Tesis

Proporsi Derajat Keparahan Berdasarkan Skor Bronchiectasis Severity Index (BSI) dan Nilai Faal Paru Pasien Bronkiektasis pada Bekas Tuberkulosis di Rumah Sakit Persahabatan = Proportion of Severity Levels Based on the Bronchiectasis Severity Index (BSI) Score and Pulmonary Function Values in Post-Tuberculosis Bronchiectasis Patients at Persahabatan Hospital.

Latar Belakang: Bronkiektasis merupakan komplikasi jangka panjang dari infeksi tuberkulosis paru yang menyebabkan dilatasi bronkus permanen dan gangguan fungsi paru. Indonesia sebagai negara dengan beban tuberkulosis (TB) tinggi memiliki potensi besar terhadap meningkatnya kasus bronkiektasis bekas TB. Namun, data mengenai derajat keparahan berdasarkan skor Bronchiectasis Severity Index (BSI) dan nilai faal paru pada bronkiektasis bekas TB masih terbatas di Indonesia, khususnya di RS Persahabatan. Metode: Penelitian ini merupakan desain potong lintang yang dilakukan di poli paru RS Persahabatan pada September-Desember 2024. Sebanyak 74 pasien bronkiektasis yang telah menyelesaikan pengobatan tuberkulosis dan memenuhi kriteria inklusi serta eksklusi. Data dikumpulkan melalui anamnesis, pemeriksaan fisis, pemeriksaan spirometri, Diffusing lung capacity for carbon monoxide (DLCO), High-Resolution Computed Tomography (HRCT) toraks dan biakan sputum mikroorganisme. Derajat keparahan bronkiektasis ditentukan menggunakan skor BSI. Analisis dilakukan secara deskriptif, bivariat dan multivariat. Hasil: Proporsi terbanyak derajat keparahan bronkiektasis adalah sedang (36.5%), diikuti ringan (32.4%) dan berat (31.1%), meskipun secara persentase relatif seimbang. Gangguan ventilasi paru ditemukan pada 93.2% pasien, dengan pola campuran obstruksi dan restriksi sebagai yang tersering (50%). Gangguan kapasitas difusi ditemukan pada 75.7% pasien, sebagian besar dengan derajat sedang. Biakan sputum mikroorganisme menunjukkan pertumbuhan pada 48.6% subjek, terutama Pseudomonas aeruginosa dan Klebsiella pneumoniae. Analisis bivariat menunjukkan hubungan bermakna antara jenis kelamin dengan derajat keparahan bronkiektasis bekas TB berdasarkan skor BSI (p=0.045), namun analisis multivariat tidak menunjukkan hubungan (p > 0.05). Selain itu, terdapat hubungan antara jenis kelamin (p=0.04) dan riwayat merokok (p=0.046) dengan derajat obstruksi, serta antara indeks massa tubuh (IMT) dengan gangguan restriksi (p=0.002) dan difusi (p=0.04). Kesimpulan: Proporsi derajat keparahan bronkiektasis bekas TB berdasarkan skor BSI di RS Persahabatan relatif seimbang, dengan urutan derajat sedang, ringan dan berat serta menunjukkan gangguan faal paru yang bermakna.
Kata kunci: bekas tuberkulosis, bronkiektasis, faal paru., skor BSI


Background: Bronchiectasis is a long-term complication of pulmonary tuberculosis infection, leading to permanent bronchial dilatation and impaired lung function. As a country with a high tuberculosis burden, Indonesia has a significant potential for an increased incidence of post-tuberculosis bronchiectasis. However, data on the severity of bronchiectasis based on the Bronchiectasis Severity Index (BSI) and pulmonary function in post-TB patients remain limited in Indonesia, particularly at Persahabatan General Hospital. Methods: This study was a cross-sectional design conducted at the Pulmonology Clinic of Persahabatan Hospital from September to December 2024. A total of 74 bronchiectasis patients who had completed tuberculosis treatment and met the inclusion and exclusion criteria were enrolled. Data were collected through anamnesis, physical examination, spirometry, diffusing lung capacity for carbon monoxide (DLCO), High-Resolution Computed Tomography (HRCT) of the thorax, and sputum culture for microorganisms. The severity of bronchiectasis was assessed using the Bronchiectasis Severity Index (BSI). Data analysis was performed using descriptive, bivariate, and multivariate methods. Results: The largest proportion of bronchiectasis severity was moderate (36.5%), followed by mild (32.4%) and severe (31.1%), although the percentages were relatively balanced. Pulmonary ventilation impairment was found in 93.2% of patients, most commonly with a mixed obstructive and restrictive pattern (50%). Diffusion capacity impairment was observed in 75.7% of patients, predominantly at a moderate level. Sputum cultures revealed microbial growth in 48.6% of subjects, mainly Pseudomonas aeruginosa and Klebsiella pneumoniae. Bivariate analysis showed a significant association between sex and bronchiectasis severity post-tuberculosis based on the BSI score (p=0.045), while multivariate analysis did not show a significant association (p > 0.05). Additionally, significant associations were found between sex (p=0.04) and smoking history (p=0.046) with the degree of obstruction, as well as between body mass index (BMI) and restrictive (p=0.002) and diffusion (p=0.04) impairments. Conclusion: The distribution of bronchiectasis severity post-tuberculosis based on the BSI score at Persahabatan Hospital was relatively balanced, with moderate severity being the most common, followed by mild and severe, and was associated with significant pulmonary function impairment.
Keywords: bronchiectasis, BSI score, lung function, post-tuberculosis