Tesis

Uji Validasi Simplified Acute Physiology Score (Saps) 3 untuk Prediksi Mortalitas Rawat Inap Pneumonia Komunitas Bakterial dan Viral Berat Di RSUPN Cipto Mangunkusumo = Validation Test of Simplified Acute Physiology Score (SAPS) 3 as a Predictor of In-hospital Mortality of Severe Bacterial and Viral Community-Acquired Pneumonia in Cipto Mangunkusumo National General Hospital.

Latar Belakang Pneumonia komunitas berat (severe community acquired pneumonia atau SCAP) merupakan salah satu bentuk penyakit kritis yang sering dijumpai dengan angka mortalitas jangka pendek yang tinggi. Pelbagai model prediksi klinis general telah banyak dievaluasi memiliki performa yang baik dalam memprediksi luaran klinis untuk penyakit kritis, namun evaluasi performa SAPS 3 sebagai salah satu sistem skor yang luas digunakan dalam perawatan intensif terhadap SCAP hingga saat ini belum memadai untuk memandu klinisi dalam menangani kasus tersebut. Tujuan Penelitian ini bertujuan untuk mengetahui proporsi mortalitas SCAP serta mengevaluasi performa kalibrasi dan diskriminasi dari SAPS 3 terhadap mortalitas rawat inap. Metode Penelitian ini menggunakan desain kohort retrospektif dan mengambil data rekam medis dari pasien dengan SCAP yang masuk rawat di instalasi gawat darurat, ruang perawatan high care maupun intensive care di RSUPN Cipto Mangunkusumo selama 3 tahun (Maret 2019-Maret 2021). Dilakukan penilaian mortalitas rawat inap selama 30 hari perawatan. Data terkumpul dianalisis dengan uji Hosmer-Lemeshow goodness-of-fit untuk mengetahui performa kalibrasi dan pembuatan kurva Receiver Operating Curve (ROC) untuk mengetahui performa diskriminasi skor SAPS 3 terhadap luaran mortalitas rawat inap. Hasil Diperoleh 484 subjek SCAP dengan proporsi mortalitas 49,2%. Sebanyak 73,8% adalah infeksi viral (COVID-19) dan sisanya bakterial (25,6%) dan campuran fungal-bakterial (0,6%). Performa kalibrasi adalah baik (p=0,519, koefisien korelasi r=0,993). Performa diskriminasi tampak sangat baik untuk skor total SAPS 3 dengan nilai AUC 0,921 (IK95% 0,898-0,944). Kesimpulan Performa kalibrasi dan diskriminasi SAPS 3 dalam memprediksi mortalitas rawat inap SCAP adalah baik.
Kata Kunci Pneumonia komunitas berat, mortalitas, SAPS 3


Background Severe community-acquired pneumonia (SCAP) is one of the most commomly encountered critical illness with high mortality rate. Several generic clinical prediction models are known to have better performance in predicting the clinical outcome of critical illnesses, but SAPS 3 score, as one of the most widely used in intensive care practice, to predict and guide clinical decision making has not yet been assessed adequately, especially for SCAP. Aim This study aims to get the mortality proportion of SCAP and evaluate the calibration and discrimination performance of SAPS 3 score to predict the inhospital mortality outcome. Methods We use retrospective cohort study design and gather the medical record of patients admitted with SCAP to emergency ward, high care and intensive care unit of Cipto Mangunkusumo Hospital for 3 consecutive years (March 2019-March 2021). The 30 days in-hospital mortality was documented during the study. Collected data were analyzed using goodness-of-fit Hosmer-Lemeshow tset for the calibration performance and Receiver Operating Curve (ROC) for the discrimination performane of SAPS 3 score toward the in-hospital mortality outcome. Results There were 484 subjects with SCAP included in this study with the proportion of mortality as high as 49,2%. Among them, 73,8% was identified to have viral pneumonia due to COVID-19 and the rest were bacterial (25,6%) and fungal-bacterial (0,6%). The calibration performance was good (p=0,519, coefficient of correlation r=0,993). Discrimination performance was found to be excellent for total score of SAPS 3 with AUC 0,921 (95%CI 0,898-0,944). Conclusion The calibration and discrimination performance of SAPS 3 score in predicting the in-hospital mortality of SCAP is good.
Keywords. Severe community acquired pneumonia, mortality, SAPS 3