Tesis

Hubungan Antara Indeks Kebocoran Kapiler, Mikroalbuminuria dan Efektif Renal Perfusion Pressure dengan kejadian AKI Pada Pasien Pasca Operasi Bedah Abdomen Mayor = Relationship between Capillary Leakage Index, Microalbuminuria, and Effective Renal Perfusion Pressure with Incidence of AKI after Mayor Abdominal Surgery.

Latar Belakang. Pembedahan dikatakan sebagai penyebab 40% kasus AKI di rumah sakit yang sering terjadi pada hari-hari awal setelah operasi hingga 4 hari pasca operasi. Patofisiologi AKI pasca operasi bersifat multifaktorial, penelitian difokuskan pada pengaruh ekstravasasi cairan ke interstitial yang disebabkan karena kebocoran kapiler. Kebocoran kapiler juga mengakibatkan terjadinya mikroalbuminuria. Peningkatan CVP atau tekanan intraabdominal (IAP) akan menghasilkan penurunan filtrasi ginjal sesuai dengan derajat transmisi tekanan ke glomeruli. Penelitian ini dimaksudkan untuk melihat hubungan antara indeks kebocoran kapiler (CLI), mikroalbuminuria (ACR) dan efektif renal perfusion pressure (eRPP) sebagai prediktor AKI pada pasien pasca bedah abdomen mayor. Metode. Penelitian ini merupakan studi analitik observasional dengan desain longitudinal kohort prospektif dengan consecutive sampling terhadap pasien usia 18-65 tahun yang menjalani bedah abdomen mayor sejak tanggal sejak 29 Agustus 2021 sampai 21 Desember 2021. Penelitian mendapatkan total 76 subjek penelitian, dengan 2 pasien drop out. CLI, ACR, dan eRPP diukur pra-operasi, 12 jam pasca bedah, dan 36 jam pasca bedah dan kejadian AKI diamati hingga hari keempat pasca bedah. Uji statistik dengan menggunakan uji chi square kemudian dilanjutkan dengan cox-regresi untuk menilai secara multivariat jika memenuhi persyaratan. Hasil. Data observasi CLI pada jam ke-0 diperoleh RR 1,29 pada titik potong ROC CLI > 50. Data observasi ACR pada jam ke-0 dan jam ke-12 masing-masing memperoleh RR 1,261 (p=0,104; 95% CI 1,003-1,586) dan RR 1,211 (p=0,10; 95% CI 1,017-1,444). Data eRPP pada setiap jam pengukuran pada analisis bivariate tidak bermakna secara statistik namun pada analisis multivariate menggunakan cox regresi untuk mengetahui hubungan CLI, ACR, dan eRPP terhadap kejadian AKI setelah di-adjusted variabel perancu pada jam ke-0 diperoleh nilai RR dari variabel eRPP sebesar 9,125 dengan p= 0,037; CI 95% = 1,141293 - 72,95725. Subyek dengan AKI mengalami mortalitas sebesar 31,58% dan berisiko 2,384 kali untuk mengalami kematian (p = 0,0351, CI 95% = 1,133-5,018). Simpulan. Subjek dengan nilai eRPP < 40 berisiko 9,125 kali untuk mengalami AKI. Subyek yang mengalami AKI berisiko 2,384 kali untuk mengalami kematian.
Kata Kunci: AKI, Indeks kebocoran kapiler, mikroalbuminuria, efektif renal perfusion pressure, abdomen mayor


Background. Surgery caused of 40% of AKI cases in hospital which often occurs in the early days up to 4 days after surgery. The pathophysiology of postoperative AKI is multifactorial, the study focused on the effect of extravasation of fluid into the interstitium caused by capillary leakage. Capillary leakage also results in microalbuminuria. An increase in CVP or intra-abdominal pressure (IAP) will result decrease in renal filtration according to the degree of pressure transmission to the glomeruli. This study was intended to examine the relationship between capillary leakage index (CLI), microalbuminuria (ACR) and effective renal perfusion pressure (eRPP) as predictors of AKI in patients after major abdominal surgery. Methods. This is an observational analytic study with a prospective longitudinal cohort design with consecutive sampling of patients aged 18-65 years who underwent major abdominal surgery from August 29, 2021 to December 21, 2021. The study included a total of 76 subjects, with 2 patients dropped out. The variables were CLI, ACR, and eRPP were measured preoperatively, 12 hours postoperatively, and 36 hours postoperatively and the incidence of AKI was observed until the fourth postoperative day. Statistical test using chi square test then followed by logistic regression to assess multivariately if it meets the requirements. Results. CLI observation data at hour 0 obtained RR 1.29 at the point of intersection ROC CLI > 50. ACR observation data at hour 0 and hour 12 each obtained RR 1.261 (p=0.104; 95% CI 1.003-1.586) and RR 1.211 (p=0.10; 95% CI 1.017-1.444). The eRPP data at each hour of measurement in bivariate analysis was not statistically significant, but in multivariate analysis using cox regression to determined relationship between CLI, ACR, and eRPP on the incidence of AKI after adjusting confounding variables at 0th hour the RR value of the eRPP was 9.125 with p = 0.037; 95% CI = 1,141293 - 72,95725. Subject with AKI experience a mortality of 31,58% and 2.384 times risk of mortality (p = 0,0351, CI 95% = 1,133-5,018). Conclusions. Subjects with an eRPP value < 40 have 9.125 times risk AKI. Subject with AKI had a 2.384 times risk mortality.
Keywords: AKI, capillary leaks index, microalbuminuria, effective renal perfusion pressure, major abdominal surgery