Tesis

Hubungan antara Kadar HIF-1 alpha Jaringan dengan Risiko Amputasi Berdasarkan Skor SVS WIfI pada Pasien Ulkus Kaki Diabetik = Correlation Between HIF-1 alpha Tissue Level and AmputationRisk Based on WIfI Score in Patient with Diabetic Foot Ulcer.

Tujuan. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar HIF- 1α dengan risiko amputasi yang dinilai berdasarkan skor SVS WIfI. Diharapkan, HIF-1α dapat dijadikan sebagai salah satu marker penentu derajat tungkai kritis, membantu klinisi menentukan tata laksana yang tepat pada tungkai kritis berdasarkan derajat keparahannya. Metode. Penelitian ini merupakan studi potong lintang, yang dilakukan pada bulan Mei–Juli 2022. Pasien ulkus kaki diabetik yang menjalani perawatan di RSUPN Cipto Mangunkusumo tanpa riwayat keganasan, vasculitis, ataupun autoimun diinklusi ke dalam penelitian. Variabel yang diteliti meliputi usia, status gizi (IMT), profil glikemik (gula darah sewaktu dan HbA1c), jenis kelamin, kadar HIF-1alpha jaringan, dan risiko amputasi berdasarkan skor WIfI. Data numerik dianalisis dengan uji T tidak atau Mann Whitney. Bila terdapat > 2 variabel dengan nilai p ≤ 0.25, dilakukan uji multivariat regresi linear atau regresi logistik. Hasil. Sebanyak enam puluh empat pasien luka kaki diabetik yang menjalani tindakan di RSUPN Dr. Cipto Mangunkusumo diinklusi dalam penelitian ini, dengan rerata usia 55,77 ± 10,46 tahun. Terdapat 45% pasien dengan risiko amputasi tinggi dalam 1 tahun. Terdapat perbedaan median kadar HIF-1alpha jaringan yang bermakna pada tiap derajat luka, amputasi, dan infeksi kaki berdasarkan skor WIfI (p < 0,05). Median kadar HIF-1alpha untuk risiko amputasi rendah, sedang, dan tinggi berturut-turut sebesar 23,94 (1,56–211,12), 23,44 (0,55–86,78), 7,48 (1,13– 53,47) ng/mg.protein (p = 0,007). Gula darah sewaktu juga ditemukan berhubungan dengan risiko amputasi (p < 0,010). Simpulan. Pasien dengan kategori amputasi tinggi, mengekspresikan HIF-1alpha dengan kadar yang lebih rendah. Kadar gula darah sewaktu ditemukan lebih tinggi pada kelompok risiko amputasi tinggi.
Kata kunci: HIF-1alpha; risiko amputasi; skor SVS WIfI; dan ulkus kaki diabetik.



Aim. This study aimed to determine the relationship between HIF-1α levels and the risk of amputation as assessed based on the SVS WIfI score. It is hoped that HIF-1α can be used as a marker for determining the degree ofcritical limb, helping clinicians determine the appropriate management of critical limbs based on the degree of severity. Methods. This study was a cross-sectional study, conducted in May–July 2022. Diabetic foot ulcer patients undergoing treatment at Cipto Mangunkusumo General Hospital without a history of malignancy, vasculitis, or autoimmunity were included in the study. The variables studied included age, nutritional status (BMI), glycemic profile (temporary blood sugar and HbA1c), gender, tissue HIF- 1α level, and risk of amputation based on the WIfI score. Numerical data were analyzed with no T test or Mann Whitney. If there are > 2 variables with a value of p ≤ 0.25, a linear regression or logistic regression multivariate test is performed. Results. A total of sixty-four patients with diabetic foot injuries who underwent surgery at RSUPN Dr. Cipto Mangunkusumo was included in this study, with an average age of 55.77 ± 10.46 years. There are 45% of patients with a high risk of amputation within 1 year. There were significant differences in the median levels of HIF-1α in each degree of injury, amputation, and foot infection based on the WIfI score (p < 0.05). Median HIF-1α levels for low, medium, and high risk of amputation were 23.94 (1.56–211.12), 23.44 (0.55–86.78), 7.48 (1) respectively .13–53.47) ng/mg.protein (p = 0.007). Intermittent blood sugar was also found to be associated with risk of amputation (p < 0.010). Conclusion. Patients with high amputation category express HIF-1α at lower levels. Blood sugar levels were found to be higher in the high amputation risk group.
Keywords: amputation risk; diabetic foot ulcer; HIF-1alpha; and SVS WIfI score