Nilai Akurasi Mean Platelet Volume (MPV), White Blood Cell (WBC) dan Neutrofil pada Pasien Appendisitis Sederhana dan Appendisitis Komplikasi Anak di RSUP. H. Adam Malik Medan

Abstract

Background: Diagnosis of appendicitis remains a challenge, especially in the age group of children. An accurate diagnosis of appendicitis was based on history, physical examination and laboratory tests and imaging. Mean platelet volume (MPV) is presented in a complete blood cell count used routinely and is an indicator of platelet activation. Very few studies have examined the diagnostic accuracy of the parameters of platelet function in case of appendicitis. The purpose of this study is to determine the accuracy of the MPV in diagnosing simple appendicitis and complicated appendicitis in children. Materials and Method: Retrospective study was conducted on 151 patients under 18 years of age who present to Central General Hospital (RSUP) H. Adam Malik Medan with symptoms of appendicitis and appendectomy was performed from January 2011 to September 2015. Blood samples were taken and sent to a laboratory to determine the value of MPV, White Blood Cell (WBC) and Neutrophil preoperatively. Histopathology appendectomy and post-operative examination is carried out. By histopathology, appendicitis is grouped into simple and complicated appendicitis. To MPV, WBC and neutrophil, the assessment is made on the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) was analyzed for each laboratory examination. Results: From a sample of 151 subjects in this study, it was found that histopathologically simple appendicitis is 36.4% and complicated appendicitis is 63.6%. By age group, simple appendicitis is most prevalent in the age group 12-18 years that is 78.2% and complicated appendicitis is most prevalent in the age group <12 years that is 63.5%. The mean value of MCV in complicated appendicitis is 9.32 ± 0.99 which is relatively similar to simple appendicitis which has a mean value of 9.39 ± 1.13 (p> 0.05), which means there is no significant difference in the value of MPV between types of complicated appendicitis with simple appendicitis. MPV has a sensitivity 11%, specificity 80%, accuracy 36%, PPV 50%, NPV 34%. WBC has a sensitivity 81%, specificity 44%, accuracy 68%, PPV 72%, NPV 57%. Neutrophils have a sensitivity 75%, specificity 67%, accuracy 60%, PPV 75%, NPV 47%. Conclusion: MPV value was not statistically significant in predicting appendicitis simple and complicated appendicitis. Examination of the MPV in patients with appendicitis has a lower value of accuracy than the examination of the WBC and neutrophil.

Latar Belakang: diagnosis appendisitis masih merupakan suatu tantangan teutama pada kelompok usia anak. Diagnosis yang akurat dari appendisitis didasarkan oleh anamnesis, pemeriksaan fisik dan pemeriksaan laboratorium serta pencitraan. Mean Platelet Volume (MPV) dipresentasikan dalam jumlah sel darah total yang digunakan secara rutin dan merupakan indikator dari aktivasi trombosit. Sangat sedikit studi yang meneliti akurasi diagnostik dari parameter fungsi trombosit dalam kasus appendisitis. Tujuan penelitian ini untuk mengetahui nilai akurasi MPV dalam mendiagnosis appendisitis sederhana dan appendisitis komplikasi pada anak. Material dan Metode: Studi retrospektif terhadap 151 pasien usia dibawah 18 tahun yang datang ke RSUP H. Adam Malik Medan dengan gejala appendisitis dan dilakukan appendektomi dari bulan januari 2011 hingga September 2015. Sampel darah diambil dan dikirim ke laboratorium untuk mengetahui nilai MPV, White Blood Cell (WBC) dan Neutrofil preoperatif. Dilakukan appendektomi dan pemeriksaan histoptologi pascaoperasi. Berdasarkan histopatologi, appendisitis dikelompokkan menjadi appendisitis sederhana dan komplikata. MPV, WBC dan netrofil dinilai sensitivitas, spesifisitas, akurasi, nilai positi prediktif (NPP) dan nilai prediktif negatif (NPN) kemudian dianalisis untuk masing-masing pemeriksaan laboratorium. Hasil : Dari 151 sampel dalam penelitian berdasarkan histopatologi didapat 36,4% appendisitis sederhana dan 63,6% appendisitis komplikata. Berdasarkan kelompok umur appendisitis sederhana terbanyak pada usia 12-18 tahun sebanyak 78,2% dan appendisitis komplikasi terbanyak pada usia <12 tahun sebanyak 63,5%. Nilai rerata MPV pada appendisitis komplikasi 9,32 ± 0,99 relatif sama dengan appendisitis sederhana yang mempunyai nilai rerata 9,39 ± 1,13 (p>0,05) yang berarti tidak ada perbedaan yang bermakna nilai MPV pada jenis appendisitis komplikasi dengan appendisitis sederhana. MPV memiliki sensitivitas 11%, spesifisitas 80%, akurasi 36%, NPP 50%, NPN 34%. WBC memiliki sensitivitas 81%, spesifisitas 44%, akurasi 68%, NPP 72%, NPN 57%. Netrofil memiliki sensitivitas 75%, spesifisitas 67%, akurasi 60%, NPP 75%, NPN 47%. Kesimpulan :. nilai MPV secara statistik tidak bermakna dalam memprediksi appendisitis sederhana dan appendisitis komplikasi. Pemeriksaan MPV pada pasien appendisitis memiliki nilai akurasi yang lebih rendah dibanding dengan pemeriksaan WBC dan neutrofil