Perbandingan Nilai Neutropil Gelatinase-Associated Lopcalin (NGAL) dan Renal Resistive Index (RI) sebagai Prediktor Kejadian AKI pada Pasien Kritis yang Dirawat di ICU Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Background: Acute kidney injury is a complication found in critically ill patients. The current consensus explains that diagnosis of AKI is based on increased serum creatinine and decreased urine output. Neutrophil gelatinase-associated lipocalin (NGAL) level is increased a few hours after tubular damage occured and can predict AKI more significantly than serum creatinine. Renal resistive index (RI) is also a good marker in predicting the early stage of AKI. Purpose: This study aimed to compare renal resistive index (RI) and neutrophil gelatinase- associated lipocalin (NGAL) level as marker to predict the incidence of AKI in critically ill patients treated in ICU at RSUP H Adam Malik Medan. Method: This was an observational prospective cohort study and was conducted in ICU at RSUP H Adam Malik Medan in April-May 2021. This study had been approved by the Ethics Committee of the Faculty of Medicine, University of North Sumatra and RSUP H. Adam Malik Medan. The inclusion criteria were critical patients aged 18-65 years with 1st and 2nd priority level. Consecutive sampling was used. RI was measured using USG Doppler by researcher and the results were confirmed by ICU supervisors; urine NGAL level was measured within 3 hours after ICU admission. Plasma ureum and creatinine level were measured after 24 hours after ICU admission. Result : A total of 40 samples were collected; the percentage of men and women were 66% and 35%, respectively (p=0,001). There was a significant difference RI between AKI-group and non-AKI group (0.719 ± 0.060 and 0.060 ± 0.077, respectively) (p=0.001). RI has a sensitivity of 71%, specificity of 84%, and accuracy of 87% in predicting the occurrence of AKI with a value of AUROC = 0.871. Meanwhile, NGAL has a sensitivity of 66%, specificity of 89%, and accuracy of 78% in early prediction of AKI incidence in critically ill patients. Conclusion: RI value was higher in the AKI group than non-AKI group. Renal resistive index (RI) has better sensitivity and specificity than Neutrhophil gelatinase associated lipocalin (NGAL) in predicting the incidence of AKI.

Latar Belakang : Acute kidney injury merupakan komplikasi yang sering dijumpai pada pasien kritis yang dirawat di intensive care unit (ICU). Konsensus terkini, diagnosis AKI didasarkan pada peningkatan kreatinin serum dan penurunan output urin. Peningkatan Neutrophil gelatinase- associated lipocalin (NGAL) beberapa jam setelah terjadinya kerusakan tubular dan dilaporkan dapat memprediksi AKI lebih awal dibandingkan kreatinin serum. Renal resistive index (RI) yang juga dilaporkan dapat menjadi marka awal AKI yang baik. Tujuan : Penelitian ini bertujuan membandingkan nilai renal resistive index (RI) dengan neutrophil gelatinase-associated lipocalin (NGAL) sebagai prediktor kejadian AKI pada pasien kritis yang dirawat di ICU Rumah Sakit Umum Pusat Haji Adam Malik. Metode : Penelitian ini merupakan studi analitik observasional dengan desain kohort prospektif. Dilakukan di ICU Rumah Sakit Haji Adam Malik Medan pada bulan April-Mei 2021 dan telah mendapat persetujuan Komite Etik Fakultas Kedokteran Universitas Sumatera Utara dan RSUP H. Adam Malik Medan. Kriteria inklusi adalah pasien kritis berusia 18-65 tahun dengan prioritas 1 dan 2. Teknik pengambilan sampel adalah nonprobability sampling dengan consecutive sampling. Penelitian dilakukan dengan pemeriksaan USG Doppler renal untuk menilai RI (dilakukan oleh peneliti dan dikonfirmasi oleh supervisor ICU) dan NGAL urin dalam rentang 3 jam sejak admisi ICU. Pemeriksaan ulang terhadap kadar ureum dan kreatinin dilakukan 24 jam perawatan. Hasil : Penelitian ini diikuti oleh 40 subjek yang telah memenuhi kriteria inklusi. jumlah sampel laki- laki sebanyak 26 (66%) dan perempuan 14 (35%) orang (p = 0,001). didapatkan perbedaan pada nilai rerata renal resistive index antara kelompok AKI dengan non-AKI, yaitu 0,719 ± 0,060 berbanding 0,060 ± 0,077 (p=0.001). RI memiliki sensitivitas 71%, spesifisitas 84%, dan akurasi 87 % dalam memprediksi kejadian AKI dengan nilai AUROC = 0,871. Sementara, NGAL memiliki sensitivitas 66%, spesifisitas 89%, dan akurasi 78 % dalam prediksi dini kejadian AKI pada pasien rawatan ICU. Kesimpulan : Nilai RI lebih tinggi pada kelompok yang mengalami AKI dibandingkan kelompok yang tidak mengalami AKI. Renal resistive index (RI) memiliki sensitivitas dan spesifitas lebih baik dibandingkan Neutrhophil gelatinase associated lipocalin (NGAL) dalam memprediksi kejadian AKI.