Hubungan Profil Lipid dan Derajat Keparahan Penyakit Berdasarkan Skor Pediatric Logistic Organ Dysfunction-2 (Pelod-2) pada Anak dengan Sepsis

Abstract

Background: Sepsis is the most common cause of mortality in neonates and children in the hospital. Sepsis and septic shock may lead to neuro-endocrine and metabolic alterations including plasma lipid and lipoprotein. But association between lipid profile and severity of disease in pediatric sepsis is still unclear. Objective: To investigate the association between lipid profile and severity of disease in pediatric sepsis. Methods: A cross-sectional study was conducted from July to October 2017 in PICU, Haji Adam Malik hospital. The samples were included children from one month to <18 year old who diagnosed with sepsis. Patients who suffered from diabetes mellitus, nephrotic syndrome, overweight, severe malnutrition, received statin and parenteral lipid were excluded. There were 30 children included this study. Severity of disease was examined by using PELOD-2 score. Cut-off points for each lipid profile based on Receiver Operating Characteristic (ROC) curves. The association between lipid profile and severity of disease was analyzed using chi-square or fisher exact test. The P value <0,05 was considered to be statistically significant. Results: Cut-off point for total cholesterol was 93,5 mg/dL, triglyceride 181,5 mg/dL, HDL 18,5 mg/dL and LDL 33,5 mg/dL. The association between lipid profile and severity of disease (PELOD-2 score) had P values as follows: total cholesterol 0,007, triglyceride 0,013, HDL 0,052 and LDL 0,547. Conclusion: The association between total cholesterol and triglyceride with severity of disease in pediatric sepsis were statistically significant, except for HDL and LDL.

Latar belakang: Sepsis penyebab kematian terbanyak pada bayi dan anak di rumah sakit. Sepsis dan syok septik menyebabkan perubahan neuroendokrin dan metabolik termasuk konsentrasi dan komposisi lipid plasma serta lipoprotein. Tetapi hubungan profil lipid dan derajat keparahan penyakit pada anak dengan sepsis masih belum jelas. Tujuan: Mengetahui hubungan profil lipid terhadap derajat keparahan penyakit pada anak dengan sepsis. Metode: Penelitian potong-lintang bulan Juli sampai Oktober 2017 di PICU, RSUP Haji Adam Malik. Sampel adalah anak usia 1 bulan sampai <18 tahun yang didiagnosa sepsis. Pasien yang menderita diabetes melitus, sindrom nefrotik, gizi lebih, gizi buruk, mendapatkan terapi statin dan insulin diekslusikan. Didapatkan 30 orang anak yang memenuhi kriteria. Derajat keparahan penyakit dinilai berdasarkan skor PELOD-2. Nilai cut-off masingmasing profil lipid berdasarkan kurva ROC. Hubungan antara profil lipid dan derajat keparahan penyakit dianalisa dengan uji chi-square atau fisher exact. Nilai P < 0,05 dianggap bermakna secara statistik . Hasil: Nilai cut-off kolesterol total 93,5 mg/dL, trigliserida 181,5 mg/dL, HDL 18,5 mg/dL dan LDL 33,5 mg/dL. Didapatkan hubungan profil lipid dan derajat keparahan penyakit (PELOD-2) dengan nilai P: kolesterol total 0,007, trigliserida 0,013, HDL 0,052, dan LDL 0,547. Kesimpulan: Terdapat hubungan bermakna antara kadar kolesterol total dan trigliserida dengan PELOD-2, sedangkan HDL dan LDL tidak bermakna.