Tesis

Validasi Skor ACEF sebagai Prediktor Mortalitas 30 Hari Pascabedah Pintas Koroner di RSUPN Dr Cipto Mangunkusumo = Validation of ACEF score as Predictor of 30-Day Mortality Following Coronary Artery Bypass Grafting Surgery in Cipto Mangunkusumo National General Hospital .

Latar Belakang : Keputusan pasien untuk menjalani bedah pintas koroner dipengaruhi risiko mortalitas. Stratifikasi risiko mortalitas 30 hari pascabedah menjadi penting. Skor Age, Creatinine and Ejection Fraction (ACEF) merupakan skor sederhana untuk memprediksi mortalitas 30 hari pascabedah pintas koroner dan telah ditunjukkan memiliki performa yang setara dengan skor lain yang lebih kompleks. Perbedaan karakteristik pasien di RSUPN Dr. Cipto Mangunkusumo (RSCM) dapat mempengaruhi performa skor ini sehingga perlu dilakukan validasi sebelum digunakan. Tujuan : Menilai performa kalibrasi dan diskriminasi skor ACEF dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSCM. Metode : Penelitian ini merupakan studi kohort retrospektif terhadap pasien penyakit jantung koroner dewasa yang menjalani bedah pintas koroner di unit Pelayanan Jantung Terpadu (PJT) RSCM tahun 2013 – 2015. Usia, kreatinin, dan fraksi ejeksi dinilai sebelum pasien menjalani bedah. Pasien diikuti hingga 30 hari pascabedah untuk dilihat outcome-nya (meninggal atau tidak). Penelitian ini telah mendapatkan keterangan lolos kaji etik dari Komite Etik Penelitian Kesehatan Fakultas Kedokteran Universitas Indonesia. Performa kalibrasi skor ACEF dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor ACEF dinilai dengan area under the curve (AUC). Hasil Penelitian : Sebanyak 308 subjek diikutsertakan dengan angka mortalitas 30 hari pascabedah pintas koroner sebanyak 43 subjek (14%). Performa kalibrasi skor ACEF dengan uji Hosmer-Lemeshow menunjukkan p=0,991 dan plot kalibrasi menunjukkan koefisien korelasi r=0,95. Performa diskriminasi skor ACEF ditunjukkan dengan nilai AUC sebesar 0,728 (IK95% 0,644; 0,811) Simpulan : Skor ACEF memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSCM.
Kata Kunci : mortalitas 30 hari, bedah pintas koroner, skor ACEF (Age, Creatinine and Ejection Fraction), validasi


Background : The preference of patients to undergo coronary artery bypass grafting (CABG) surgery is influenced by the risk of mortality. Stratification of 30day postoperative mortality risk is essential. Age, Creatinine and Ejection Fraction (ACEF) score is a simple score to predict 30-day mortality following CABG surgery and had been shown to be equivalent to more complex models. Differences in characteristic of patients in Cipto Mangunkusumo National General Hospital as the tertiary referral hospital in Indonesia may influence the performance of the score, hence validation is needed before applying the scoring system. Objective : To assess the performance of calibration and discrimination of ACEF score in predicting 30-day mortality following CABG surgery in Cipto Mangunkusumo Hospital. Methods : This was a retrospective cohort study of adult coronary artery disease patients undergoing CABG surgery in Pelayanan Jantung Terpadu (PJT) unit, Cipto Mangunkusumo Hospital in 2013 – 2015. Age, creatinine, and ejection fraction were obtained before surgery. The subjects were followed up for up to 30 days postoperatively to assess the outcome (dead or alive). Our study protocol was approved by the Ethics Committee of the Faculty of Medicine, University of Indonesia. Calibration properties of ACEF score were assessed by HosmerLemeshow test and calibration plot. Discrimination properties of ACEF score were assessed by the area under the curve (AUC). Results : A total of 308 subjects were followed up. Thirty-day mortality following CABG surgery was observed in 43 subjects (14%). Hosmer Lemeshow test of ACEF score showed p=0.991 and calibration plot showed r=0.95. Discrimination of ACEF score was shown by the AUC value of 0.728 (95%CI 0.644; 0.811). Conclusion : ACEF score have a good calibration and discrimination performance in predicting 30-day mortality following CABG surgery in Cipto Mangunkusumo Hospital.
Keywords : 30-day mortality, coronary artery bypass grafting surgery, ACEF (Age, Creatinine and Ejection Fraction) score, validation