Disertasi

Pengembangan sistem skor sebagai prediktor kebocoran plasma pada demam berdarah dengue: peran sTNFR-1, VEGF, sVE-CADHERIN dalam patofisiologi kebocoran plasma. = Development of the scoring system as a predictor of plasma leakage in dengue hemorrhagic fever: the role of sTNFR-1, VEGF, sVE-Cadherin in plasma leakage pathophysiology.

Tujuan: Mengetahui peran 1NF-a, VEGF dan VE-cadherin dalam patofisiologi kebocoran plasma dan mengembangkan sistem skor sebagai prediktor kebocoran plasma pada inf~ksi dengue. Subjek penelitian : Penderita infeksi dengue yang dirawat di lantai 8 Gedung A RSCM Jakarta dengan demam ~ 48 jam. Pengukuran: Terhadap subjek dilakukan pemeriksaan tanda perdarahan spontan, s1NFR-1, VEGF, sVE-cadherin, trombosit, leukosit, SGOT, SGPT, uji serologi, dan RT-PCR virus dengue. Perbedaan rerata dianalisis dengan menggunakan uji t tidak berpasangan pada data yang berdistribusi normal atau uji Mann-Whitney jika data tidak berdistribusi normal. Model prediksi kebocoran plasma dibuat dengan analisis Cox's proportional hazard regression. Hasil Penelitian: Dari 64 penderita yang dirawat, 39 penderita dengan kebocoran plasma dan 25 penderita tanpa kebocoran plasma. Penderita infeksi dengue dengan kebocoran plasma menunjukkan kadar s1NFR-1, VEGF, perdarahan spontan, aktivitas enzim SGOT dan SGPT yang lebih tinggi serta jumlah trombosit dan leukosit yang lebih rendah dibandingkan penderita tanpa kebocoran plasma. Model prediksi akhir mendapatkan variabel kejadian petekie (skor 14), jumlah trombosit < 134.000 / ilL (skor 31), dan aktivitas enzim SGOT ::: 48 U / L (skor 10) sebagai prediktor kebocoran plasma. Jumlah skor ::: 24 merupakan indikasi rawat dan pemberian cairan intravena. Simpulan: TNF-a berperan dalam patofisiologi kebocoran plasma pada awal perjalanan sakit sedangkan VEGF berperan pada tahap selanjutnya. Kebocoran lebih mudah bila pada awal sakit telah terjadi vaskulopati dan migrasi leukosit. Petekie, jumlah trombosit, dan aktivitas enzim SGOT dapat dipergunakan sebagai prediktor kebocoran plasma pada infeksi dengue.
Kata kunci: Kebocoran plasma, patofisiologi, prediksi, sistem skor.



Objective: To understand the role of TNF-a, VEGF and VE-cadherin in pathophysiology of plasma leakage and to develop, a scoring system as a predictor of plasma leakage in dengue infection. Research subjects: Patients with dengue infection who were treated on the 8th Floor Building A RSCM Jakarta with fever :s 48 hours. Measurements: Subjects were examined for spontaneous bleeding, sTNFR-l, VEGF, sVE-cadherin, platelet, leucocyte, SGOT, SGPT, serologic testing, and RT-PCR dengue virus. Mean differences were analyzed using unpaired t-test on normally distributed data or Mann-Whitney test if data are not normally distributed. Model prediction of plasma leakage was made by analysis of Cox's proportional hazard regression. Results: Total of 64 patients were treated, 39 patients with plasma leakage and 25 patients without plasma leakage. Patients with plasma leakage in dengue infection showed higher levels of sTNFR-l, VEGF, spontaneous bleeding, SGOT and SGPT enzyme activity and lower number of platelets and leukocytes than patients without plasma leakage. End of prediction models resulted in variable incidence of petechiae (score 14), platelet count < 134,000/ ul, (score 31), and the activity of enzymes AST 2: 48 U / L (score 10) which were assessed within the first 48 hours of fever for prediction of plasma leakage. Total score ~ 24 is indicative of hospitalization and intravenous fluid administration. Conclusion: TNF-a plays a role in the pathophysiology of plasma leakage at the beginning of disease while VEGF acts at a later stage. Leakage is easier when vasculopathy and leukocyte migration have occurred previously. Petechiae, platelet count, and AST enzyme activity can be used as predictors of plasma leakage in dengue infection.
Keywords: pathophysiology, plasma leakage, prediction, scoring system.