Tesis

Prevalensi dan Determinan Diagnostik Defisiensi Vitamin D pada Pasien Usia Lanjut Rawat Jalan = Prevalence and Diagnostic Determinants of Vitamin D Deficiency in Outpatient Elderly Patients.

Latar Belakang. Vitamin D penting dalam metabolisme kalsium dan mencegah disfungsi sistem organ, terutama pada usia lanjut (lansia). Prevalensi defisiensi vitamin D di Indonesia bervariasi antara 35,1 -91,7%. Implikasi klinis kondisi defisiensi berpengaruh terhadap penurunan kesehatan tulang, otot, juga terhadap peningkatan risiko berbagai penyakit, termasuk sindrom geriatri. Sampai saat ini pemeriksaan baku emas belum rutin dilakukan, terkait keterbatasan biaya dan fasilitas. Beberapa instrumen penyaring berbasis skor telah dikembangkan di luar negeri, namun terdapat perbedaan musim, geografis, dan karakteristik pasien. Tujuan. Mengetahui prevalensi, determinan diagnostik, dan model prediksi diagnostik defisiensi vitamin D pada pasien lansia rawat jalan. Metode. Dengan desain potong lintang, penelitian dilakukan di poliklinik Geriatri Terpadu Rumah Sakit Cipto Mangunkusumo periode Desember 2022-Januari 2023. Kepada subjek dilakukan pengambilan data sosiodemografi dan faktor-faktor risiko menggunakan kuesioner, rekam medis, dan pemeriksaan kalsidiol serum. Hasil. Sebanyak 264 subjek memenuhi kriteria inklusi dan eksklusi, dengan median usia 72,5 (60-92) tahun dan proporsi perempuan 64,8%. Prevalensi defisiensi vitamin D 28,0%. Uji multivariat menunjukkan perempuan, obesitas, tanpa suplementasi vitamin D, kemungkinan depresi, paparan matahari rendah, dan eGFR < 30 sebagai determinan diagnostik. Model prediksi diagnostik menunjukkan AUC 0,770 (0,708-0,831). Batas total skor 3 ditentukan sebagai cut offdengan sensitivitas 94,59% dan spesifisitas 20,0%. Kesimpulan. Prevalensi defisiensi vitamin D pada lansia rawat jalan sebesar 28,0%. Jenis kelamin perempuan, obesitas, kemungkinan depresi, paparan matahari rendah, tidak adanya suplementasi vitamin D, dan eGFR < 30 merupakan determinan diagnostik. Model prediksi diagnostik dapat digunakan untuk menyaring defisiensi vitamin D.
Kata Kunci. Vitamin D, defisiensi, lansia, rawat jalan, model prediksi


Background. Vitamin D has important role in the calcium metabolism and in preventing multiple organ dysfunction. In Indonesia, the prevalence of vitamin D deficiency varies from 35.1% - 91.7%. Deficient conditions affect bone and muscle health, as well as increased risk of various diseases, including geriatric syndrome. Due to facilities and costs barrier, standard test has not been regularly performed. Several score-based instruments have been developed, but there are differences in seasonality, geography, and patient characteristics. Aim. To know the prevalence, diagnostic determinants, and predictive models of vitamin D deficiency in elderly outpatients. Method. The study was carried out at Cipto Mangunkusumo Hospital's geriatric integrated clinic using cross-sectional design from December 2022 to January 2023. Sociodemographic data and risk factors were collected using questionnaire and medical records. Blood samples were taken for vitamin D examination. Result. A total of 264 subjects, mainly female (64,8%) met the inclusion and exclusion criteria, with a median age of 72.5 (60-92). The prevalence of vitamin D deficiency is 28.0%. Multivariate test showed female, obesity, no vitamin D supplementation, possible depression, low sun exposure, and eGFR < 30 as diagnostic determinants. The diagnostic model showed AUC 0.770 (0.708-0.831). The total score of 3 was determined as a cut off with a sensitivity and specificity of 94.59% and 20.0%, respectively. Conclusion. The prevalence of vitamin D deficiency is 28.0%. Female, obesity, depressive status, low sun exposure, no vitamin D supplementation, and eGFR < 30 are diagnostic determinants. This model may be used for vitamin D deficiency screening.
Keywords. Vitamin D, deficiency, elderly, outpatient, predictive model