KORELASI KADAR FIBRINOGEN PLASMA DENGAN SKOR MODEL OF END STAGE LIVER DISEASE PADA PENDERITA SIROSIS HATI

dr. Mochammad Abdul Nasir, dr. Neneng Ratnasari SpPD-KGEH.

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Salah satu komplikasi yang sering terjadi pada sirosis hati adalah perdarahan. Beratnya perdarahan erat hubungannya dengan gangguan hemostasis sedang gangguan hemostasis umumnya berhubungan dengan gangguan fungsi hati. Sehingga diperlukan biomarker untuk mengukur secara obyektif tingkat keparahan sirosis hati. Fibrinogen merupakan salah satu faktor pembekuan darah yang dapat digunakan untuk menentukan beratnya sirosis hati. Skor MELD merupakan alternatif paling baik dari skor Child-Pugh. Skor MELD dapat digunakan pada pasien sirosis hati dengan rentang luas keparahan penyakit dan etiologi bahkan pada pasien yang sirosis tidak jelas penyebabnya. Selama ini belum pernah ada penelitian yang menghubungkan antara konsentrasi kadar fibrinogen plasma menurut skor MELD pada penderita sirosis hati. Penelitian ini dilakukan untuk mengetahui adanya hubungan antara konsentrasi kadar fibrinogen plasma menurut skor MELD pada penderita sirosis hati. Desain penelitian adalah potong lintang. Pengambilan sampel dilakukan secara consecutive sampling. Subyek penelitian adalah penderita sirosis hati yang berkunjung ke Poliklinik Gastroenterohepatologi atau dirawat di Bangsal Bagian Penyakit Dalam RSUP Dr. Sardjito Yogyakarta pada november 2011 hingga Oktober 2012 yang memenuhi kriteria inklusi dan eksklusi. Hubungan antara konsentrasi kadar fibrinogen plasma menurut skor MELD dinilai secara statistik dengan uji korelasi. Hasil akhir uji korelasi dinyatakan dalam koefisien korelasi (r). Didapatkan 37 subyek yang memenuhi kriteria, 26 laki-laki dan11 perempuan, rerata usia adalah 52±12,42. Penyebab sirosis infeksi virus hepatitis B Sebanyak 16 (43,2%), hepatitis C 9 (24,3%), non viral 12 (32,5%). Subyek dengan asites 17 (47,91%), tanpa asites 20 (54,1%). Disertai pendarahan 30 (81,1%) subyek, 7(18,9%) tanpa pendarahan. Variabel penyusun skor MELD (bilirubin total, kreatinin dan INR) didapatkan rerata 4,09±5,89 mg/dl; 1,23±0,67 mg/dl; dan 1,57±0,70. Rerata kadar fibrinogen plasma adalah 211±126 mg/dl, sedangkan rerata skor MELD adalah 15,86±8,02. Koefesiensi korelasi Spearman antara kadar fibrinogen plasma dan skor MELD adalah r = -0,384 (p = 0,009). Kesimpulan terdapat korelasi negatif antara kadar fibrinogen dan skor MELD pada pasien sirosis hati.

Bleeding is one of the complications that often develops in liver cirrhosis. The bleeding severity has been associated with hemostasis disorders, which in turn is associated with impaired liver function. Biomarkers to objectively measure the severity of liver cirrhosis is needed. Fibrinogen is a blood clotting factor that may be used to determine the severity of liver cirrhosis. MELD score is the best alternative of the Child-Pugh score. MELD score can be used in liver cirrhosis patients with wide range of severity and etiology even in patients without any clear etiology. So far there are no reports investigating the relationship plasma fibrinogen concentration level according to MELD score in patients with liver cirrhosis. This study was conducted to determine the the relationship plasma fibrinogen concentration level according to MELD score in patients with liver cirrhosis. This is a cross-sectional study. Patients were recruited through consecutive sampling. Subjects were patients with liver cirrhosis who visited the Gastroenterohepatology outpatient clinic or treated in the Internal Medicine ward of Dr. Sardjito Hospital, Yogyakarta between November 2011 and October 2012 who fulfilled the inclusion and exclusion criteria. The correlation between plasma fibrinogen levels and MELD scores were assessed with correlation tests. The result of the correlation test were presented in correlation coefficient (r). There were 37 subjects who fulfilled the criteria, 26 male dan11 female, with mean age of 52±12.42. The cause of cirrhosis were hepatitis B in 16 (43.2%), hepatitis C in 9 (24.3%), and non-viral in 12 (32.5%). Seventeen subjects with ascites (45.9%) and without ascites 20 (54.5%). Bleeding were found in 30 (81.1%) subjects, while 7 subjects (18.9%) dind’t have bleeding. Constituent variables MELD score (bilirubin total, kreatinin dan INR) 4,09±5,89 mg/dl; 1,23±0,67 mg/dl; and 1,57±0,70. Mean plasma fibrinogen levels were 211±126 mg/dl, while the mean MELD score was 15.86±8.02. Pearson correlation coefficient between plasma fibrinogen levels and MELD scores was r=-0.384 (p=0.009). This study conculded that there is a negative correlation between fibrinogen concentration level according to MELD score in patients with liver cirrhosis.

Kata Kunci : sirosis hati, fibrinogen, skor MELD