Tesis

Prediktor Kematian Difteri Klinis Anak di Provinsi DKI Jakarta dan Kabupaten Tangerang pada Kejadian Luar Biasa tahun 2017-2018 = Predictors of Mortality of Pediatric with Clinical Diphtheria in the Province of Jakarta and Tangerang District During 2017-2018 Outbreak.

Latar belakang: Difteri masih menjadi penyakit infeksi yang endemis dan menjadi masalah kesehatan di Indonesia, bahkan setelah era imunisasi. Pada tahun 2017 kejadian luar biasa difteri di beberapa provinsi di Indonesia. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui prediktor kematian difteri klinis pada anak di Provinsi DKI Jakarta dan Kabupaten Tangerang selama kejadian luar biasa tahun 2017-2018. Metode: Penelitian kohort retrospektif dilakukan menggunakan data rekam medis dilakukan di lima rumah sakit rujukan di DKI Jakarta dan satu di Kabupaten Tangerang periode 1 Januari 2017 – 31 Agustus 2018. Pasien anak usia 1-18 tahun dengan diagnosis difteri klinis dinilai faktor epidemiologi, klinis dan laboratoris yang berhubungan dengan luaran kematian. Uji korelasi chi square dilakukan untuk mengetahui hubungan variabel bebas dan luaran. Besar risiko kematian dinyatakan sebagai relative risk. Multivariat analisis menggunakan cox regression dilakukan untuk menentukan prediktor kematian. Analisis data dilakukan dengan program SPSS for Window ver 20,0 Hasil: Pasien anak dengan difteri klinis sejumlah 283 kasus dengan case fatality rate 3,5%. Riwayat imunisasi dasar (RR 6,967; p 0,003), suara serak (RR 7,611; p 0,035), stridor (RR 16,963; p < 0,001), bullneck (RR 28,456; p < 0,001), limfadenopati (RR 3,838; p 0,045), komplikasi miokarditis (p < 0,001), leukositosis >15.000sel/mm 3 (RR 7,500; p 0,004), trombositopenia (RR 35,549; p < 0,001), kultur C. diphtheriae positif (RR 6,587; p 0,04) berhubungan dengan kematian. Analisis multivariat menunjukkan stridor (HR 11,951; p 0,006), lekositosis (HR 11,425; p 0,01), dan trombositopenia (HR 44,199; p < 0,001) berhubungan dengan kematian. Simpulan: Faktor prediktor kematian pada difteri klinis anak adalah stridor, lekositosis dan trmbositopenia.
Kata kunci: difteri, difteri klinis, kejadian luar biasa, prediktor, kematian


Background: Diphtheria is endemic and still a health problem in Indonesia. In 2017 diphtheria outbreak has taken place in several provinces. Objective: The aim of this study was to identify predictors of mortality outcome of pediatric patients with clinical diphtheria during period of outbreak in 2017-2018 in the Province of Jakarta and Tangerang District. Methods: A retrospective cohort study has been held using patient medical record at five referral hospital in the Province of Jakarta and one in Tangerang District during January 2017 and 31 August 2018. All children between the age group of 1-18 years old admitted with sign and symptoms and discharge as clinical diphtheria formed the study group. All details that is demographic data, clinical features, immunization status, complication and laboratory profiles and outcome were entered in proforma and analyzed. Variables were compared among survivors and non survivors to determine the predictors of mortality. A chi square test and cox regression was done to asses association between variables and outcome. Data were analyzed using SPSS for Window ver 20,0. Results: A total of 283 pediatric patients with clinical diphtheria were included in the study group with case fatality rate of 3.5%. Basic immunization status (RR 6.967; p 0.003), hoarness (RR 7.611; p 0.035), stridor (RR 16.963; p < 0.001), bullneck (RR 28.456; p < 0.001), limphadenopaty (RR 3.838; p 0.045), myocarditis (p < 0,001), leukocytosis > 15,000 cell/mm 3 (RR 7.500; p 0.004), thrombocytopenia < 150,000 3 cell/mm (RR 35.549; p < 0.001), C. diphtheriae positive culture (RR 6.587; p 0.04) were found correlated to mortality. Multivariat analysis showed that stridor (HR 11.951; p 0.006), leukocytosis (HR 11,425; p 0,01), and thrombocytopenia (HR 44.199; p < 0.001) correlated to death. Conclusion: Diphtheria is fatal disease with increased mortality. Presence of stridor, leukocytosis and thrmbocytopenia are important predictors of mortality
Keywords: diphtheria, clinical diphtheria, outbreak, predictors, mortality