Hubungan Kadar Antithrombin Iii (At-Iii) saat Awal Masuk Rumah Sakit terhadap Kematian 30 Hari pada Pasien Pneumonia Komunitas

Abstract

Background. In patients with community acquired pneumonia (CAP), assessing the severity of the disease during the patient's initial hospital admission is very important to determine the best management for the patient in order to reduce 30-day mortality rate. Antithrombin III (AT-III) is a coagulation biomarker that is useful for the assessment of the severity of CAP at the time of admission. AT-III may play a role in the diagnosis and prognosis of patients with CAP. Objective. To determine the association between the level of antithrombin during hospital admission with 30-day mortality in patients with CAP. Materials and Methods. This is a prospective cohort study. Subjects that met CAP criteria in the emergency department were examined for their CURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, Age >65 years), AT-III, laboratory blood, sputum culture, blood culture and chest radiographs. We then use statistic analysis to determine the association between level of AT-III and 30-day mortality. Result. Of the total 55 study subjects, 9 subjects (100%) with low levels of AT-III had severe CURB-65 score. Of the remaining 46 subjects with normal levels of AT-III, 28 subjects (60,9%) had mild CURB-65 score, 18 subjects (39,1%) had severe CURB-65. A total of 20 subjects died (36,4%) : 8 subjects (88,9%) from the low level AT III group and 12 subjects (26,1%) from the normal level AT-III group. Using the chi-square test we found a significant relationship between low levels of AT-III with 30-day mortality (p =0,0001) Conclusion. AT-III levels during hospital admission in patients with CAP is associated with 30-day mortality.

Latar Belakang. Pada pasien pneumonia komunitas (PK), melakukan penilaian derajat keparahan pada awal pasien masuk sangat penting sebab akan menentukan beratnya penyakit dan rencana tatalaksana selanjutnya yang lebih baik sehingga angka kematian 30 hari pada PK dapat dikurangi. Antithrombin III (AT-III) sebagai biomarker koagulasi yang berguna untuk menilai tingkat keparahan PK pada saat awal masuk AT-III dapat berperan dalam diagnosis dan prognosis penderita PK. Tujuan. Untuk mengetahui hubungan kadar AT-III saat awal masuk rumah sakit terhadap kematian 30 hari pada pasien PK. Bahan dan Cara. Penelitian dilakukan secara cohort study yang bersifat prospektif. Subjek dengan PK yang masuk dari instalasi gawat darurat, setelah memenuhi kriteria dilakukan penilaian skor CURB-65(Confusion, Urea, Respiratory rate, Blood pressure, Age >65 years), AT-III, laboratorium darah, kultur sputum, kultur darah dan foto thorax. Selanjutnya kadar AT-III dihubungan dengan kematian 30 hari. Hasil. Dari 55 subjek penelitian dimana 9 subjek (100%) tergolong kadar AT-III rendah dengan skor CURB-65 berat, 46 subjek tergolong kadar AT-III normal terdiri dari 28 subjek (60,9%) dengan skor CURB-65 ringan dan 18 subjek (39,1%) dengan skor CURB-65 berat, dijumpai total yang meninggal sebanyak 20 subjek (36,4%), dari 9 subjek yang tergolong dalam kadar AT-III rendah meninggal 8 subjek (88,9%), dan 46 subjek yang tergolong dalam kadar AT-III normal meninggal 12 subjek (26,1%). Setelah dilakukan chi-Square test diperoleh hubungan signifikan antara penurunan kadar AT-III dengan kematian 30 hari (p =0,0001) Kesimpulan. Kadar AT-III saat awal masuk rumah sakit pada pasien PK berkorelasi kuat dengan jumlah kematian 30 hari, dimana semakin rendah kadar AT-III maka semakin tinggi jumlah kematian 30 hari.