Perbedaan Nilai Parameter Bioelectrical Impedance Analysis (BIA) pada Pasien Pria Sepsis HIV dan Non HIV

Abstract

Background : Sepsis occurs by severe infection complication with systemic inflammation character and wide lesion over the tissue. The incidency and mortality of sepsis is quite high especially in HIV infection patient. Sepsis in the patient with HIV or without HIV infection would impact alteration in the body composition according to the difference of severity level. The alteration of body composition may be evaluated by BIA which it would assess of the nutritional state, the body fluid state and phase angle as the severity level indicator so it would be expected to be useful for management sepsis in the future. Aim : To understand difference of BIA value parameter among the sepsis male patient with or without HIV infection. Methode : The study was conducted as cross-sectional design between July until September 2011 at RSUP H Adam Malik Medan. Subjects were recruted in two male groups i.e. HIV sepsis and without HIV sepsis, and the age was between 20 and 60 years old. Sepsis was established by SIRS with blood culture and procalsitonin while HIV infection was established by three-methode of ELISA. Then evaluation was done by BIA, the calculation result would be appeared automatically. The normal distribution of data would be analysed by independent t test, while the abnormal one would be analysed by Mann-Whitney test, it was statistically significant if P value of < 0.05. Result : There were 42 samples which was consisted of 21-HIV sepsis patients and 21-without HIV sepsis patients. The baseline characteristics of both groups i.e. : age (29.5±5.8 and 43.6±13.2 years old), body weight (49.2±6.5 and 60.0±8.2 kg), BMI (17.8±2.2 and 22.1 ±3.2 kg/m2 ), respectively, the etiology of sepsis was not different significantly in two groups. There was significantly different of nutritional state parameter which HIV sepsis group was lower than another one : BCM (19.5±2.9 vs 24.0±3.7 kg), FFM (43.6±5.8 vs 49.5±6.4 kg), FM (5.6±2.2 vs 10.4±6.1 kg), FM % (11.3±4.1 vs 16.9±7.8 %), muscle (19.3±3.0 vs 22.7±2.8 kg) and glicogen (395.7±53.1 vs 450.5±57.9 g), respectively. There was only FFM (%) higher in HIV sepsis group (88.7±4.1 vs 83.1±7.8 %). Body fluid volume was also significantly different which HIV sepsis group was lower than another one : TBW (30.1±4.0 vs 35.9±6.4 litres), ICW (10.9±3.1 vs 15.5±4.6 litres), ICW % (36.8±11.0 vs 43.6±10.8 %), and TBK (94.5±13.9 vs 115.9±17.7 g), respectively. There was only ECW (%) higher in HIV sepsis group (63.1±11.0 vs 56.4±10.8 %). Parameter of phase angle was also significantly different which it was lower in HIV sepsis group than another one (3,4±1,0 vs 4,4±1,90 Conclusion : There was significantly different of nutritional state, body fluid volume and phase angle which it was measured by BIA and the result was lower in HIV sepsis patient than without HIV one. There was only FFM (%) and ECW (%) higher in HIV sepsis group.

Latar belakang : Sepsis terjadi akibat komplikasi infeksi berat dengan karakteristik inflamasi sistemik dan jejas pada jaringan yang luas. Insidensi dan mortalitas sepsis sangat tinggi, terutama pada pasien dengan infeksi HIV. Sepsis pada infeksi HIV atau non HIV akan menyebabkan perubahan pada komposisi tubuh dalam tingkat keparahan yang berbeda. Perubahan komposisi tubuh dapat dievaluasi dengan menggunakan BIA, yang dapat menilai status nutrisi, status cairan tubuh, dan phase angle sebagai indikator keparahan penyakit, sehingga diharapkan bermanfaat untuk tatalaksana pasien sepsis ke depan. Tujuan : Untuk mengetahui perbedaan nilai parameter BIA antara pasien pria sepsis pada infeksi HIV dengan sepsis pada non HIV Metode : Penelitian dilakukan secara potong lintang mulai Juli – September 2011 di RSUP H.Adam Malik Medan dengan subjek penelitian kelompok sepsis HIV dan non HIV, jenis kelamin pria, usia 20-60 tahun. Sepsis ditegakkan berdasarkan SIRS ditambah kultur darah dan prokalsitonin, infeksi HIV ditegakkan dengan ELISA 3 metode. Kemudian dilakukan pemeriksaan dengan alat BIA, hasil kalkulasi akan keluar otomatis. Data berdistribusi normal dianalisa memakai uji t tidak berpasangan, yang tidak berdistribusi normal memakai Mann-Whitney test, dikatakan bermakna bila P < 0,05. Hasil : Dari 42 sampel, terdiri atas 21 orang sepsis HIV dan 21 orang sepsis non HIV. Karakteristik dasar kelompok sepsis HIV dan non HIV: umur (29,5±5,8 dan 43,6±13,2 tahun), berat badan (49,2±6,5 dan 60,0±8,2 kg), IMT (17,8±2,2 dan 22,1 ±3,2 kg/m2 ), diagnosis etiologi sepsis antara kedua kelompok tidak berbeda bermakna. Dijumpai perbedaan bermakna parameter status nutrisi, dimana kelompok sepsis HIV lebih rendah dibanding non HIV: BCM (19,5±2,9 vs 24,0±3,7 kg), FFM (43,6±5,8 vs 49,5±6,4 kg), FM (5,6±2,2 vs 10,4±6,1 kg), FM % (11,3±4,1 vs 16,9±7,8 %), muscle (19,3±3,0 vs 22,7±2,8 kg), dan glikogen (395,7±53,1 vs 450,5±57,9 g). Hanya FFM (%) yang nilainya lebih tinggi pada kelompok sepsis HIV (88,7±4,1 vs 83,1±7,8 %). Status volume cairan tubuh juga berbeda bermakna, dimana parameter kelompok sepsis HIV lebih rendah dibanding non HIV: TBW (30,1±4,0 vs 35,9±6,4 liter), ICW (10,9±3,1 vs 15,5±4,6 liter), ICW % (36,8±11,0 vs 43,6±10,8 %), dan TBK (94,5±13,9 vs 115,9±17,7 g). Hanya ECW (%) yang nilainya lebih tinggi pada sepsis HIV (63,1±11,0 vs 56,4±10,8 %). Parameter phase angle juga berbeda bermakna, dimana pada sepsis HIV lebih rendah dibanding non HIV (3,4±1,0 vs 4,4±1,90 Kesimpulan : Terdapat perbedaan bermakna parameter status nutrisi, volume cairan tubuh, dan phase angle yang diukur dengan BIA, dimana nilai pada kelompok sepsis HIV lebih rendah dibanding non HIV. Hanya FFM (%) dan ECW (%) yang nilainya lebih tinggi pada kelompok sepsis HIV