 2,473, 95%CI 1,301-4,702), stroke perdarahan (RR = 2,479, 95%CI 1,384-5.461), ukuran lesi yang signifikan (RR = 2,808, 95%CI 1,566-5,066), edema serebri (RR = 2,653, 95%CI 1,497-4,700), midline shift (RR = 2,265, 95%CI 1,253-4,094) dan lokasi lesi infratentorial (RR = 2,566, 95%CI 1,433-4,557) berhubungan dengan risiko kematian yang lebih tinggi dalam 7 hari setelah stroke. Analisis regresi logistik multivariat menunjukkan bahwa hanya derajat kesadran rendah (GCS ≤ 7), ukuran lesi dan letak lesi infratentorial memiliki hubungan signifikan dan independen dengan outcome kematian pada 7 hari onset stroke (semua nilai p < 0,05). Kesimpulan : Derajat kesadaran rendah (skor GCS ≤ 7) terbukti berperan sebagai faktor prognosis mortalitas pasien stroke akut.

Introduction: Stroke is the number two cause of death in the world. Many factors have been implicated in the mortality rate among acute stroke patients, one of tem is consciousness level. Objective: To investigate the role of consciousness level as a predictor for mortality in acute stroke patients admitted in Stroke Unit of dr. Sardjito Hospital, Yogyakarta Methods: This is a prospective cohort study, with subjects recruited by consecutive sampling of acute stroke patients admitted in the stroke unit who diagnosed with stroke based on CT scan. Patients’ history, physical examination results and lab results were then recorded. Low level of consciousness group (GCS score ≤ 7) was compared with group (GCS >7) for mortality outcome in 7 days of stroke. Results: A total of 99 patients (56 males and 43 females, mean of age 62 ± 12,5 years old) in the study. 43 patients (43,4%) were treated for hemorrhagic stroke. Low level of consciousness (GCS < 7) (RR = 6,249, 95%CI 3,260-11,979), body temperature ≥ 37,5 o C (RR = 2,473, 95%CI 1,301-4,702), hemorrhagic stroke (RR = 2,479, 95%CI 1,384-5.461), significant lesion size (RR = 2,808, 95%CI 1,566-5,066), cerebral edema (RR = 2,653, 95%CI 1,497-4,700), midline shift (RR = 2,265, 95%CI 1,253- 4,094) and infratentorial location (RR = 2,566, 95%CI 1,433-4,557) were significantly correlated with higher mortality risk in 7 days of stroke. Multivariate logistic regression analysis indicated that only low level of consciousness (GCS ≤ 7), significant lesion size and infratentorial lesion were independently associated with higher mortality in 7 days of stroke (all adjusted p < 0,05). Conclusion : Low level of consciousness (GCS ≤ 7) proved to act as a mortality prognostic factor of acute stroke.

Kata Kunci : Derajat kesadaran, mortalitas, stroke akut