Hubungan Antara Pemberian Adjuvan Intravena Tiamin, Asam Askorbat, dan Kombinasi Keduanya dengan Tingkat Insidensi, Rasio Kadar MMP-9/TIMP-1, dan Skor Sofa pada Pasien Sepsis yang Dirawat di Icu

Abstract

Background: Increasing cases of sepsis have resulted in the need for adequate management of sepsis. Several therapeutic agents continue to be developed as adjuvants for the management of sepsis. Ascorbic acid and thiamine are currently potential agents that are being intensively studied for their benefits in sepsis. Methods: This study was a retrospective cohort analytic study. This research was conducted at Haji Adam Malik Hospital Medan and Grand Medistra Hospital. Blood tests were carried out at the Integrated Laboratory of the Faculty of Medicine, University of North Sumatra. This research was conducted for 12 months. Patient data obtained from research Bastian et. al. and medical records. The patients in this study were 147 septic patients who were divided into 4 groups (NaCl, thiamine, ascorbic acid and combination groups). The parameters measured were the enzyme MMP-9, and the enzyme TIMP-1. Results: From 147 septic patients, properity score analysis was performed to obtain homogeneous patients, so that a sample of 25 patients in each group was obtained. In this study, it was found that the combination of ascorbic acid and thiamine on the incidence rate obtained an odds ratio of 1.19 (0.37-3.8) at 95% CI, but the single administration of ascorbic acid significantly reduced the incidence rate of 0.4 times and 0.67 times in the thiamine single group compared with the control group. In the combination of ascorbic acid and thiamine to the ratio of MMP-9/TIMP-1 levels, the odds ratio was 0.34 (0.09-1.30) at 95% CI even though single administration of ascorbic acid and thiamine could also reduce the MMP- 9/TIMP-1 were 0.77 and 0.78, respectively. Meanwhile, the combination of ascorbic acid and thiamine on SOFA scores obtained an odds ratio of 2.66 (0.85- 8.36) at 95% CI and for single ascorbate and single thiamine each of 1.38 (0.45-2, 24) and 1.17 (0.38-3.83) at 95% CI Conclusion: The administration of thiamine alone and ascorbate alone provides better benefits compared to the combination of the two when assessed from the incidence rate, MMP-9/TIMP-1 ratio, and SOFA score.