Tesis

Peran Rasio Neutrofil-Limfosit Sebagai Prediktor Sindrom Curah-Jantung Rendah Pascabedah Jantung Terbuka Anak dengan Penyakit Jantung Bawaan = The Role of Neutrophil-Lymphocyte Ratio as a Predictor of Low Cardiac Output Syndrome after Open Heart Surgery in Children with Congenital Heart Disease.

Latar belakang. Low cardiac output syndrome (LCOS) adalah salah satu komplikasi berat yang sering terjadi pascabedah jantung terbuka dengan insidens 25-32%. LCOS dapat terjadi akibat proses inflamasi melalui jalur inflamasi dan komplemen setelah pintas jantung-paru (PJP). Diperlukan suatu marker inflamasi yang dapat memprediksi terjadinya LCOS. Pada penelitian ini dilakukan pemeriksaan rasio neutrofil-limfosit (neutrophil lymphocyte ratio, NLR) yang merupakan marker inflamasi sederhana dan rutin dilakukan, tetapi penggunaannya sebagai prediktor dalam menentukan LCOS belum banyak dilaporkan. Tujuan. Mengetahui peran NLR prabedah dan 0, 4, dan 8 jam pascabedah sebagai prediktor kejadian LCOS pascabedah jantung terbuka anak dengan penyakit jantung bawaan (PJB). Metode. Penelitian menggunakan uji prognostik dengan desain kohort prospektif, dilaksanakan pada 1 Desember 2020 hingga 30 Juni 2021 di cardiac intensive care unit (CICU) Pelayanan Jantung Terpadu (PJT) RSUPN Dr. Cipto Mangunkusumo, Jakarta. Hasil. Dari 90 subyek didapatkan 25 subyek (27,8%) mengalami LCOS. Nilai NLR prabedah berperan dalam memprediksi kejadian LCOS (AUC 70), dengan cut off ≥ 0,88 (p=0,027) didapatkan sensitivitas dan spesifisitas 64% dan 64,62% (IK 95%, 57-83). Sedangkan NLR 0 jam pascabedah memiliki nilai prediksi yang baik (AUC 81) terhadap kejadian LCOS, dengan cut off ≥ 4,73 (p < 0,0001) didapatkan sensitivitas dan spesifisitas masing-masing 80% (IK 95%, 69-94). Selanjutnya NLR 4 dan 8 jam pascabedah memiliki nilai prediksi yang sangat baik (AUC 97 dan 98) terhadap kejadian LCOS, dengan cut off berturut-turut adalah ≥ 6,19 (p < 0,0001) dan ≥ 6,78 (p < 0,0001) didapatkan sensitivitas dan spesifisitas berturut-turut adalah 92% dan 96% (IK 95%, 92-100), serta 92% dan 96,92% (IK 95%, 94-100). Kesimpulan. NLR prabedah dan 0, 4, dan 8 jam pascabedah terbukti berperan sebagai prediktor kejadian LCOS pascabedah jantung terbuka anak dengan PJB.
Kata kunci: limfosit, neutrofil, pintas jantung-paru, rasio neutrofil-limfosit, sindrom curah-jantung rendah


Background. Low cardiac output syndrome (LCOS) is a severe complications that often occurs in children after open heart surgery, with an incidence 25-32%. It can occur as a result of inflammatory response involving the inflammatory and complement pathways after cardiopulmonary bypass (CPB). An inflammatory marker is needed to predict the occurrence of LCOS. In this study, an examination of the neutrophil-lymphocyte ratio (NLR) which is a simple and routine marker of inflammation is carried out, but its use as a predictor in determining LCOS has not been widely reported. Objective. We aimed to explore the role of preoperative and 0, 4, and 8 hours postoperative NLR as a predictor of LCOS after open heart surgery in children with congenital heart disease (CHD). Methods. This study used a prognostic test with a prospective cohort design, was done from 1 st December 2020 until 30 th June 2021 at cardiac intensive care unit (CICU) Pelayanan Jantung Terpadu (PJT) RSUPN Dr. Cipto Mangunkusumo, Jakarta. Results. From 90 subjects, 27.8% (25 subjects) had LCOS. Preoperative NLR had a fair predictive value (AUC 70) for the incidence of LCOS, with a cut off value ≥ 0.88 (p=0.027) having a sensitivity and specificity of 64% and 64.62% (CI 95%, 57-83).While the NLR 0 hours post-operative also had a good predictive value (AUC 81) for the incidence of LCOS, with a cut off value ≥ 4.73 (p < 0.0001) having a sensitivity and specificity of 80% (CI 95%, 69-94), respectively. Furthermore, NLR 4 and 8 hours postoperative had a very good predictive value (AUC 97 and 98) for the incidence of LCOS, with cut off value ≥ 6.19 (p < 0.0001) and ≥ 6.78 (p < 0.0001), having a sensitivity and specificity of 92% and 96% (CI 95%, 92-100), as well as 92% and 96.92% (CI 95%, 94100). Conclusion. Preoperative and 0, 4, and 8 hours postoperative NLR can be a predictor of LCOS after open heart surgery in children with CHD.
Keywords: cardiopulmonary bypass, low cardiac output syndrome, lymphocyte, neutrophil, neutrophil-lymphocyte ratio.