Tesis

Acute Kidney Injury sebagai Luaran Morbiditas Hiperglikemia pada Anak Sakit Kritis = Acute Kidney Injury as an Outcome of Hyperglycemia in Critically Ill Children.

Latar belakang: Hiperglikemia dan AKI merupakan komorbiditas yang sering dijumpai pada anak sakit kritis. Keduanya berhubungan dengan peningkatan morbiditas dan mortalitas. Hubungan antara hiperglikemia dan AKI pada anak sakit kritis belum banyak diketahui. Tujuan: Diketahuinya perbedaan proporsi AKI pada kelompok anak sakit kritis dengan hiperglikemia dan nonhiperglikemia. Diketahuinya perbedaan rerata kadar gula darah admisi, kadar gula darah puncak, dan durasi hiperglikemia pada kelompok anak sakit kritis dengan AKI dan tanpa AKI. Metode: Penelitian kohort prospektif dilakukan pada anak sakit kritis usia 1 bulan-18 tahun di ruang resusitasi IGD dan perawatan intensif anak RSCM selama bulan Agustus-Desember 2016. Pemeriksaan kadar gula darah, kreatinin serum, dan kadar NGAL urine dilakukan pada saat admisi. Pemantauan kadar gula darah dilakukan dengan interval 2 jam pada kelompok hiperglikemia. Seluruh subyek diikuti sampai keluar ruang perawatan intensif. Hasil: Proporsi subyek anak sakit kritis yang mengalami hiperglikemia adalah 46,5% (IK 95% 36,8-56,2%). Proporsi subyek dengan hiperglikemia yang mengalami AKI menurut kriteria AKIN adalah 30,7% (IK 95% 21,8–39,6%), sedangkan proporsi subyek dengan hiperglikemia yang memiliki kadar NGAL urine >135 ng/mL adalah 21,8% (IK 95% 13,8–29,8%). Acute kidney injury menurut kriteria AKIN maupun kadar NGAL urine lebih banyak dijumpai pada subyek dengan hiperglikemia, namun perbedaan proporsi tersebut tidak bermakna secara statistik (kriteria AKIN: RR 2,08; IK 95% 0,93-4,67; P 0,072; NGAL urine >135 ng/mL: RR 1,34; IK 95% 0,81-2,1; P 0,243). Paparan hiperglikemia pada perawatan intensif dengan durasi ≥4 jam risiko AKI meningkat sebesar 2,38 kali (IK 95% 1,25–4,56). Simpulan: Acute kidney injury banyak dijumpai pada anak sakit kritis yang mengalami hiperglikemia. Paparan hiperglikemia ≥4 jam pada perawatan intensif berkaitan dengan peningkatan risiko AKI pada anak sakit kritis.
Kata kunci: hiperglikemia, acute kidney injury, sakit kritis, anak


Background: Hyperglycemia and AKI are common in critically ill children. Both conditions are associated with increasing mortality and morbidity. The association of hyperglycemia and AKI in critically ill children is still not well understood. Objective: To evaluate the difference in proportion of AKI between critically ill children with and without hyperglycemia. To evaluate the mean difference of initial blood glucose, peak blood glucose, and the duration of hyperglycemia between critically ill children with and without AKI. Method: A prospective cohort study was conducted in critically ill children aged 1 month to 18 years at the emergency unit and the pediatric intensive care unit at Cipto Mangunkusumo Hospital between August-December 2016. Blood glucose, creatinine serum, and urine NGAL was examined at admission. Blood glucose was monitored every 2 hours in hyperglycemic subjects. All of the subjects were followed until time of discharge from the intensive care unit. Result: Hyperglycemia in critically ill children was found in 46.5% subject ( 95% CI 36.8-56.2%). Acute kidney injury based on the AKIN criteria was found in 30.7% hyperglycemic subjects (95% CI 21,8–39,6%), and hyperglycemia with an increased urine NGAL level (>135 ng/mL) was found in 21.8% subjects (95% CI 13.8–29.8%). Acute kidney injury and an increased urine NGAL were more frequently found in subjects with hyperglycemia, however, the difference in the proportion was statistically insignificant (AKIN criteria: RR 2,08; 95% CI 0,934,67; P 0,072; urine NGAL level >135 ng/mL: RR 1,34; 95% CI 0,81-2,1; P 0,243). The duration of hyperglycemia ≥4 hours at the intensive care unit increases the risk of AKI up to 2.38 times (CI 95% 1.25–4.56). Conclusion: Acute kidney injury are frequently seen in hyperglycemic critically ill children. A duration of hyperglycemia of ≥4 hours in intensive care unit is associated with an increased risk of AKI in critically ill children.
Key words: hyperglycemia, acute kidney injury, critically ill children