Tesis

Perbedaan Rasio LDH/ADA, Kadar LDH, CRP, CA-125 Cairan Pleura antara Efusi Pleura Malinga (EPM) dan non maligna pada pasien yang menjalani torakoskopi medis = Differences in LDH/ADA Ratio, LDH, CRP, CA-125 Pleural Fluid Levels between Malignant and Non-malignant Pleural Effusion (EPM) in patient whom undergo medical thoracoscopy.

Latar Belakang: Efusi pleura maligna (EPM) merupakan komplikasi serius pada kanker stadium lanjut yang terjadi pada sekitar 15% pasien kanker dan menjadi penyebab kedua tersering efusi pleura eksudatif. Di Amerika Serikat dan Eropa, kasus EPM cukup tinggi, sementara di Indonesia, data dari beberapa rumah sakit menunjukkan proporsi dan angka kematian yang signifikan. EPM sering menunjukkan prognosis buruk dengan median kelangsungan hidup 3–12 bulan. Diagnosis definitif ditegakkan melalui deteksi sel ganas dalam cairan pleura atau biopsi, namun sensitivitas sitologi relatif rendah, sehingga diperlukan metode tambahan seperti torakoskopi medis yang memiliki akurasi tinggi. Parameter biokimia seperti LDH, ADA, CA-125, dan CRP dapat membantu mendukung diagnosis. Penatalaksanaan EPM bersifat paliatif dengan tujuan utama mengurangi gejala dan meningkatkan kualitas hidup pasien melalui berbagai intervensi, termasuk torakosentesis, pleurodesis, dan pemasangan kateter pleura jangka panjang. Tujuan: Studi ini bertujuan untuk mengidentifikasi perbedaan kadar berbagai biomarker imunologi dan rasio cancer (LDH/ADA) antara pasien EPM dan nonEPM yang menjalani prosedur torakoskopi. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien dewasa dengan efusi pleura tanpa etiologi yang jelas yang menjalani torakoskopi medik di RSCM periode Januari 2023 hingga Februari 2025. Pengambilan sampel dilakukan secara consecutive sampling. Data dianalisis menggunakan SPSS 23 dengan analisis univariat dan bivariat sesuai distribusi data. Hasil: Sebanyak 78 pasien dengan efusi pleura tanpa etiologi yang jelas diikutsertakan dalam penelitian ini, terdiri dari kelompok kasus (EPM; n=36, 49,72%) dan kontrol (non-EPM; n=42, 45,19%). Rerata usia subjek adalah 47,28 tahun (SD 14,47), dengan proporsi laki-laki lebih banyak (55,1%). Dari kelompok EPM, 53% juga menunjukkan hasil positif pada sitologi cairan. Uji normalitas menunjukkan hanya variabel usia yang berdistribusi normal. Analisis bivariat menunjukkan perbedaan signifikan antara kelompok EPM dan non-EPM pada rasio LDH serum/ADA cairan (p=0,020), rasio LDH cairan/ADA (p=0,030), dan kadar LDH cairan (p=0,011). Tidak ditemukan perbedaan signifikan pada kadar CRP cairan (p=0,243) dan CA-125 cairan (p=0,290). Simpulan: Terdapat perbedaan bermakna antara pasien dengan efusi pleura maligna (EPM) dan non-EPM pada rasio LDH serum/ADA cairan, rasio LDH cairan/ADA cairan, serta kadar LDH cairan, di mana ketiganya lebih tinggi pada kelompok EPM. Sebaliknya, kadar CRP cairan dan CA-125 cairan tidak menunjukkan perbedaan signifikan antara kedua kelompok. Rasio dan kadar LDH menunjukkan potensi sebagai indikator diagnostik tambahan dalam membedakan EPM dari non-EPM.
Kata kunci: Efusi pleura maligna, torakoskopi medik, LDH, ADA, rasio biomarker, CRP, CA-12


Background: Malignant pleural effusion (EPM) is a serious complication of advanced cancer that occurs in about 15% of cancer patients and is the second most common cause of exudative pleural effusion. In the United States and Europe, EPM cases are quite high, while in Indonesia, data from several hospitals show a significant proportion and mortality rate. EPM often shows a poor prognosis with a median survival of 3-12 months. Definitive diagnosis is made through detection of malignant cells in pleural fluid or biopsy, but the sensitivity of cytology is relatively low, so additional methods such as medical thoracoscopy are required which have high accuracy. Biochemical parameters such as LDH, ADA, CA-125, and CRP can help support the diagnosis. Management of EPM is palliative with the main goal of reducing symptoms and improving the patient's quality of life through various interventions, including thoracocentesis, pleurodesis, and long-term pleural catheter placement. Objective: This study aims to identify differences in the levels of various immunological biomarkers and cancer ratio (LDH/ADA) between EPM and nonEPM patients undergoing thoracoscopic procedures. Methods: This study is a retrospective cohort study on adult patients with pleural effusion without clear etiology who underwent medical thoracoscopy at RSCM from January 2023 to February 2025. Sampling was done by consecutive sampling. Data were analysed using SPSS 23 with univariate and bivariate analysis according to distribution of data. Results: A total of 78 patients with pleural effusion without clear etiology were included in this study, consisting of case (EPM; n=36, 49.72%) and control (nonEPM; n=42, 45.19%) groups. The mean age of the subjects was 47.28 years (SD 14.47), with a higher proportion of males (55.1%). Of the EPM group, 53% also showed positive results on fluid cytology. Normality test showed that only the age variable was normally distributed. Bivariate analysis showed significant differences between the EPM and non-EPM groups in serum LDH/fluid LDH ratio (p=0.020), fluid LDH/ADA ratio (p=0.030), and fluid LDH levels (p=0.011). No significant difference was found in fluid CRP (p=0.243) and fluid CA-125 (p=0.290) levels. Conclusions: There were significant differences between patients with malignant pleural effusion (EPM) and non-EPM in serum LDH/fluid LDH ratio, fluid LDH/fluid LDH ratio, and fluid LDH levels, all of which were higher in the EPM group. In contrast, fluid CRP and fluid CA-125 levels showed no significant difference between the two groups. LDH ratio and levels showed potential as additional diagnostic indicators in differentiating EPM from non-EPM.
Key words: Malignant pleural effusion, medical thoracoscopy, LDH, ADA, biomarker ratio, CRP, CA-125