SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS) SAAT MASUK RUMAH SAKIT SEBAGAI PREDIKTOR PROGNOSTIK PASIEN STROKE ISKEMIA AKUT

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

2012 | Tesis | S2 Ilmu Penyakit Saraf

Latar Belakang: Systemic inflammatory response syndrome (SIRS) merupakan respon sistemik tubuh terhadap infeksi dan bentuk non infeksi yang telah diketahui pada berbagai keadaan gangguan serebral akut termasuk stroke iskemia. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan dan signifikansi SIRS saat masuk rumah sakit sebagai faktor prediktor prognostik pasien stroke iskemia akut. Metode: Penelitian ini menggunakan rancangan observasional kohort prospektif. Subjek penelitian diambil dari pasien yang dirawat di Unit Stroke dan Bangsal Saraf RSUP dr. Sardjito Yogyakarta. Adanya SIRS saat masuk rumah sakit jika telah memenuhi kriteria yaitu didapatkan ≥ 2 dari hal berikut: suhu tubuh <36°C atau >38°C, denyut jantung >90 kali permenit, respirasi >20 kali permenit, dan angka leukosit <4000/mm3 atau >12000/mm3. Kriteria SIRS dan parameter prognostik yang lainnya dievaluasi sebagai prediktor dikotomik dengan skor Skala Stroke Gadjah Mada (SSGM). Hasil: Sebanyak 86 86 subjek penelitian terbagi menjadi dua kelompok, yaitu 43 pasien yang memenuhi kriteria SIRS dan 43 pasien tanpa SIRS yang telah dilakukan matching. Hasil analisis univariat didapatkan 3 faktor yang bermakna sebagai prediktor perburukan defisit neurologis, yaitu SIRS saat masuk rumah sakit (p<0,01; RR 4,00; CI 95% 1,96-8,15), riwayat hipertensi (p=0,04; RR 2,94; CI 95% 0,80-10,78) dan tekanan darah sistolik (p=0,01; RR 2,26; CI 95% 1,12-4,55). Analisis multivariat didapatkan SIRS saat masuk rumah sakit bermakna mempengaruhi perburukan defisit neurologis. Simpulan: Systemic inflammatory response syndrome (SIRS) saat masuk rumah sakit dapat digunakan sebagai prediktor perburukan defisit neurologis pada pasien stroke iskemia akut.

Background: Systemic inflammatory response syndrome (SIRS) is a systemic response to infection and non-infectious forms known in various conditions such as acute cerebral ischemic stroke Objective: The aim of this study was to determine the relationship and significance of SIRS on hospital admission as a prognostic predictor factor of acute ischemic stroke patients. Methods: The study used a prospective observational cohort method. The subjects were taken from patients treated in the stroke unit and neurologic ward RSUP dr. Sardjito Yogyakarta. The occurrence of SIRS was assessed according to the presence of ≥2 of the following: body temperature <36°C or >38°C, heart rate of >90 bpm, respiratory rate >20 breaths/min and white blood cell count of <4000/mm 3 or >12000/mm 3 . SIRS criteria and other prognostic parameters were evaluated as predictors of dichotomous Gadjah Mada Stroke Scale score. Results: A total of 86 subjects divided into two groups, the 43 patients who met the criteria of SIRS and 43 patients without SIRS. The results of univariate analysis found that there are 3 significant factors as predictors of worsening neurological deficits, such as the SIRS event on hospital admission (p <0.01, RR 4.00 CI 95% 1.96 to 8.15), history of hypertension (p = 0,04; RR 2.94 CI 95% 0.80 to 10.78) and systolic blood pressure (p = 0.01, RR 2.26 CI 95% 1.12 to 4.55). Multivariate analysis found SIRS event on hospital admission affect the progression of worsening neurological deficits significantly. Conclusions: Systemic inflammatory response syndrome at hospital admission can be used as a predictor of worsening neurological deficits in patients with acute ischemic stroke.

Kata Kunci : SIRS, prognosis, perburukan defisit neurologis, stroke iskemia akut, kohort prospektif