Tesis

Skor Sofa Pada Pasien Kanker Paru Di Instalasi Gawat Darurat Rumah Sakit Persahabatan Pusat Respirasi Nasional = Sofa Score In Lung Cancer Patient In Emergency Ward, Persahabatan Hospital, National Respiratory Center.

Latar Belakang : Kanker paru merupakan keganasan yang berasal dari parenkim paru dan saat ini menjadi penyumbang kematian terbesar akibat kanker. Berdasarkan data WHO 2020, terdapat 2,2 juta kasus baru kanker paru dengan 1,8 juta kematian. Kanker paru terbagi menjadi jenis sel kecil (KPKSK) dan bukan sel kecil (KPKBSK) dengan adenokarsinoma jenis terbanyak. Skor SOFA dapat digunakan untuk menilai disfungsi organ serta memprediksi mortalitas, namun penelitian tentang penggunaan skor SOFA khusus pada populasi kanker paru masih terbatas. Metode : Penelitian ini merupakan penelitian dengan desain studi potong lintang yang dilakukan di instalasi gawat darurat (IGD) RS Persahabatan pada bulan Maret – Juni 2024. Subjek penelitian adalah pasien kanker paru yang sudah tegak jenis dan datang ke IGD sesuai kriteria inklusi dan eksklusi. Lalu dilakukan anamnesis dan pemeriksaan fisis. Data karakteristik klinis, laboratorium dan skor SOFA diambil dari rekam medis. Hasil : Pada penelitian ini didapatkan 101 subjek penelitian. Dari 101 subjek, ditemukan 52,5% subjek memiliki skor SOFA < 4 dan 47,5% subjek dengan skor SOFA ≥ 4. Dari penelitian ini juga didapatkan 60,4% subjek mendapatkan perawatan < 7 hari dan 39,6% mendapat perawatan selama ≥ 7 hari. Berdasarkan hasil penelitian ini juga ditemukan 48,5% subjek hidup dan 51,5% subjek meninggal dunia. Berdasarkan analisis bivariat, skor SOFA ≥ 4 secara statistik meningkatkan risiko mortalitas dengan OR 10,586 (IK 95% : 4,192-26,732), P 0,001. Skor SOFA ≥ 4 juga meningkatkan risiko durasi lama rawat dengan OR 2,679 (IK 95% : 0,645 – 11,129), P 0,279. Pada analisis multivariat ditemukan variabel lain yang meningkatkan risiko mortalitas dan bermakna secara statistik yaitu ECOG dengan nilai OR 17,164 (IK 95% : 5,414 0 54,417), P 0,001. Sedangkan skor SOFA ≥ 4 diketahui meningkatkan risiko mortalitas dengan OR 4,625 (IK 95% : 1,420-15,273), P 0,011. Kesimpulan : Skor SOFA yang lebih tinggi dikaitkan dengan peningkatan risiko mortalitas dan durasi perawatan. Hal ini menegaskan peran skor SOFA sebagai prediktor mortalitas yang signifikan secara statistik serta sebagai prediktor durasi perawatan yang, meskipun tidak signifikan secara statistik, tetap memiliki potensi nilai klinis di IGD RS Persahabatan, sehingga dapat mendukung pengambilan keputusan klinis.
Kata Kunci : Kanker paru, lama rawat, mortalitas, skor SOFA


Background : Lung cancer is a malignancy that originates from the lung parenchyma and is currently the largest contributor to cancer deaths. Based on WHO 2020 data, there are 2.2 million new cases of lung cancer with 1.8 million deaths. Lung cancer is divided into small cell (SCLC) and non-small cell (NSCLC) types with adenocarcinoma being the most common type. SOFA scores can be used to assess organ dysfunction as well as predict mortality, however research on the use of SOFA scores specifically in the lung cancer population is limited. Methods : This study utilized a cross-sectional design and was conducted in the Emergency Department of Persahabatan Hospital from March until June 2024. The study population comprised lung cancer patients who presented to the emergency department and met the established inclusion and exclusion criteria. A detailed history-taking and physical examination were performed for all eligible patients. Clinical characteristics, laboratory results, and SOFA scores were obtained from medical records to ensure comprehensive data collection. Results : This study included a total of 101 subjects. Of these, 52.5% had a SOFA score < 4, while 47.5% had a SOFA score ≥ 4. Additionally, 60.4% of the subjects were hospitalized for < 7 days, whereas 39.6% required hospitalization for ≥ 7 days. The study also revealed that 48.5% of the subjects survived, while 51.5% succumbed to their illness. Bivariate analysis showed that a SOFA score ≥ 4 significantly increased the risk of mortality, with an odds ratio (OR) of 10.586 (95% CI: 4.192–26.732, P = 0.001). Similarly, a SOFA score ≥ 4 was associated with an increased risk of prolonged hospitalization, with an OR of 2.679 (95% CI: 0.645–11.129, P = 0.279), though this result was not statistically significant.Multivariate analysis identified another statistically significant factor associated with increased mortality risk: ECOG, with an OR of 17.164 (95% CI: 5.414–54.417, P = 0.001). Meanwhile, a SOFA score ≥ 4 remained a significant predictor of mortality, with an OR of 4.625 (95% CI: 1.420–15.273, P = 0.011). Conclusions : A higher SOFA score is associated with an increased risk of mortality and a longer length of stay. This underscores the role of the SOFA score as a statistically significant predictor of mortality and as a predictor of length of stay, which, although not statistically significant, may still hold clinical value in the emergency department of Persahabatan Hospital, thereby supporting clinical decision-making.
Keyword : length of stay, lung cancer, mortality rate, SOFA score