Tesis

Skor CURB 65 dan C-reactive protein 24 jam Pertama Diagnosis sebagai Prediktor Mortalitas Dini pada Hospital Acquired Pneumonia = CURB 65 Score and C-Reactive Protein First 24 hours Diagnosis as Predictors of Early Mortality in Hospital Acquired Pneumonia.

Latar Belakang : HAP merupakan salah satu infeksi nosokomial dengan angka mortalitas yang cukup tinggi. Skor CURB-65 pada pasien HAP dan VAP di Turki memiliki area under curve (AUC) 0,747, namun penelitian sebelumnya di Indonesia mendapatkan AUC 0,376. C-reactive protein (CRP) berperan sebagai faktor independen dalam memprediksi mortalitas pasien pneumonia. Tujuan : Menilai kemampuan skor CURB 65 dan CRP 24 jam pertama diagnosis serta manfaat penambahan CRP ke dalam skor CURB 65 untuk memprediksi mortalitas 14 hari pasien HAP. Metode : Penelitian ini merupakan studi kohort prospektif berbasis riset prognostik dengan subjek penelitian pasien HAP yang dirawat di RS Cipto Mangunkusumo. Keluaran yang dinilai adalah mortalitas pasien dalam 14 hari. Penilaian performa skor CURB 65, CRP 24 jam pertama diagnosis dan skor CURB 65 yang ditambahkan CRP terhadap mortalitas menggunakan area under the curve (AUC). Hasil : 92 pasien ikut serta dalam penelitian ini dengan angka mortalitas 43,48%. Analisis kesintasan pada hari ke 2, 3, dan 7 diagnosis adalah 95,66%, 88,04% dan 70,65%. Performa diskriminasi skor CURB 65 didapatkan nilai AUC 0,811 ( IK95% 0,72 – 0,89). Nilai CURB > 2 memiliki sensitivitas 87,5% dan spesifisitas 67,31%, digunakan untuk menilai kebutuhan perawatan high care/intensive care pada HAP. Performa diskriminasi CRP 24 jam pertama diagnosis pada titik potong > 100mg/L didapatkan nilai AUC 0,575, RR 1,86 (IK95% 0,79-4,33) dengan sensitivitas 65% dan spesifisitas 50%. Penambahan CRP pada skor CURB 65 tidak dilakukan karena hasil pada analisis tidak bermakna. Simpulan : Skor CURB 65 digunakan untuk memprediksi mortalitas 14 hari pasien HAP, skor > 2 perlu perhatian khusus dan perawatan ruang intermediate/ intensif terkait peningkatan mortalitas dan kebutuhan support ventilasi.
Kata Kunci : HAP, mortalitas 14 hari, CURB 65, C-reactive protein


Background : Hospital acquired pneumonia (HAP) is one of the nosocomial infections with a high mortality rate. The CURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, Age 65) in HAP and VAP patients in Turki had area under curve (AUC) 0,747, but research in Indonesia had AUC 0,376. CReactive Protein (CRP) has an independent role in predicting the mortality of patients with pneumonia. Aim : To evaluate the ability of CURB 65 scores and CRP first 24 hours diagnosis as well as the benefits of adding CRP to the CURB 65 score to predict a 14-day mortality of HAP patients. Methods : This is a prospective cohort, prognostic-based study with the subject of HAP patients at Cipto Mangunkusumo hospital (RSCM). The outcome of the study is patient mortality within 14 days. Performance of CURB-65 score, CRP first 24 hours diagnosis and CRP added to CURB 65 score to mortality are evaluated with area under the curve (AUC). Results: 92 patients was included in the study with a mortality rate of 43.48%. Survival analysis in 2 nd rd th , 3 , 7 day were 95,66%, 88,04% and 70,65%. Performance discrimination CURB 65 score with AUC 0.811 ( CI95% 0.72 – 0.89). The CURB value > 2 had a sensitivity of 87.5%, and a specificity of 67.31%, could be use to assess needs for high care/intensive care in HAP patients. Performance discrimination of CRP first 24 hours diagnosis at the cutting point > 100mg /L had AUC 0.575, RR 1.86 (CI95% 0.79-4.33) with sensitivity 65% and spesificity 50% . The addition of CRP to CURB score 65 could not be done because the result after analysis was not significant. Conclusion : A CURB 65 score can be used to predict 14-days mortality in HAP, score >2 need special attention for highcare/intensive care because its increase mortality probability and need for ventilation support probability.
Keywords : HAP, 14-day mortality, CURB 65, C-reactive protein