Skripsi

Faktor Prognostik pada Chronic Limb Threatening Ischemia terhadap Angka Amputasi Mayor di RSCM dan RSUI Tahun 2020-2024 = Prognostic Factors of Chronic Limb-Threatening Ischemia Associated with Major Amputation Rates in RSCM and RSUI 2020-2024.

Latar Belakang Chronic Limb-Threatening Ischemia (CLTI) merupakan stadium terberat dari penyakit arteri perifer yang ditandai oleh iskemia ekstremitas bawah, nyeri istirahat, ulkus, atau gangren. CLTI memiliki risiko amputasi mayor yang tinggi dan menjadi tantangan besar dalam tata laksana penyakit vaskular. Faktor prognostik seperti inflamasi sistemik, derajat iskemia lokal, serta parameter metabolik diduga berperan penting dalam menentukan luaran klinis, namun data komprehensif di Indonesia masih terbatas. Metode Penelitian ini menggunakan desain retrospektif observasional dengan analisis data rekam medis pasien CLTI di RS Cipto Mangunkusumo (RSCM) dan RS Universitas Indonesia (RSUI) periode 2019–2024. Sebanyak 69 pasien yang memenuhi kriteria inklusi dianalisis. Variabel yang diteliti meliputi usia, jenis kelamin, GDS, eGFR, LDL, BMI, CRP, leukosit, Hb, hematokrit, NLR, limfosit, neutrofil, prokalsitonin, durasi rawat inap, skor Rutherford, skor WIfI, letak stenosis arteri, dan keberhasilan revaskularisasi. Analisis bivariat dan multivariat dilakukan menggunakan uji Chi-Square, Mann–Whitney, dan regresi logistik. Hasil Sebanyak 32 pasien (46,4%) mengalami amputasi mayor, menunjukkan tingginya proporsi pasien yang datang pada stadium lanjut. Pada analisis bivariat, beberapa variabel menunjukkan hubungan bermakna, termasuk jenis kelamin, leukosit, neutrofil, durasi rawat inap, skor Rutherford, dan skor WIfI. Namun, pada analisis multivariat, hanya jenis kelamin yang tetap signifikan sebagai faktor prognostik independen (p = 0,011; Adjusted OR = 6,080; 95% CI: 1,523–24,272). Pasien laki-laki memiliki risiko sekitar enam kali lebih tinggi mengalami amputasi mayor dibandingkan perempuan. Variabel lain seperti skor WIfI, LN_NLR, dan durasi rawat inap menunjukkan kecenderungan klinis namun tidak signifikan secara statistik. Kesimpulan Jenis kelamin merupakan satu-satunya faktor prognostik independen terhadap kejadian amputasi mayor pada pasien CLTI di RSCM dan RSUI. Faktor inflamasi, metabolik, dan keparahan ekstremitas tetap relevan secara fisiopatologis, namun tidak terbukti signifikan pada analisis multivariat. Penelitian dengan sampel lebih besar diperlukan untuk memperkuat bukti terkait kontribusi faktor-faktor tersebut dalam memprediksi amputasi mayor pada populasi CLTI di Indonesia.
Kata Kunci: Chronic Limb-Threatening Ischemia, amputasi mayor, faktor prognostik, jenis kelamin, Indonesia


Introduction Chronic Limb-Threatening Ischemia (CLTI) represents the most advanced stage of peripheral arterial disease, characterized by rest pain, ischemic ulcers, or gangrene in the lower extremities. CLTI carries a high risk of major amputation and poses a major challenge in vascular management. Systemic inflammation, local ischemic severity, and metabolic parameters are suspected to play important roles in determining clinical outcomes; however, comprehensive data in Indonesia remain limited. Method This retrospective observational study analyzed medical records of CLTI patients treated at Cipto Mangunkusumo Hospital (RSCM) and Universitas Indonesia Hospital (RSUI) between 2019 and 2024. A total of 69 patients who met the inclusion criteria were included. The evaluated variables comprised age, sex, random blood glucose (RBG), estimated glomerular filtration rate (eGFR), LDL, BMI, CRP, leukocyte count, hemoglobin, hematocrit, neutrophil-to-lymphocyte ratio (NLR), lymphocyte percentage, neutrophil percentage, procalcitonin, length of hospital stay, Rutherford score, WIfI score, arterial stenosis location, and revascularization success. Bivariate and multivariate analyses were performed using Chi-square, Mann–Whitney, and binary logistic regression tests. Results A total of 32 patients (46.4%) underwent major amputation, reflecting the high proportion of individuals presenting at an advanced stage of disease. In the bivariate analysis, several variables demonstrated significant associations, including sex, leukocyte count, neutrophil count, length of hospital stay, Rutherford score, and WIfI score. However, in the multivariate logistic regression, sex remained the only statistically significant independent prognostic factor (p = 0.011; Adjusted OR = 6.080; 95% CI: 1 .523–24.272). Male patients had approximately six times higher risk of undergoing major amputation compared to female patients. Other variables such as WIfI score, LN_NLR, and length of hospital stay showed clinical tendencies but did not reach statistical significance. Conclusion Sex was identified as the only independent prognostic factor associated with major amputation among patients with CLTI at RSCM and RSUI. Although inflammatory, metabolic, and limb severity factors remain physiopathologically relevant, they did not demonstrate statistical significance in the multivariate analysis. Future studies with larger sample sizes are needed to further clarify the contribution of these factors to major amputation outcomes in the Indonesian CLTI population.
Keywords: Chronic Limb-Threatening Ischemia, major amputation, prognostic factors, sex, Indonesia