HUBUNGAN FIBRILASI ATRIAL DENGAN KEJADIAN GANGGUAN KOGNITIF PADA PASIEN STROKE ISKEMIA DI RSUP Dr. SARDJITO

GALUH DYAH FATMALA, dr Rusdy Ghazali Malueka Ph.D; dr Abdul Gofir, Sp.S (K)

2016 | Skripsi | S1 PENDIDIKAN DOKTER

Latar belakang: Stroke iskemia merupakan jenis stroke dengan prevalensi tertinggi di Indonesia. Stroke iskemia memiliki burden of disease yang relatif berat ditandai dengan munculnya gangguan kognitif. Salah satu faktor risiko yang mungkin menyebabkan gangguan kognitif pada stroke iskemia adalah fibrilasi atrial, namun belum banyak penelitian terkait hal ini. Tujuan: Penelitian bertujuan untuk mengetahui hubungan fibrilasi atrial dengan kejadian gangguan kognitif pada pasien stroke iskemia di RSUP Dr. Sardjito. Metode: Desain penelitian ini adalah kasus kontrol berpasangan. Sampel penelitian berjumlah 27 subyek dengan gangguan kognitif dan 27 subyek normal yang matching berdasarkan usia, jenis kelamin dan rekurensi stroke. Sampel merupakan pasien Unit Stroke RSUP Dr. Sardjito yang diambil secara consecutive sampling. Data dianalisis secara deskriptif dan menggunakan analisis Mc.Nemar, T test, Wilcoxon, dan conditional logistic regression. Hasil: Hasil uji bivariat menunjukkan variabel yang mempunyai OR berisiko dan signifikan hanya AF (OR 7; p=0,003). Variabel dengan OR berisiko namun tidak signifikan: tingkat pendidikan (OR 3; p=0,317), status bekerja (OR 2,3; p=0,206), status BI (OR 2,7; p=0,13), status NIHSS (OR 1,5; p 0,53), riwayat DM (OR 1,5; p=0,53), kadar GDS (OR 1,33; p=0,70). Variabel dengan OR protektif dan signifikan: kadar LDL (OR 0,31; p=0,03) dan onset (OR 0,12; p=0,019). Variabel denga OR protektif namun tidak signifikan: Riwayat hipertensi (OR 0,56; p=0,285), riwayat dislipidemia (OR 0,4; p=0,26), kadar kolesterol total (OR 0,36; p=0,07), trigliserida (OR 0,25; p=0,06), riwayat merokok (OR 0,67; p=0,53), dan tekanan darah saat masuk RS (OR 0,4; p=0,19). Variabel status BMI dan hasil CT-scan bukan menjadi faktor risiko ataupun protektif (OR 1, p=1). Berdasarkan analisis multivariat hanya AF yang terbukti signifikan menjadi faktor risiko (OR 6,39; p=0,026). Kesimpulan: AF merupakan faktor risiko kuat terhadap kejadian gangguan kognitif pada pasien stroke iskemia di RSUP Dr. Sardjito.

ABSTRACT Background: Cognitive impairment after ischemic stroke might worsen the quality of life of the patients. A number of studies have reported that atrial fibrillation could increase the risk of stroke and lift up the risk of cognitive impairment after stroke, but in Indonesia the study has little performed. Purpose: The goal of this study was to examine whether or not atrial fibrillation as the risk factor of cognitive impairement after ischemic stroke at RSUP Dr. Sardjito. Methods: This study was a paired case control design. There were 27 subjects with cognitive impairment and 27 normal subjects who were matched by age, sex, and reccurence of stroke and being asserted by consecutive sampling. This study held at Unit Stroke RSUP Dr. Sardjito from September to Desember 2015. The datum are analyzed descriptively and using Mc.Nemar, T test, Wilcoxon, and conditional logistic regression. Results: The result showed that only AF significantly became risk factor (OR 7; p=0,003). The variables potentially became risk factors but not significantly enough: educational status (OR 3; p=0,317), employment status (OR 2,3; p=0,206), BI status (OR 2,7; p=0,13), NIHSS status (OR 1,5; p 0,53), history of DM (OR 1,2; p=0,76), concentration of random blood glucose (OR 1,33; p=0,70). The variables significatly became protective factors: concentration of LDL (OR 0,31; p=0,03) and onset (OR 0,12; p=0,019). The variables potentially became protective factors but not significantly enough: history of hypertension (OR 0,56; p=0,285), history of dyslipidemia (OR 0,4; p=0,26), concentration of total cholesterol (OR 0,36; p=0,07), triglyceride (OR 0,25; p=0,06), history of smoking (OR 0,67; p=0,53), and initial blood pressure (OR 0,4; p=0,19). BMI status and CT-scan were neither risk factor nor protective factor (OR 1, p=1). Based on multivariate analysis only AF was significantly being risk factor (OR 6,39; p=0,026). Conclusion: Atrial fibrillation is a strong risk factor of cognitive impairment after ischemic stroke among patients at RSUP Dr. Sardjito.

Kata Kunci : Atrial fibrillation, ischemic stroke, cognitive impairment, Moca-INA