Tesis

Korelasi antara Rasio Neutrofil Limfosit dengan Perubahan Lingkar Betis pada pasien Intensive Care Unit = Correlation between Neutrophil Lymphocyte Ratio and Changes in CalfCircumference in Intensive Care Unit Patients.

Latar Belakang: Malnutrisi seringkali didapatkan pada pasien dengan penyakit akut dan kronis. Penyebab malnutrisi pada pasien sakit kritis bersifat multifaktorial, salah satu penyebabnya adalah inflamasi yang tinggi. Inflamasi merupakan penyebab malnutrisi yang dapat menyebabkan anoreksia, berkurangnya asupan makan, katabolisme otot, dan resistensi insulin yang akan merangsang keadaan katabolik. Respon inflamasi terhadap pembedahan, trauma, atau kondisi medis parah lainnya menyebabkan gangguan metabolisme (misalnya katabolisme protein) pada pasien yang dirawat di ICU. Rasio neutrofil limfosit (RNL) adalah indikator yang sangat sensitif terhadap infeksi, peradangan dan sepsis, yang telah divalidasi dalam banyak penelitian. Selain inflamasi, malnutrisi pada pasien sakit kritis disebabkan oleh kesulitan mencapai target nutrisi yang optimal dan membuat pasien menghadapi risiko malnutrisi atau memperburuk kondisi malnutrisi yang sudah ada sebelumnya. Oleh karena itu penting untuk melakukan penilaian status gizi dalam rangka mengidentifikasi malnutrisi dan mengevaluasi hasil terapi gizi yang diberikan. Beberapa pengukuran komposisi tubuh untuk melihat massa otot dapat menggunakan beberapa pemeriksaan tervalidasi seperti magnetic resonance imaging (MRI), CT scan, DXA dan bioelectrical impedance analysis (BIA). Beberapa pemeriksaan antropometri untuk memprediksi massa otot dapat dilakukan, diantaranya lingkar lengan atas dan lingkar betis dapat dilakukan sebagai pemeriksaan pengganti karena sederhana, murah, tidak invasif. Penelitian ini bertujuan untuk mengetahui korelasi antara kadar RNL dengan perubahan lingkar betis pada pasien ICU. Metode: Penelitian ini merupakan studi prospektif observasional pada pasien sakit kritis di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Karakteristik subjek penelitian meliputi usia, jenis kelamin, etiologi sakit kritis, status gizi, status gizi (IMT), skor SOFA, antibiotik, asupan energi harian dan asupan protein harian. Dilakukan analisis korelasi antara rasio neutrofil limfosit dan perubahan lingkar betis (LB). Hasil: Terdapat 53 subjek denganrerata subjek berusia 50 (19-65) tahun. Subjek lebih banyak laki- laki 40 (74,1%) subjek. Sebagian besar subjek dengan status gizi BB kurang sebanyak 20 (367%). Rerata berat badan dan tinggi badan secara berturut-turut adalah sebesar 57±15,3 kg dan 165 (147- 176) cm. Etiologi sakit kritis subjek paling banyak adalah pembedahan yaitu sebanyak 25 (47,2%) seubjek. Berdasarkan skor SOFA, subjek penelitian terbanyak memiliki skor SOFA 0-6 36 (67,9%), dan lebih banyak subjek telah mendapatkan terapi antibiotik yaitu 36 (67,9%) seubjek. Rerata asupan energi dan protein subjek sebesar 15 (4-39) kkal/kgBB/hari dan 0.7(0-2) g/kgBB/hari. Sebagian besar subjek memiliki asupan energi tidak cukup 46(84%) dan asupan protein tidak cukup 36(66%). Hitung neutrofil, limfosit dan RNL pada penelitian berturut-turut adalah 20,07 (1,81-99,2) (103 /µL), 2,9 (0,14-28,8) (103 /µL), dan 7,9 (0,7-69). Rerata LB awal adalah 31,6±4,05 cm, rerata LB akhir 30,4±4,10 cm setelah perawatan adalah sebesar 1,2±0,7. Terdapat perbedaan bermakna perubahanLB setelah 10 hariperawatandiICU (p < 0,001), namun tidak terdapat korelasi berrmakna antara RNL dengan perubahan LB. Kesimpulan: Tidak terdapat korelasi bermakna RNL dengan perubahan LB selama 10 hari perawatan.
Kata kunci: Rasio neutrofil limfosit, lingkar betis, sakit kritis


Background: Malnutrition is common in patients with acute and chronic illnesses. The causes of malnutrition in critically ill patients are multifactorial, one of which is high inflammation. Inflammation is a cause of malnutrition that can lead to anorexia, reduced food intake, muscle catabolism, and insulin resistance that will stimulate a catabolic state. The inflammatory response to surgery, trauma or other severe medical conditions leads to metabolic disturbances (e.g. protein catabolism) in patients admitted to the ICU. The ratio ofneutrophil lymphocytes (NLR) is a highly sensitive indicator of infection, inflammation and sepsis, which has been validated in many studies. In addition to inflammation, malnutrition in critically ill patients is caused by difficulty achieving optimal nutritional targets and puts patients at risk of malnutrition or worsens pre-existing malnutrition conditions. Therefore, it is important to assess nutritional status in order to identify malnutrition and evaluate the results of nutritional therapy. Several validated body composition measurements such as magnetic resonance imaging (MRI), CT scan, DXA and bioelectrical impedance analysis (BIA) can be used to assess muscle mass. Some anthropometric examinations to predict muscle mass can be done, including upper arm circumference and calfcircumference can be done as a substitute examination because it is simple, cheap, non-invasive. This study aims to determine the correlation between NLR levels and changes in calf circumference in patients in the ICU. Methods: This study is a prospective observational study on critically ill patients at Dr. Cipto Mangunkusumo Hospital and University of Indonesia Hospital. The characteristics of the study subjects included age, gender, etiology of critical illness, nutritional status, nutritional status (BMI), SOFA score, antibiotics, daily energy intake and daily protein intake. Correlation analysis was conducted between neutrophil-lymphocyte ratio and changes in calf circumference (CC). Results: There were 53 subjects with an average age of 50 (19-65) years. There were 40 (74.1%) male subjects. Most of the subjects with underweight nutritional status were 20 (367%). The mean body weight and height were 57±15.3 kg and 165 (147- 176) cm, respectively. The etiology of the most subject's critical illness was surgery, as many as 25 (47.2%) subjects. Based on the SOFA score, the most subjects had a SOFA score of 0-6 36 (67.9%), and more subjects had received antibiotic therapy, namely 36 (67.9%) subjects. The mean energy and protein intake of the subjects was 15 (4-39) kcal/kgBB/day and 0.7 (0-2) g/kgBB/day. Most subjects had insufficient energy intake 46(84%) and insufficient protein intake 36(66%). The neutrophil, lymphocyte and RNL counts in the study were 20.07 (1.81 -99.2) (103 /µL), 2.9 (0.14- 28.8) (103 /µL), and 7.9 (0.7-69), respectively. The mean initial CC was 31.6±4.05 cm, the mean final CC was 30.4±4.10 cm after treatment was 1.2±0.7. There was a significant difference in CC change after 10 days of ICU treatment (p < 0.001), but there was no significant correlation between RNL and CC change. Conclusion: There was no significant correlation between RNL and call circumference change during the 10 days of treatment.
Keywords: Neutrophil lymphocyte ratio, calfcircumference, critically ill