Tesis

Peran Rasio C-Reactive Protein dan Albumin (RCA) Sebagai Diagnostik dan Prediktor Disfungsi Kardiovaskuler Serta Mortalitas Pada Bayi Prematur Dengan Sepsis Neonatorum Awitan Lambat = Role of C-Reactive Protein Albumin Ratio as Diagnostic and Predictor Cardiovascular dysfunction and Mortality in Preterm Infant with Late Onset Neonatal Sepsis.

Latar belakang: Sepsis neonatorum awitan lambat (SNAL) merupakan penyebab morbiditas dan mortalitas penting khususnya pada bayi prematur. Terjadinya sepsis berat berupa disfungsi kardiovakuler (syok maupun hipertensi pulmoner) sulit untuk diprediksi. Interleukin-6 (IL-6), prokalsitonin (PCT), dan presepsin terbukti membantu dalam mendiagnosis dan memprediksi perburukan sepsis. Manfaat pemeriksaan rasio C-reactive protein dan albumin (RCA) untuk mendukung diagnosis maupun prediktor perjalanan penyakit sepsis neonatorum masih terbatas. Tujuan: Mengetahui peran RCA dalam mendiagnosis dan memprediksi terjadinya disfungsi kardiovaskuler dan mortalitas pada bayi prematur dengan SNAL. Metode: Penelitian secara prospektif ini dilakukan di Unit Neonatologi FKUI RSCM sejak April-Oktober 2023 dengan melibatkan bayi prematur yang diduga mengalami SNAL. Pemeriksaan darah perifer lengkap, albumin, dan penanda infeksi (CRP, PCT, presepsin) dilakukan secara serial pada awal perburukan (T0), 48-72 jam pascaterapi (T1), dan 5-10 hari pascaterapi (T2). Pemeriksaan kultur dan IL-6 dilakukan pada T0. Subjek yang didiagnosis SNAL kemudian dipantau selama 14 hari untuk kemungkinan terjadi disfungsi kardiovaskuler maupun mortalitas. Hasil: Sebanyak 225 subjek yang diduga mengalami perburukan, tetapi hanya 145 (64,4%) subjek yang terdiagnosis SNAL dan 39,1% diantaranya merupakan proven sepsis. Tercatat 40% subjek yang SNAL mengalami disfungsi kardiovaskuler. Tingkat mortalitas SNAL sebesar 18,6%. Nilai diagnostik RCA setara dengan IL-6, PCT, dan presepsin dalam mendiagnosis probable (nilai batas 4,39x10-4, AUC 0,923) maupun proven sepsis (4,85x10-4, AUC 0,918). Pada awal penyakit (T0), RCA (nilai batas 11,3x10-4, AUC 0,938) memilki nilai prediktor terjadinya disfungsi kardiovaskuler yang sama baiknya dengan IL-6, PCT, dan presepsin. Pada T2, nilai prediktor mortalitas RCA (nilai batas 14,4x10-4, AUC 0,965) setara PCT maupun presepsin. Simpulan: RCA dapat menjadi penanda infeksi alternatif untuk mendiagnosis serta memprediksi terjadinya disfungsi kardiovaskuler dan mortalitas pada bayi prematur dengan SNAL.
Kata Kunci: SNAL, prematur, RCA, disfungsi kardiovaskuler, mortalitas


Background: Late onset neonatal sepsis (LONS) is an important cause of morbidity and mortality, particularly in preterm infants. The occurrence of severe sepsis such cardiovascular dysfunction (shock or pulmonary hypertension) is difficult to predict. Interleukin-6 (IL-6), PCT, and presepsin have been proven to be useful in diagnosing and predicting course of disease. Role of C-reactive protein and albumin (CAR) ratio in supporting diagnosis and predicting course of neonatal sepsis is still limited. Objective: To know the role of CAR in diagnosing and predicting cardiovascular dysfunction and mortality in premature infants with LONS. Methods: This prospective study was conducted at Neonatology Unit of FMUI-Cipto Mangunkusumo Hospital from April-October 2023, involving preterm infants with suspected LONS. Complete peripheral blood count, albumin, and biomarker (CRP, PCT, presepsin) was examined serially at the beginning (T0), 48-72 hours post therapy (T1), and 5-10 days post therapy (T2). Blood culture and IL-6 was performed only on T0. Subjects with LONS were continue to be monitored for possibility occurrence of cardiovascular dysfunction or mortality outcome in 14 days. Results: A total of 225 subjects were suspected LONS, but only 145 (64.4%) subjects were diagnosed with LONS and 39.1% of them had proven sepsis. It was 40% of LONS had cardiovascular dysfunction with mortality rate was 18.6%. The diagnostic value of RCA is equivalent to IL-6, PCT, and presepsin in diagnosing probable (cut-off 4.39x10- 4, AUC 0.923) and proven sepsis (4.85x10-4, AUC 0.918). At the onset of sepsis (T0), CAR (cut-off 11.3x10-4, AUC 0.938) had a similar value in predicting of cardiovascular dysfunction as IL-6, PCT, and presepsin. At T2, CAR mortality predictor values (cut-off 14.4x10-4, AUC 0.965) were equivalent to PCT and presepsin. Conclusions: CAR may be an alternative marker for diagnosing and predicting cardiovascular dysfunction and mortality in preterm infants with LONS.
Keywords: LONS, preterm infants, CAR, cardiovascular dysfunction, mortality