HIPERGLIKEMIA DALAM 24 JAM PERTAMA PERAWATAN SEBAGAI FAKTOR PROGNOSIS LUARAN KLINIS PASIEN KRITIS DI PICU

LUCIANA INTANTI PUTRIJAYA, dr. Nenny Sri Mulyani, SpA(K)

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

Penelitian mengenai hiperglikemia dan pengaruhnya terhadap luaran klinis anak sakit kritis menunjukkan hasil yang inkonsisten. Penelitian ini dilakukan untuk mengkaji hubungan antara hiperglikemia dalam 24 jam pertama perawatan dengan luaran klinis (mortalitas dan lama perawatan) pasien kritis di PICU. Metode penelitian menggunakan rancangan kohort retrospektif. Subyek adalah anak berumur 1 bulan-18 tahun yang dirawat di PICU RSUP Dr. Sardjito sejak Februari 2009 sampai Januari 2011, tanpa riwayat diabetes melitus, dan tidak mendapat terapi insulin selama dirawat di PICU. Berdasarkan catatan medis diambil data kadar glukosa darah tertinggi dalam 24 jam pertama perawatan, skor PRISM III, umur, jenis kelamin, status gizi, jenis kasus, faktor luar yang berpengaruh terhadap kejadian hiperglikemia (glukokortikoid eksogen, katekolamin eksogen, diuretik, dekstrosa intravena), serta luaran mortalitas dan lama perawatan di PICU. Subyek dibagi menjadi 2 kelompok dengan kadar glukosa darah >150 mg/dL(hiperglikemia) dan kadar glukosa darah 80-150 mg/dL (normoglikemia). Dari 190 subyek yang memenuhi kriteria (95 subyek pada masing-masing kelompok), 32,6% meninggal pada akhir perawatan di PICU. Mortalitas lebih tinggi pada kelompok subyek dengan kadar glukosa darah >150 mg/dL (35,8% vs 29,5%), tetapi hubungan ini tidak bermakna secara statistik (RR 1,2; IK 95% 0,8-1,8; p=0,353; uji x2. Pada 128 subyek dengan luaran hidup lama perawatan kedua kelompok tidak berbeda bermakna (p=0,904; uji Mann-Whitney). Disimpulkan bahwa hiperglikemia dalam 24 jam pertama bukan faktor prognosis mortalitas dan lama perawatan pasien kritis di PICU.

Several studies showed that hyperglycemia is common in critically ill children and associated with poor clinical outcomes. However these findings are still inconsistent. This study was conducted to identify whether hyperglycemia within the first 24 hours of hospitalization is a prognostic factor for PICU mortality and length of stay. This was a retrospective cohort study. Subjects were children aged 1 month- 18 years hospitalized at PICU Dr. Sardjito General Hospital from February 2009 to January 2011, with no history of diabetes mellitus and administration of insulin. Data of the highest blood glucose levels within the first 24 hours,PRISM III score, nutritional status, surgical/medical case, external factors affecting the incidence of hyperglycemia (exogenous glucocorticoids, exogenous catecholamines, diuretics, intravenous dextrose), mortality and length of stay, were collected from medical records. Subjects were divided into two blood glucose level group: >150 mg/dL (hyperglycemia) and 80-150 mg/dL (normoglycemia). Of the 190 eligible subjects (95 subjects in each blood glucose level group), 32,6% died in PICU. Mortality was higher in subjects with blood glucose levels >150 mg/dL compared to 80-150 mg/dL (35.8% vs 29.5%), but the association was not significant (RR 1.2, 95%CI 0.8 to1.8; p=0.353; x2 test). In 128 survivors, the length of stay in both groups was not significantly different (p=0.904; Mann-Whitney test). In conclusion, hyperglycemia within the first 24 hours is not a prognostic factor for mortality and length of stay in critically-ill children.

Kata Kunci : hyperglycemia, critically ill, mortality, length of stay, PICU