Hubungan Kadar D-Dimer dengan Modified Rankin Scale dan National Institute of Health Stroke Scale Hari ke-15 Pasca Stroke Akut

Abstract

Latar Belakang : Stroke merupakan suatu abnormalitas fungsi otak akibat terputusnya sirkulasi ke otak. Pada stroke akut terjadi gangguan fungsi hemostatik, salah satu marker prognosis adalah D-dimer yang berasal dari degradasi fibrin. Marker fibrin formation ditemukan meningkat secara signifikan setelah stroke akut. Tujuan penelitian ini adalah untuk mengetahui hubungan kadar D-dimer pada penderita stroke akut dengan dengan outcome yang dinilai dengan Modified Rankin Scale (MRS) dan National Institute of Health Stroke Scale (NIHSS). Metodologi: Penelitian ini merupakan studi prospektif terhadap 30 penderita stroke akut yang diambil secara random dengan metode konsekutif dari bangsal Neurologi RSUP.H.Adam Malik Medan periode November 2006 hingga April 2007. Diagnosis stroke dilakukan dengan anamnesis, pemeriksaan klinis, neurologik dan neuroimajing. Pengambilan darah vena untuk pemeriksaan kadar D-dimer dilakukan pada saat onset ≤ 7hari. Dilakukan pemeriksaan skala MRS dan NIHSS pada hari ke 15. Digunakan analisa uji t-independent, dan uji korelasi Pearson dengan nilai kemaknaan p<0.05 Hasil : Karakteristik subjek penelitian adalah 18 perempuan (60%) dan 12 laki-laki (40%) dengan rerata usia 59.7 tahun. Ada 21 penderita stroke iskemik (70%) dan 9 penderita stroke hemoragik (30%). Rerata kadar D-dimer adalah 960.00 ± 376.09 ng/ml, rerata kadar D-dimer menurut jenis kelamin yaitu 1047.22±427.35 ng/ml pada perempuan dan 829.17±243.15 ng/ml pada laki-laki, rerata skor MRS adalah 3.13±1.47 dan rerata skor NIHSS 12.20±7.20. Ada perbedaan bermakna kadar D-dimer dengan skor MRS dan NIHSS. (p<0.05). Pada MRS (4-6) ditemukan kadar D-dimer yang tinggi yaitu rerata 1239.29±385.39 ng/ml dan pada nilai NIHSS (>13) ditemukan rerata kadar D-dimer 1345.45±353.16 ng/ml. Ada Hubungan yang bermakna kadar D-dimer dengan skor MRS (p=0.00) Kesimpulan : Peningkatan kadar D-dimer berpengaruh terhadap keluaran defisit neurologis dengan penggunaan MRS secara bermakna pada stroke akut.

Background : Stroke is an abnormality of brain function caused by distribution of the circulation of the brain. In acute stroke, there is a disturbance in the hemostatic function, one of the prognostic factor is D-dimer which is a fibrin degradation product. Marker fibrin formation was found significantly increased after acute stroke. Our objective was to study determine the correlation between D-dimer level in acute stroke patients and outcome. We used to Modified Rankin Scale (MRS) and National Institute of Health Stroke Scale (NIHSS) Methods : This is a prospective study of 30 acute stroke patients, randomized with consecutive method who were admitted in the Neurology ward at H.Adam Malik Hospital Medan, from November 2006 to April 2007. The diagnosis of stroke was made based on history taking, physical, neurological examinations and neuroimaging. Vein blood for D-dimer level examination was taken on onset ≤ 7 day. Modified Rankin Scale and National Institute of Health Stroke Scale was evaluated on day 15. T-independent and Pearson Correlation tests were used with level of significant of < 0.05. Results: The subjects of this study were consisted of 18 female (60%) and 12 male (40%), mean of age was 59.7 years old. There were 21 patient (70%) with ischemic stroke and 9 patients (30%) suffered hemorrhage stroke. The mean of D-dimer level was 960.00± 376.09 ng/ml. The mean of D-dimer level based on gender was 1047.22±427.35 ng/ml in female subjects and 829.17±243.15 ng/ml in male subjects. The mean of Modified Rankin Scale score was 3.13±1.47 and mean of National Institute of Health Stroke Scale score was 12.20±7.20. There was a significant different between D-dimer level and Modified Rankin Scale score and National Institute of Health Stroke Scale score (p<0.05), where in MRS score 4-6, the highest D-dimer level was found, with mean of 1239.29±385.39 ng/ml and NIHSS score (>13) was found the highest with mean of D-dimer level mean of 1345.45±353.16 ng/ml (p<0.05). There was a significant correlation between increased D-dimer level and MRS score.(p=0.00) Conclusions: The increased of D-dimer level has an influence toward neurological deficits outcome using the Modified Rankin Scale in acute stroke patients.