Hubungan Kadar D-Dimer Saat Awal Pemeriksaan pada Pasien Pneumonia Komunitas terhadap Kematian 30 Hari

Abstract

Background Pneumonia in patients with community, to assess the degree of severity in the early admission is crucial because it will determine the severity of the disease and subsequent treatment of the plan better so that 30-day mortality rate can be reduced on the PK. D-dimer (DD) is known as coagulation biomarkers are useful in assessing the degree of severity of community acquired pneumonia (CAP) . DD can play a role in the prognosis of patients with community acquired pneumonia (CAP). Objective : To determine the relationship of D-dimer levels at initial examination of community pneumonia patients to death 30 days. Materials and Methods : Research conducted a prospective cohort study. Subjects with CAP coming from the emergency department, after meeting the assessment criteria CURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, Age > 65 years), DD, laboratory blood, sputum and blood cultures. We had correlate the DD levels with CURB-65 to 30-day mortality. Result : Of the 57 subjects in which the dead were 17 subjects (36.2%) were classified in the CURB-65 score has a weight of DD levels > 500 μg/L, and as many as 3 subjects (6.4%) were classified in the CURB-65 score had mild-moderate levels of DD levels < 500 μg/L. After the chi-square test obtained a significant relationship between elevated levels of DD with 30-day mortality (p = 0.0001) Conclusion : D-dimer levels in patients with pneumonia early inspection is strongly correlated with the number of community deaths 30 days, where the higher the higher levels of D-dimer, the higher number of deaths 30 days.

Latar Belakang Pada penderita pneumonia komunitas, melakukan penilaian derajat keparahan pada awal pasien masuk sangat penting sebab akan menentukan beratnya penyakit dan rencana tatalaksana selanjutnya yang lebih baik sehingga angka kematian 30 hari pada PK dapat dikurangi. D-dimer (DD) dikenal sebagai biomarker koagulasi yang berguna dalam menilai derajat keparahan PK. DD dapat berperan dalam prognosis penderita PK. Tujuan : Untuk mengetahui hubungan kadar D-dimer pada saat awal pemeriksaan pasien pneumonia komunitas terhadap kematian 30 hari. Bahan dan Cara : Penelitian dilakukan secara cohort study yang bersifat prospektif. Subjek dengan pneumonia komunitas yang masuk dari instalasi gawat darurat, setelah memenuhi kriteria dilakukan penilaian skor CURB-65(Confusion, Urea, Respiratory rate, Blood pressure, Age >65 years), DD, laboratorium darah, kultur sputum dan darah. Selanjutnya skor CURB-65 dihubungan dengan DD dan kematian 30 hari. Hasil : Dari 57 subjek penelitian dimana yang meninggal sebanyak 17 subjek (36,2%) yang tergolong dalam skor CURB-65 berat memiliki kadar DD > 500 μg/ L, dan sebanyak 3 subjek (6,4%) yang tergolong dalam skor CURB-65 ringan-sedang memiliki kadar kadar DD < 500 μg/ L. Setelah dilakukan chi-Square test diperoleh hubungan signifikan antara peningkatan kadar DD dengan kematian 30 hari (p= 0,0001) Kesimpulan : Kadar D-dimer diawal pemeriksaan pada penderita pneumonia komunitas berkorelasi kuat dengan jumlah kematian 30 hari, dimana semakin tinggi tinggi kadar D-dimer maka semakin tinggi jumlah kematian 30 hari.