Hubungan antara Phase Angle pada Pemeriksaan Bioelectrical Impedance Analysis dengan Skor Child Pugh pada Penderita Sirosis Hati

Abstract

Background: Malnutrition, commonly suffered by patients with liver cirrhosis, has impact on survival, quality of life and complication of cirrhosis. Assessment on the nutritional status in liver cirrhosis based on anthropometric measurement is not ideal and objective measurement like albumin serum is influenced by many factors. Examination by bioelectrical impedance analysis in chronic disease has been studied to assess the nutritional status and the phase angle as the prognostic parameters. Objectives: To determine the correlation between the phase angle and the Child Pugh score on patients with liver cirrhosis. Material and Methods: Observational study was conducted using the cross-sectional measurement method. Patients with liver cirrhosis were examined for the anthropometric measurement, blood examination, abdomen ulstrasound and the Bioelectrical Impedance Analysis (BIA) as well. Nutritional status was assessed by BMI, albumin and BIA parameters. Then phase angle as one of the BIA parameters was correlated statistically with the Child Pugh score using the Pearson correlation. Results: Of the 33 subjects of research, malnutrition based on the albumin serum <3.5 gr/dl was found on 25 patients (73.53%) with the percentage of Child Pugh A (3.68 ± 0.40 gr/dl) was only 25%, percentage of Child Pugh B (2.75 ± 0.52 gr/dl) was 82.26 % and 100% Child Pugh C (2.14 ± 0.4 gr/dl). The mean value of phase angle of Child Pugh A (6.53) was higher than those of Child Pugh B (5.24) and C (4.16) with a significant difference between Child Pugh A and C (p=0.003). On the Pearson correlation test, a significant negative correlation between the Child Pugh score and the phase angle value (r=0.522, p=0.002) was obtained. Conclusion: The lower the phase angle value is, the higher the Child Pugh score will be. The prevalence on the malnutrition is still high on outpatients or hospitalized patients with liver cirrhosis at H. Adam Malik hospital. Keywords: phase angle, bioelectrical impedance analysis, Child Pugh

Latar Belakang Malnutrisi sering dijumpai pada pasien sirosis hati yang berdampak pada harapan hidup, kualitas hidup dan komplikasi sirosis. Penilaian status nutrisi pada sirosis hati dengan pengukuran antropometrik kurang ideal dan pengukuran objektif seperti albumin serum dipengaruhi banyak faktor. Pemeriksaan bioelectrical impedance analysis (BIA) telah diteliti pada penyakit kronik dalam menilai status nutrisi dan phase angle sebagai salah satu parameter prognosis. Tujuan : Untuk mengetahui hubungan antara phase angle dengan skor Child Pugh pada pasien penderita sirosis hati Bahan dan Cara : Penelitian observasional dengan metode pengukuran cross-sectional. Subjek dengan sirosis hati, dilakukan pengukuran antropometrik, pemeriksaan darah dan ultrasonografi abdomen serta pemeriksaan bioelectrical impedance analysis. Status nutrisi dinilai dengan BMI, albumin dan parameter BIA. Phase angle sebagai salah satu parameter BIA kemudian dikorelasikan secara statistik dengan Skor Child Pugh dengan korelasi Pearson. Hasil : Dari 34 subjek penelitian dijumpai malnutrisi berdasarkan kadar albumin <3.5 gr/dl sebanyak 25 pasien (73.53%) dengan klassifikasi Child Pugh A (3.68 ± 0.40 gr/dl) hanya 25%, Child Pugh B (2.75 ± 0.52 gr/dl) sebesar 82.36 % dan semua Child Pugh C (2.14 ± 0.40 gr/dl). Rerata nilai phase angle Child Pugh A (6.53) lebih besar dari B (5.24) dan C (4.16) dengan perbedaan yang signifikan antara Child Pugh A dan C (p=0.003). Pada uji korelasi Pearson diperoleh hubungan negatif yang signifikan antara skor Child Pugh dengan nilai phase angle (r= 0.522, p= 0,002). Kesimpulan : Semakin rendah nilai phase angle maka semakin tinggi skor Child Pugh. Prevalensi malnutrisi masih tinggi pada pasien sirosis hati rawat jalan dan rawat inap RSUP. H. Adam Malik. Kata Kunci : phase angle, bioelectrical analysis impedance, Child Pugh