Prediktor Mortalitas Pasien dengan Ventilator-Associated Pneumonia di RS Cipto Mangunkusumo

AbstrakVentilator-associated pneumonia (VAP) merupakan infeksi yang sering terjadi di intensive care unit (ICU) dan memiliki angka mortalitas yang tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Mengetahui faktor-faktor prediktor mortalitas pasien VAP di RSCM. Penelitian ini merupakan studi kohor retrospektif pada pasien di ICU RSCM yang didiagnosis VAP selama tahun 2003–2012. Data klinis dan laboratorium beserta status luaran selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, infeksi kuman risiko tinggi, komorbiditas, renjatan sepsis, kultur darah,prokalsitonin, ketepatan antibiotik empiris, acute lung injury, skor APACHE-II, dan hipoalbuminemia. Variabel diidentifikasi dengan analisis multivariat regresi logistik. Dari 201 pasien didapatkan mortalitas selama perawatan 57,2%. Kelompok usia, komorbiditas, renjatan sepsis, prokalsitonin, ketepatan antibiotik empiris, dan skor APACHE II merupakan variabel yang berpengaruh terhadap mortalitas pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah antibiotik empiris yang tidak tepat (OR 4,70; IK 95% 2,25 sampai 9,82; p<0,001), prokalsitonin > 1,1 ng/mL (OR 4,09; IK 95% 1,45 sampai 11,54; p=0,01), usia ≥ 60 tahun (OR 3,71; IK 95% 1,35 sampai 10,20;p=0,011), dan renjatan sepsis (OR 3,53; IK 95% 1,68 sampai 7,38; p=0,001). Disimpulkan bahwa pemberian antibiotik empiris yang tidak tepat, prokalsitonin yang tinggi, usia 60 tahun atau lebih, dan renjatan sepsis merupakan prediktor independen mortalitas pada pasien VAP.Kata Kunci: prediktor mortalitas, ventilator-associated pneumoniaAbstractVentilator-associated pneumonia (VAP) is a frequently found infection with high mortality rates in intensive care unit (ICU). The prediction of outcome is important in decision-making process. To determine predictors of mortality in patients with VAP in Cipto Mangunkusumo Hospital (CMH), we performed a retrospective cohort study on patients admitted to the ICU who developed VAP between 2003–2012. Clinical and laboratory data along with outcome status were obtained for analysis. We compared age, presence of high-risk pathogens infection, presence of comorbidity, septic shock status, blood culture result, procalcitonin, appropriateness of initial antibiotics therapy, presence of acute lung injury, APACHE II score, and serum albumin between the two-outcomegroups. Logistic regression analysis was performed to identify independent predictors of mortality. A total of 201 patients were evaluated in this study. In-hospital mortality rate was 57.2%. Age, comorbidity, septic shock status, procalcitonin, appropriateness of initial antibiotics therapy, and APACHE II score were significantly different between outcome groups. The independent predictorsof mortality in multivariate logistic regression analysis were inappropriate initial antibiotics therapy (OR: 4.70; 95% CI 2.25 to 9.82; p < 0.001), procalcitonin > 1.1 ng/mL (OR: 4.09; 95% CI 1.45 to 11.54; p = 0.01), age ≥ 60 years old (OR: 3.71; 95% CI 1.35 to 10.20; p = 0.011), and presence of septic shock (OR: 3.53; 95% CI 1.68 to 7.38; p = 0.001). It was concluded that inappropriate initial antibiotic therapy, high serum procalcitonin, age 60 years or older, and septic shock were independent predictors of mortality in patients with VAP. Keywords: predictor of mortality, ventilator-associated pneumonia