Penggunaan Delta C-Reactive Protein dan SOFA Score Sebagai Prediktor Kematian Pasien Sepsis

Penelitian ini berfokus pada penggunaan skor DELTA CRP dan SOFA dalam memprediksi prognosis pada pasien ICU. Penelitian observasional kohort digunakan sebagai desain. Penelitian dilakukan di RSUP Dr. Sardjito periode Februari–Juli 2019. Sampel dipilih menggunakan teknik pengambilan sampel berturut-turut. Para peneliti mengumpulkan 32 responden dengan sepsis dan syok sepsis yang dirawat di ICU berdasarkan kondisi ini. Skor area under curve (AUC) delta CRP menunjukkan >0,7 (0,780;CI 95%: 0,58–0,97) dengan cut-off 3 (sensitivitas=53,8%, spesifisitas=91%), menyiratkan bahwa CRP delta dapat menunjukkan keadaan pasien sepsis dan syok septik yang memburuk, tetapi kurang sensitif untuk memprediksi kematian. Sementara itu, skor AUC of SOFA >0,7 (0,787; 95% CI: 0,58–0,98) pada hari ke-0 dengan cut-off 8,5 (sensitivitas=76,9%, spesifisitas=81,8%), dan 0,836 (CI 95%: 0,67–0,99) pada hari ke-2 dengan cut-off 6 (sensitivitas=84,6%, spesifisitas=72,7%). Hal ini menunjukkan bahwa skor SOFA dapat memprediksi tingkat kematian prognostik pada pasien yang didiagnosis sepsis dan syok septik di ICU. Baik skor delta CRP dan SOFA memiliki nilai AUC lebih besar dari 0,7, tetapi hanya delta CRP yang memiliki sensitivitas rendah sebagai prognostik kematian.Penelitian ini berfokus pada penggunaan skor DELTA CRP dan SOFA dalam memprediksi prognosis pada pasien ICU. Penelitian observasional kohort digunakan sebagai desain. Sampel dipilih menggunakan teknik pengambilan sampel berturut-turut. Para peneliti mengumpulkan 32 responden dengan sepsis dan syok septik yang dirawat di ICU berdasarkan kondisi ini. Skor AUC delta CRP menunjukkan > 0,7 (0,780) (CI 95%: 0,58-0,97) dengan cut off 3 (sensitivitas= 53,8%, spesifisitas= 91%), menyiratkan bahwa CRP delta dapat menunjukkan keadaan pasien sepsis dan syok septik yang memburuk, tetapi kurang sensitif untuk memprediksi kematian. Sementara itu, skor AUC of SOFA > 0,7 (0,787) (95% CI: 0,58-0,98) pada hari ke-0 dengan cut off 8,5 (sensitivitas=76,9%, spesifisitas= 81,8%), dan 0,836 (CI 95%: 0,67-0,99) pada hari ke-2 dengan cut off 6 (sensitivity=84,6%, spesifisitas=72,7%). Hal ini menunjukkan bahwa skor SOFA dapat memprediksi tingkat kematian prognostik pada pasien yang didiagnosis sepsis dan syok septik di ICU. Baik skor delta CRP dan SOFA memiliki nilai AUC lebih besar dari 0,7, tetapi hanya delta CRP yang memiliki sensitivitas rendah sebagai prognostik kematian.

Predictive accuracy of the APACHE IV scores on mortality and prolonged stay in the intensive care unit of Dr Sardjito Hospital

Introduction: Acute Physiology and Chronic Health Evaluation (APACHE) is the most widely used scoring system in the intensive care unit (ICU). The APACHE IV showed a good level of discrimination and calibration on predicting mortality and prolonged stay (PLOS) in some countries. This study is aimed to determine the predictive accuracy of the APACHE IV score on mortality and PLOS at the ICU of Dr Sardjito General Hospital (SGH). Materials and Methods: This study involved all adult patients at the ICU of SGH during 2018 that met the inclusion criteria. The discrimination of APACHE IV scores on mortality and PLOS was analyzed with Receiver Operating Characteristic Curve, and the optimal cut-off point was assessed with the Youden Index. The calibration of the APACHE IV score was assessed with the Hosmer-Lemeshow goodness-of-fit test, and a p-value of >0.05 is considered a good calibration. Results: From the data of 742 patients, only 476 were included. The overall mortality and PLOS rate was 25.4 and 15.1 , respectively. The mean of APACHE IV score was 66.27±27.7. The area under the receiving curve with a 95 confidence interval for mortality is 0.99(0.97-1.00) and for PLOS was 0.68(0.62-0.74). The optimal cut-off point of the APACHE IV score for mortality was 78.9, with a sensitivity of 0.96 and a specificity of 0.96. The optimal cut-off point of the APACHE IV score for PLOS is 62.5 (in the 6th percentiles), with a sensitivity of 0.72 and a specificity of 0.61. The calibration is good for mortality prediction (p=0.98) but is poor for PLOS prediction (p=0.01). Conclusion: APACHE IV score has excellent accuracy for mortality prediction but is poor for PLOS prediction in patients in the ICU of SGH. © 2022, Malaysian Medical Association. All rights reserved

A simple diagnostic scoring system for COVID-19 screening

Background: The COVID‐19 pandemic has prompted the world to make various efforts to control its spread by finding ways to diagnose COVID‐19 quickly and accurately. Early identification of COVID‐19 infection is essential, especially in hospitals with limited resources. We aimed to generate two scores based upon clinical and laboratory findings in patients screen for COVID-19 infection. Methodology: This study used a retrospective cohort design that involved 705 adults (≥ 18 y old) admitted in Dr. Sardjito Hospital and Dr. S. Hardjolukito Hospital. The patients' data collected included demographic characteristics, anamnesis on signs and symptoms, history of contact with COVID-19 patients, history of staying or visiting an endemic area, comorbidities, and laboratory and radiologic indicators. All variables with a P < 0.25 on the bivariate test were included in a univariable logistic regression. If the P < 0.05, the variable was included in the multivariable logistic regression with a P < 0.05 considered significant. Receiver Operating Characteristic (ROC) producing an area under the curve (AUC) with 95% confidence intervals (CIs) was used to assess discrimination power. Results: Two scores were generated; score in Model 1 consisted of clinical signs, basic laboratory indicators, and chest X-ray, and in Model 2 consisted of clinical signs, chest X-ray, basic and advanced laboratory indicators, including C-reactive protein (CRP), lactate dehydrogenase (LDH), albumin, and D-dimer. The ROC score of Model 1 was 0.801 (0.764−0. 838), which is considered good discrimination, and of Model 2 had excellent discrimination with a ROC of 0.858 (0.826−0. 891); the differences in the ROC of the two models was statistically significant (P = 0.03). The score of Model 1 more than 5 had 85% sensitivity and 61% specificity of positive COVID-19. A score of Model 2 more than 4 had 83% sensitivity and 72% specificity for diagnosing positive COVID-19. Conclusions: A simple score consisting of clinical symptoms and signs, and simple laboratory indicators can be used to screen for COVID-19 infection