Hubungan antara Gangguan Ginjal Akut dan Mortalitas pada Anak dengan Penyakit Kritis di Unit Perawatan Intensif Anak

Abstract

Background The mortality from acute kidney injury (AKI) is as high as 60% in critically ill children. This high mortality rate is influenced by the severity of the disease, organ dysfunction, and stage of acute kidney injury. Objective To assess the association between AKI and mortality in critically ill children. Methods A cross-sectional study was conducted in April – July 2012. All patients aged 1 month – 18 years which admitted to PICU > 24 hours were included. The urine output and serum creatinine were evaluated daily. Patient were categorized according to the pRIFLE criteria. Chi square Fisher Exact Test, Mann-Whitney, and Kruskal-Wallis tests were used to assess the association between AKI, mortality, PELOD score and length of stay. Data was analyzed by computer programme with P<0.05 and confidence interval 95%. Results During the follow-up period, 57 children were admitted, consisted of 25 (43.9%) female and 32 (56.1%) male with median age 43 months. The prevalance of AKI was 31.5% and classified into stage: risk 72.2%, injury 16.7% and failure 11.1%. The prevalence of death in AKI was 16.7%. There was no association between AKI and mortality (P=0.592). The PELOD scores were found equal in all patients (SD 11.32 vs SD 12.23, P=0.830), and there was no association between AKI and length of stays (P=0.819). Conclusion There is no association between AKI and mortality at PICU in H. Adam Malik Hospital. Keywords: acute kidney injury, critical disease, mortality, PELOD score

Latar belakang Laporan kematian gangguan ginjal akut (GnGA) masih tinggi sekitar 60% pada pasien anak dengan penyakit kritis. Tingginya kematian ini dipengaruhi oleh derajat berat penyakit, disfungsi organ, dan derajat GnGA. Tujuan Mengetahui hubungan antara GnGA dan mortalitas pada pasien anak dengan penyakit kritis. Metode Penelitian ini merupakan penelitian cross-sectional, yang dilakukan selama bulan April 2012 – Juli 2012. Sampel penelitian adalah semua pasien yang berusia 1 bulan – 18 tahun yang masuk ke PICU > 24 jam. Produksi urin dan kreatinin serum diperiksa setiap hari. Pasien dikelompokkan berdasarkan kriteria pRIFLE. Untuk menilai hubungan GnGA, mortalitas, skor PELOD, dan lama rawatan digunakan uji Chi square Fisher Exact, Mann-Whitney, dan Kruskal-Wallis. Analisis data menggunakan program komputer, dengan batas kemaknaan P<0,05 dan interval kepercayaan 95%. Hasil Subjek penelitian sebanyak 57 anak yang terdiri dari 25 (43.9%) perempuan dan 32 (56.1%) laki-laki, rentang usia 1 – 206 bulan (median 43 bulan). Prevalensi GnGA sebesar 31.5%, dengan GnGA derajat risk 72.2%, injury 16.7%, dan failure 11.1%. Prevalensi kematian penderita GnGA adalah 16.7%. Tidak ada hubungan antara GnGA dan mortalitas (P=0.592). Rerata skor PELOD pada penderita GnGA dan non GnGA sama (10.28±11.32 vs 10.39±12.23), dan tidak ada hubungan antara GnGA dengan lama rawatan (P=0.819). Kesimpulan Tidak ada hubungan antara GnGA dan mortalitas di Unit Perawatan Intensif Anak RS H. Adam Malik Medan Kata kunci gangguan ginjal akut, mortalitas, penyakit kritis, skor PELOD