Hubungan Nilai Rasio Bun-Kreatinin dan Status Hemokonsentrasi Akhir Rawatan Pasien Gagal Jantung Akut Terhadap Kejadian Kardiovaskular Mayor (Kkvm) dalam Waktu 6 Bulan Setelah Pulang di Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Objective: High BUN / creatinine ratio values have been known to be associated with the incidence of death in patients with acute heart failure (ARF) who are equipped with renal dysfunction. However, the clinical impact of a high BUN / creatinine ratio at the end of treatment showed renal dysfunction, neurohormonal hyperactivity and different responses to decongestion therapy not clear. Hemoconcentration status has become a parameter that supports decongestion therapy. This study aimed to see the relationship between the BUN/creatinine ratio at the end of treatment and hemoconcentration status to Major Cardiovascular Events (MACE) after 6 months at RSUP H. Adam Malik. Methods: This study is a comparative analytical study with a retrospective cohort method from July 2018 to March 2020. The total sample was 134 patients diagnosed with acute heart failure at H. Adam Malik General Hospital who met the inclusion and exclusion criteria. Each variable will be calculated p value, with a p value <0.05 is considered statistically significant. Results: The research subjects were 134 people consisting of 98 people (73.1%) men and 36 people (10.7%) women. This study obtained a mean BUN/Cr ratio at the end of treatment 19.27 ± 8.95 and hemodilution as much as 56.7% of the sample. From the analysis with the comparative test, it was found that there were significant differences between each sample group towards the MACE. From the logistic regression analysis, it was found that the incidence of MACE in the high BUN / Cr ratio group and hemodilution was 6 times higher than the low BUN / Cr ratio group and hemoconcentration group. Conclusion : High BUN/Cr ratio at the end of admission and hemodilution in acute heart failure patients was associated with major cardiovascular events at 6 months.

Tujuan : Nilai rasio BUN/Kreatinin yang tinggi telah diketahui berkaitan dengan kejadian kematian pada pasien Gagal Jantung Akut (GJA) yang disertai disfungsi ginjal.Tetapi dampak klinis dari rasio BUN/Kreatinin tinggi di akhir rawatan menunjukkan disfungsi ginjal, hiperaktivitas neurohormonal dan respon berbeda terhadap terapi dekongesti belum jelas. Status hemokonsentrasi telah menjadi parameter keberhasilan terapi dekongesti. Penelitian ini ditujukan untuk mengetahui hubungan antara rasio BUN/Kreatinin akhir rawatan dan status hemokonsentrasi terhadap Kejadian Kardiovaskular Mayor (KKvM) setelah 6 bulan di RSUP H. Adam Malik. Metode : Penelitian ini merupakan suatu studi analisif komparatif dengan metode kohort retrospektif mulai Juli 2018 sampai Maret 2020. Jumlah sampel sebanyak 134 orang pasien yang didiagnosis dengan gagal jantung akut di RSUP H.Adam Malik yang memenuhi kriteria inklusi dan eksklusi. Masing-masing variabel akan dihitung nilai p, dengan nilai p <0,05 dianggap signifikan secara statistik. Hasil : Subyek penelitian sebanyak 134 orang yang terdiri dari 98 orang (73,1%) laki-laki dan 36 orang (10.7%) perempuan. Penelitian ini mendapatkan rerata rasio BUN/Cr akhir rawatan 19,27 ± 8,95 dan hemodilusi sebanyak 56,7% sampel. Dari analisis dengan uji komparatif didapati perbedaan bermakna antar tiap kelompok sampel terhadap KKvM. Dari hasil analisis uji regresi logistik didapati kejadian KKvM pada kelompok rasio BUN/Cr tinggi dan hemodilusi 6 kali lipat dibanding kelompok rasio BUN/Cr rendah dan hemokonsentrasi. Kesimpulan : Rasio BUN/Cr tinggi di akhir rawatan dan hemodilusi pada pasien gagal jantung akut memiliki hubungan dengan Kejadian Kardiovaskular Mayor dalam 6 bulan.