Tesis

Profil Pasien Tuberkulosis Paru dengan Komorbid Diabetes yang Mengalami Luaran Buruk Terapi = The Profile of Tuberculosis Patient with Diabetes Mellitus Comorbidity Experiencing Unfavourable Outcome.

Latar Belakang. Tatalaksana tuberkulosis paru pada pasien dengan komorbid diabetes melitus (TB-DM) masih menjadi masalah karena jumlah kasus yang meningkat, luaran buruk, dan kegagalan terapi yang tinggi. Di Indonesia belum banyak studi yang menampilkan luaran terapi dan karakteristik subjek yang mengalami luaran buruk terapi. Tujuan. Mengetahui karakteristik pasien yang berobat, luaran terapi TB-DM, dan profil pasien yang mengalami luaran buruk terapi TB-DM. Metode. Desain penelitian kohort retrospektif pada pasien TB-DM yang berobat di Rumah Sakit Cipto Mangunkusumo sejak Januari 2013 hingga Desember 2018. Luaran buruk berdasarkan program DOTS TB yaitu pasien yang mengalami gagal terapi, meninggal, putus berobat dan pasien pindah yang tidak melanjutkan terapi. Hasil. Penelitian melibatkan 141 subjek dengan median usia subjek 57 tahun (rentang 28-79 tahun), dan 56,03% subjek berjenis kelamin laki-laki. TB paru relaps pada 24,11% subjek. Hasil pengobatan TB-DM yaitu sembuh (1,42%), pengobatan lengkap (51,77%), putus berobat/loss to follow up (31,91%), tidak dievaluasi (14%), dan meninggal (7%). Proporsi luaran buruk terapi TB-DM didapatkan 46,81%, dengan profil subjek mayoritas laki-laki, menikah, pasien yang bekerja, perokok aktif, TB relaps, adherensi kurang, terdiagnosis DM sebelumnya, IMT underweight dan normoweight, terdapat penurunan laju filtrasi glomerulus ( < 60 ml/mnt/1,73m 2 ), mendapat terapi awal DM berbasis insulin, dan kontrol DM yang belum baik. Kesimpulan. Proporsi luaran buruk terapi TB-DM didapatkan 46,81% dengan komposisi putus pengobatan yang paling banyak pada kelompok luaran buruk (31,91%).
Kata Kunci: Tuberkulosis, diabetes melitus, tuberkulosis-diabetes melitus, luaran buruk terapi.


Background. The treatment of lung tuberculosis in patient with diabetes mellitus comorbidity is still a major problem because of high incidence rate, unfavourable outcome and failure. In Indonesia, there is no specific study about outcome, characteristics and profile patient with this unfavourable outcome. Objectives. To identify the treatment outcome, patient characteristic and patient profile for unfavourable outcome. Methods. This is a retrospective cohort study, analyzing medical record of lung tuberculosis patient with diabetes mellitus comorbidity that treated in Cipto Mangunkusumo Hospital from January 2013 to December 2018. Unfavourable outcome as defined by TB-DOTS national program consist of subject with failure to treat, death, loss to follow up and transferred out without known of final results. Result. A total of 141 subject enrolled in this study, with median age of subject was 57 years (range 28 to79 years) and majority subject is male (56.03%), Tb relapse found in 24.11% subject. Outcome of Tb treatment based on National Program was treatment complete in 51.77%, Cure in 1.42%, loss to follow up in 31.91%, transferred out in 14%, and died in 7% subjects. Unfavourable outcome found in 46.81% subject, with majority found in male subject, married, working subject, actively smoking, subject with previous TB treatment, non-adherence, previously known diabetes, underweight or normoweight subject, reduce eGFR below 60 ml/min/1.73m 2 , subject with insulin therapy on intensive phase, and poorly controlled diabetes. Conclusion. Unfavourable outcome found in 46,81% subject, with loss to follow up was the highest composition (31.91%)
Keywords: Tuberculosis, diabetes mellitus, tuberculosis-diabetes mellitus comorbidity, unfavourable outcomes.