Kadar D-Dimer Plasma sebagai Parameter Diagnostik pada Stroke Iskemik Akut di Rsup H. Adam Malik Medan

Abstract

Background : Stroke become a common cause of death and disability in the world. In Indonesia, stroke ranks third after heart disease and malignancy. Ischemic stroke is a clinical sign of brain dysfunction or tissue damage caused by lack of blood flow to the brain that disrupt the blood and oxygen requirements in brain tissue. Prompt diagnosis can reduce morbidity and mortality. CT-scan is the gold standard but it has some limitations that difficult to recognize early sign of ischemia in 3-6 hours, expensive and not shared by all hospitals. As a result of these limitations, it would require another sign that non invansive, sensitive, specific, easier and cheaper to detect the presence of thrombus which is the cause of ischemic stroke is D-dimer. Objective : This studywas design to determine the diagnostic value of plasma levels of D-dimer of the CT-scan in acute ishemic stroke. Method : A cross-sectional study was conducted. Forty patients who met the inclusion criteria were taken from The Neurology Department and research done at the Department of Clinical Pathology RSUP.H.Adam Malik / FK USU Medan. D dimer examination and CT-scan as the gold standard. Plasma levels of D-dimer using the latex agglutination method with a cut-off point of 500 ng/ml. Statistical analysis using a 2x2 table to determine the sensitivity, specivicity, positive predictive value, negative predictive value, prevalence and likelihood ratio. Result : Obtained sensitivity 77,7%, specivificity 53,8%, positive predictive value 77,7%, negative predictive value 53,8%, prevalens 67,5%, likelihood ratio positive 1,74 and likelihood ratio negative 0,43 Conclusion : The level plasma D-dimer can be used as an exclusion dignostic in acute ischemic stroke.

Latar Belakang : Stroke secara nyata menjadi penyebab kematian dan kecacatan di seluruh dunia. Di Indonesia, stroke menduduki peringkat ketiga setelah penyakit jantung dan keganasan. Stroke iskemik adalah tanda klinis disfungsi atau kerusakan jaringan otak yang disebabkan kurangnya aliran darah ke otak sehingga mengganggu kebutuhan darah dan oksigen di jaringan otak. Diagnosis yang tepat dapat mengurangi morbiditas dan mortalitas. CT-scan merupakan baku emas, namun memiliki keterbatasan yaitu sulit mengenali tanda awal iskemik dalam 3-6 jam, mahal dan tidak dimiliki oleh semua rumah sakit. Akibat keterbatasan tersebut, maka diperlukan petanda lain yang non invansif, sensitif, spesifik, lebih mudah dan murah untuk mendeteksi adanya trombus yang merupakan penyebab stroke iskemik yaitu D-dimer. Tujuan : mengetahui nilai diagnostik kadar D-dimer plasma terhadap CT-scan pada stroke iskemik akut. Metoda : Penelitian dilakukan secara potong lintang. Sebanyak empat puluh pasien yang memenuhi kriteria inklusi diambil dari Departemen Ilmu Penyakit Saraf dan penelitian dilakukan di Departemen Patologi Klinik RSUP.H.Adam Malik / FK USU Medan. Dilakukan pemeriksaan D-dimer dan CT-scan sebagai baku emas. Kadar D dimer plasma menggunakan metoda latex agglutination dengan cut-off point 500 ng/ml. Analisa statistik menggunakan tabel 2x2 untuk menentukan sensitivitas, spesifisitas, positive predictive value, negative predictive value, prevalens dan likelihood ratio. Hasil : Didapatkan sensitivitas 77,7%, spesifisitas 53,8%, positive predictivevalue 77,7%, negative predictive value 53,8%, prevalens 67,5%, likelihood ratio positive 1,74 dan likelihood ratio negative 0,43 Simpulan : Pemeriksaan kadar D-dimer plasma dapat digunakan sebagai exclusion diagnostic pada stroke iskemik akut.