Tesis

Pengaruh Puasa Ramadan Terhadap Hospitalisasi, Hipoglikemia, Perdarahan Saluran Cerna Bagian Atas, Skor Child-Pugh, dan Kualitas Hidup Pasien Sirosis Hepatis = The Impact of Ramadan Fasting on Hospitalization, Hypoglycaemia, Upper Gastrointestinal Bleeding, Deterioration of Child-Pugh Score, and Quality-of-Life of Cirrhosis Patients.

Latar Belakang. Puasa Ramadan adalah kewajiban bagi jutaan umat Muslim di dunia. Praktek ini merupakan hal yang relatif aman untuk individu sehat namun bisa menimbulkan risiko bagi umat yang memiliki penyakit. Sirosis adalah suatu penyakit hati tahap akhir yang menyebabkan gangguan pada fungsi hati. Meskipun begitu, data mengenai keamanan Puasa Ramadan pada pasien sirosis masih terbatas. Tujuan. Mengetahui Pengaruh Puasa Ramadan terhadap hospitalisasi, hipoglikemia, perdarahan saluran cerna bagian atas (PSCBA), skor Child Pugh, dan kualitas hidup pasien sirosis. Metode. Studi kohort prospektif ini dilaksanakan di RSCM Jakarta dengan melibatkan seluruh pasien sirosis dewasa tanpa KSH yang akan menjalankan Puasa Ramadan secara sukarela. Sepanjang Februari 2025 (periode tidak puasa), semua pasien dipantau untuk adanya kejadian hospitalisasi, hipoglikemia, PSCBA, skor Child-Pugh, dan kualitas hidup menggunakan Chronic Liver Disease Questionnaire. Hipoglikemia diobservasi pada subgrup pasien yang terpasang alat Continuous Glucose Monitoring. Semua pasien kembali diobservasi selama Ramadan (Maret 2025) untuk menilai parameter yang sama pada periode puasa. Hasil. Sebanyak 370 pasien sirosis terkumpul, dengan 156 memenuhi kriteria inklusi dan 52 menyepakati pemasangan CGM. Dari jumlah ini, 58 pasien (37,2%) merupakan pasien sirosis dekompensata. Semua pasien menyelesaikan observasi pada periode tidak puasa, namun 14 tidak berhasil menyelesaikan setidaknya 20 hari Puasa Ramadan. Menggunakan prinsip Intention-to-Treat Analysis, hubungan signifikan ditemukan antara Puasa Ramadan dengan hospitalisasi (12,2% vs 3,2%; p=0,003), PSCBA (10,9% vs 1,3%; p < 0,001), dan hipoglikemia (13,5% vs 0%; p= 0,013). Tidak terdapat hubungan antara Puasa Ramadan dengan kategori ChildPugh (14,1% vs 9,0%; p= 0,156) atau kualitas hidup (9,0% vs 6,4%; p=0,395). Kesimpulan. Proporsi hospitalisasi, hipoglikemia, dan PSCBA lebih tinggi pada pasien sirosis hepatis yang berpuasa Ramadan dibandingkan kontrol.
Kata Kunci. Sirosis, Ramadan, hospitalisasi, hipoglikemia, PSCBA, Child-Pugh, kualitas hidup


Introduction. Ramadan Fasting is a compulsory practice observed by millions of Moslems worldwide which is relatively safe for healthy individuals but might pose significant health concerns for those with underlying illnesses. Cirrhosis is the end stage of chronic liver diseases with disturbances in liver. However, data regarding safety of Ramadan Fasting in cirrhosis are still limited. Aim. The aim of this study is to assess the impact of Ramadan Fasting on hospitalization, hypoglycaemia, Upper Gastrointestinal Bleeding (UGIB), deterioration of Child-Pugh score, and the quality-of-life of cirrhosis patients. Method. This prospective cohort study was conducted at Cipto-Mangunkusumo Hospital Jakarta. Adult cirrhosis patients without HCC who would voluntarily fast were enrolled. During February 2025, patients were followed for the non-fasting data of any history of hospitalization, hypoglycaemia, UGIB, Child-Pugh score and quality-of-life using the Chronic Liver Disease Questionnaire. Hypoglycaemia was observed in a subgroup of patients with Continuous Glucose Monitoring device. Patients were then observed during Ramadan (March 2025) for the same outcomes. Result. A total of 370 cirrhosis patients were screened, with 156 met inclusion criteria and 52 underwent CGM. A total of 58 participants (37.2%) had decompensated cirrhosis. All patients completed the non-fasting phase observation, but 14 didn’t complete at least 20 days of Ramadan fasting. Using Intention-to-Treat Analysis, significant associations were noted between Ramadan Fasting and hospitalization (12.2% vs 3.2%; p=0.003), UGIB (10.9% vs 1.3%; p < 0.001), and hypoglycaemia (13.5% vs 0%; p= 0.013). No significant associations were noted between Ramadan Fasting and Child-Pugh category (14.1% vs 9.0%, p= 0.156) or quality-of-life (9.0% vs 6.4%; p=0.395). Conclusion. The proportions of hospitalization, hypoglycaemia, and UGIB are higher in fasting cirrhosis patients compared to non-fasting control.
Keywords. Cirrhosis, Ramadan, hospitalization, hypoglycaemia, UGIB, ChildPugh, quality-of-life.