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Indonesian Journal of Critical and Emergency Medicine Vol 1 No.3 July-September 2014 / ISSN : 2355-4584

Faktor-Faktor Prediktor Mortalitas pada Pasien dengan Ventilator Mekanik di Rumah Sakit Cipto Mangunkusumo, Jakarta


Bona Adhista
Cleopas M Rumende, Ceva W Pitoyo

ABSTRACT
Background:
Patients aided by mechanical ventilator are associated with critical illness bearing high mortality rate. Knowledge about predictors of mortality helps in clinical decision regarding the management and prognosis. To date there has been no comprehensive study about the predictors of mortality in patients with mechanical ventilator in Indonesia.
Objective: To acknowledge the predictors of mortality in patients with mechanical ventilator in Cipto Mangunkusumo Hospital, Jakarta.
Methods: This retrospective cohort includes patients aided by mechanical ventilator in the Intensive Care Unit (ICU) of Cipto Mangunkusumo Hospital during 2010-2012. Clinical data and laboratory results as well as clinical outcome (survival or death) were obtained from medical records. Bivariate analysis was conducted to variables age, malignancies, acute respiratory distress syndrome (ARDS), shock, post-operative state, history of cardiac arrest, hyperglycemia, stroke, acute kidney injury, sepsis and hypoalbuminemia. Variables which made the cut were included in multivariate analysis with logistic regression.
Results: The study involved 242 patients with mortality rate of 45.4%. Age, malignancies, ARDS, shock, post-operative state, history of cardiac arrest, stroke, acute kidney injury, sepsis and hypoalbuminemia show statistical difference in bivariate analysis. Multivariate analysis gathers these predictors of mortality: acute kidney injury (OR 1,91; CI95% 1,08-3,39; p=0,002), shock (OR 2,13; CI95% 1,18-3,85; p=0,012), stroke (OR 3,39; CI95% 1,65-6,95; p=0,01), ARDS (OR 2,19; CI95% 1,10-4,35; p=0,025) and history of cardiac arrest (OR 4,85; CI95% 1,56-15,07; p=0,006).
Conclusions: Acute kidney injury, shock, stroke, ARDS and history of cardiac arrest are independent predictors of mortality in patients aided by mechanical ventilator.
Key words: Predictor of mortality, mechanical ventilator
 

ABSTRAK
Latar belakang:
Pasien dengan ventilator mekanik (VM) identik dengan penyakit kritis yang memiliki mortalitas tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tata laksana dan mengetahui prognosis pasien. Belum ada studi komprehensif tentang faktor prediktor mortalitas pasien dengan VM di Indonesia.
Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien dengan VM di Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta.
Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien di Unit Perawatan Intensif (UPI) RSCM yang menggunakan VM selama 2010-2012. Data klinis dan laboratorium beserta keluaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel usia, keganasan, Acute Respiratory Distress Syndrome (ARDS), renjatan, riwayat pascaoperasi, riwayat henti jantung, hiperglikemia, stroke, gangguan ginjal akut, sepsis, dan hipoalbuminemia. Variabel yang memenuhi syarat disertakan dalam analisis multivariat dengan regresi logistik.
Hasil: Sebanyak 242 pasien diikutsertakan dalam penelitian ini. Didapati angka mortalitas selama perawatan sebesar 45,4%. Kelompok usia, keganasan, ARDS, renjatan, pascaoperasi, riwayat henti jantung, stroke, gangguan ginjal akut, sepsis, dan hipoalbuminemia merupakan variabel yang berbeda bermakna pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah gangguan ginjal akut (OR 1,91; IK95% 1,08-3,39; p=0,002), renjatan (OR 2,13; IK95% 1,18-3,85; p=0,012), stroke (OR 3,39; IK95% 1,65-6,95; p=0,01), ARDS (OR 2,19; IK95% 1,10-4,35; p=0,025), dan riwayat henti jantung (OR 4,85; IK95% 1,56-15,07; p=0,006).
Kesimpulan: Gangguan ginjal akut, renjatan, stroke, ARDS, dan riwayat henti jantung merupakan prediktor independen mortalitas pada pasien yang menggunakan VM.
Kata kunci: Prediktor mortalitas, ventilator mekanik


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