Tesis

Uji diagnostik & nilai prognostik presepsin sebagai biomarker sepsis pada anak = The diagnostic & prognostic value of presepsin as a new biomarker in pediatric sepsis.

Latar belakang: Sepsis sulit dibedakan dengan respon inflamasi non infeksi secara klinis dan kultur darah yang merupakan gold standar diagnosis sepsis memiliki banyak keterbatasan. Presepsin merupakan suatu biomarker baru namun belum banyak data tentang efektifitas penggunaanya pada anak. Tujuan: Mengetahui nilai diagnostik dan prognostik presepsin dibandingkan dengan leukosit, PCT dan CRP pada pasien anak yang dicurigai sepsis Metode: Studi potong lintang dilakukan selama bulan Maret-Desember 2020 di RSCM Jakarta pada 56 pasien anak berusia 2 bulan - 10 tahun dengan kecurigaan sepsis Diagnosis sepsis ditegakan berdasarkan kriteria sepsis-3 dan kultur darah. Pemeriksaan biomarker dan skor PELOD-2 dilakukan saat awal dan setelah 72 jam, penilaian mortalitas dilakukan pada hari ke-7. Kadar presepsin diperiksa menggunakan metode PATHFAST® . Hasil: Nilai median kadar presepsin pada kelompok proven sepsis (1183 pg/ml lebih tinggi dibandingkan kelompok unproven sepsis (369 pg/ml, p=0.001). Presepsin memiliki nilai diagnostik yang baik (AUC 0,862), dengan cut of 711 pg/ml memiliki sensitivitas 75,8%, spesifisitas 82,6%, nilai duga positif 86,2% dan nilai duga negatif 70,4%, lebih baik dibanding leukosit, PCT, dan CRP. Kadar presepsin meningkat linier dengan tingkat keparahan sepsis dan berkorelasi sedang dengan skor PELOD-2 (r=0.548; p=0.001). Analisis survival menunjukan kadar presepsin ≥ 1.250 pg/ml berhubungan signifikan dengan mortalitas dini (HR 6.31; 95%CI; 1.67-23.83; p=0,007). Kadar presepsin setelah 72 jam terapi antibiotik menurun signifikan pada kelompok sepsis yang mengalami perbaikan dan meningkat pada kelompok sepsis perburukan. Simpulan: Presepsin merupakan biomarker yang handal dan dapat digunakan untuk membantu diagnosis sepsis, memprediksi tingkat keparahan, kematian dan evaluasi terapi pada RS layanan tersier.
Kata Kunci: Presepsin, sepsis, anak, PCT, CRP, diagnostik


Background The current clinical diagnosis of sepsis has been challenging to differentiate with the non-infection systemic inflammatory response and blood culture as the gold standard has its limitations. Presepsin has been proposed as a new useful sepsis biomarker, but its data in pediatric sepsis are still limited. Objective: To investigate the diagnostic and prognostic values of presepsin, compared to leukocyte, PCT and CRP in children with suspected sepsis Methods: A cross sectional study was conducted during March – December 2020 in Cipto Mangunkusumo General Hospital, Jakarta. Fifty six hospitalized children aged 2 month – 10 years old with suspected sepsis were enrolled. The Diagnosis of sepsis was based on sepsis-3 criteria and blood culture result. The evaluation of biomarkers level and PELOD-2 score were measured at the time when the diagnosis of sepsis was first made and 72-hours after. We followed subjects for 7 days to assess their survival rate. The level of presepsin were measured using a PATHFAST® analyzer. Results: Presepsin levels were significantly higher in the proven sepsis group (1183 pg/ml) compared with unproven sepsis group (369 pg/ml, p=0.001). The AUC for presepsin was (0.86). Using a cut off 711 pg/ml, the sensitivity, specificity, positive predictive value, negative predictive value of presepsin were 75.8%, 82.6%, 86.2%, 70,4% respectively, better than leukocyte, PCT and CRP. The level of Presepsin increased in linier fashion with the severity of sepsis and has positive moderate correlation with PELOD-2 score (r=0.548; p=0.001). Using survival analysis, presepsin levels ≥ 1.250 pg/mL significantly increased risk of early mortality rate (hazard ratio 6.31; 95%CI; 1.67-23.83; p=0,007). This study finds that the presepsin levels after 72 hours of antibiotic treatment were decreased gradually from its baseline in the responsive group and rose persistently in unresponsive group Conclusions: Presepsin is a valuable biomarker for diagnosing sepsis, risk stratification, mortality prediction and for treatment evaluation in tertiary hospital.
Keywords: Presepsin, sepsis, pediatric, PCT, CRP, diagnostic