Tesis

Kadar Glukosa Darah Sewaktu sebagai Prediktor Terjadinya Keparahan dan Mortalitas Pankreatitis Bilier Akut = Random Blood Glucose as a Predictor of Gallstone Pancreatitis Severity and Mortality.

Prediktor keparahan pankreatitis bilier yang telah banyak digunakan seperti kriteria Ranson, Imrie modifikasi, dan APACHE II membutuhkan waktu pengumpulan data hingga 48 jam dengan variabel diagnostik multipel sehingga sulit untuk diterapkan. Studi ini bertujuan untuk mencari prediktor keparahan tunggal agar dapat segera ditentukan tatalaksana terbaik bagi tiap pasien. Penelitian ini menggunakan data sekunder dari rekam medis pasien-pasien pankreatitis bilier akut di RSCM tahun 2008-2016. Kadar glukosa darah sewaktu (GDS) awal, derajat keparahan, dan mortalitas dicatat dan dianalisis menggunakan SPSS 20.0. Sebanyak 41 pasien pankreatitis bilier dari 140 pasien pankreatitis akut memenuhi kriteria inklusi dari studi ini. Rerata usia pasien 49,2 tahun, 24 (58,5%) laki-laki dan 17 (41,5%) perempuan. Median kadar GDS kasus ringan, sedang, dan berat adalah 109,5 mg/dL; 131 mg/dL; dan 171 mg/dL. Terdapat perbedaan bermakna antara kadar GDS pada pankreatitis bilier ringan dengan berat, nilai p 0,008. Pada kurva ROC GDS terhadap pankreatitis bilier berat didapatkan AUC 0,885 (IK 95% 0,743 – 1,000). Nilai cut-off GDS 154,5 mg/dL memiliki sensitivitas dan spesifisitas yang optimal dalam memprediksi pankreatitis bilier akut berat, yaitu 75% dan 91,8%.Kadar GDS tersebut memilikinilai prediksi positif dan negatif sebesar 50% dan 97,1%. Tidak didapatkan hubungan antara kadar GDS dengan mortalitas, nilai p 0,249. Didapatkan hubungan antara derajat keparahan dengan mortalitas dengan nilai p 0,021 dan OR 0,028. Dari penelitian ini dapat disimpulkan bahwa kadar GDS 154,5 mg/dL dapat memprediksi pankreatitis bilier akut berat dengan akurasi yang baik.
Kata kunci: Glukosa darah sewaktu, keparahan, pankreatitis bilier


The established severity predictors of gallstone pancreatitis such as Ranson criteria, modified Imrie, and APACHE II usually require several days and multiple diagnostic variable to be fulfilled so that they are not convenient to use. This study was held to find a simple severity predictor of gallstone pancreatitis to immediately choose the best management for each patient. The data were derived retrospectively from the medical records of acute gallstone pancreatitis patients during 2008-2016. Random blood glucose (RBG) level on admission,severity grading,and mortality were recorded and analyzed using SPSS 20.0. Forty-one gallstone pancreatitis out of 140 acute pancreatitis patients were included in this study. The mean age was 49,2 years old, 24 (58,5%) were male and 17 (41,5%) were female. The median RBG level in mild, moderately severe, and severe disease were 109,5 mg/dL; 131 mg/dL; and 171 mg/dL respectively. There was a significant difference of RBG level on mild and severe disease, p value 0,008. The ROC curve of RBG and severe gallstone pancreatitis revealed the AUC of 0,885 (CI 95% 0,743 – 1,000). The cut-off point of RBG level 154,5 mg/dL had the optimal sensitivity (75%) and specificity (91,8%) to predict severe disease. The positive and negative predictive value of RBG level 154,5 mg/dL were 50% and 97,1%. There was no significant difference between RBG level and mortality, p0,249. There was a relationship between severity grading and mortality, p 0,021 and OR 0,028.We can conclude that RBG level of 154,5 mg/dL can acurately predict severe disease.
Keywords: Random blood glucose, severity, gallstone pancreatitis