Hematological Scoring System (HSS) sebagai Alat Uji Diagnostik Dini Sepsis pada Neonatus

Abstract

Background. Sepsis was the leading cause of death in babies by 30%-50% in developing countries. Early diagnosis of neonatal sepsis was still a difficult problem because of clinical features were not specific. Blood culture was the gold standard, but it took several days and expensive. The hematological scoring system (HSS) consist of hematologic parameters (leucocyte, polymorphonuclear (PMN), degenerative changes, and platelet count) for early diagnosis of neonatal sepsis. Objective. To determine whether HSS could be used as a early diagnostic tool for neonatal sepsis. Methods. A cross sectional study was conducted in March to Juny 2013. Samples were collected by consecutive sampling. Fourty neonates suspected sepsis in neonatology unit H. Adam Malik hospital underwent routine blood count, blood culture, peripheral blood smear. Each hematologic parameters were analysed using the HSS of Rodwell et al. The hematologic parameters were total leucocyte count, total PMN, total PMN immature, ratio PMN I:T, ratio PMN I:M, degenerative changes, and platelet count. The total value reveal score HSS. Diagnostic test was used in this study. Statistical analyses were conducted with computerized software. Results. Ten of fourty neonates had sepsis based on blood culture. Using the values HSS, score ≥ 4 had sensitivity 80%, specificity 90%, with positive predictive value 73%, negative predictive value 93% and P<0.001, ROC curve showed cut off point 0.902 (95% CI 0.803-0.1). Conclusion. Score HSS ≥ 4 can be use as a early diagnostic tool for neonatal sepsis.

Latar belakang. Sepsis penyebab kematian utama pada bayi sekitar 30% - 50% di negara berkembang. Pemeriksaan kultur darah merupakan baku emas, namun memerlukan waktu beberapa hari dan biaya mahal. Hematological scoring system (HSS) yang terdiri dari parameter hematologi (leukosit, polimorfonuklear (PMN), dan trombosit) dapat digunakan untuk diagnosis dini sepsis pada neonatus. Tujuan. Untuk menentukan apakah HSS dapat digunakan sebagai alat uji diagnostik dini sepsis pada neonates. Metode. Penelitian ini menggunakan desain cross sectional yang dilakukan pada bulan Maret-Juni 2013. Sampel penelitian dikumpulkan dengan metode consecutive sampling. 40 neonatus tersangka sepsis di unit neonatologi Rumah Sakit H. Adam Malik Medan dilakukan pemeriksaan darah rutin, kultur darah dan sediaan hapusan darah tepi. Parameter hematologi dianalisa dengan HSS yang diformulasikan oleh Rodwell, dkk. Parameter hematologi terdiri dari total leukosit, total PMN, total PMN imatur, rasio PMN I:T, rasio PMN I:M, perubahan degeneratif, dan total trombosit. Nilai total menunjukkan skor HSS. Penelitian ini menggunakan tes uji diagnostik. Analisa statistik dengan menggunakan program komputer. Hasil. Dari 40 neonatus, 10 neonatus mengalami sepsis berdasarkan hasil kultur darah. Penggunaan penilaian HSS, skor ≥ 4 mempunyai sensitivitas 80%, spesifisitas 90%, dengan nilai duga positif 73% dan nilai duga negatif 93%. dengan kurva ROC menunjukkan cut off point 0.902 (95%IK 0.803-0.1). Kesimpulan. Skor HSS ≥ 4 dapat digunakan sebagai alat uji diagnostik dini sepsis pada neonatus.