Association of Hematocrit and Thrombocyte Concentration with Hypoalbuminemia in Patient with Dengue Infection

Hypoalbuminemia is the hallmark of plasma leakage in patients with dengue infection. However, serum albumin measurement is not routinely performed. This study was conducted to determine the role of hematocrit and thrombocyte concentration as a predictor of hypoalbuminemia in dengue infection. This retrospective study was conducted in private hospital in Jakarta from January 2015 until June 2016. Patients older than 17 years old who were infected with dengue were included in this study. Subjects were classified as dengue infection with hypoalbuminemia and without hypoalbuminemia. Mann-Whitney test was performed to analyze the different concentration of hematocrit and thrombocyte in both group. The area under the curve was used to determine the optimal cut-off point of hematocrit and thrombocyte concentration in predicting hypoalbuminemia. Multivariate analysis was used to analyze the association of hematocrit and thrombocyte concentration with the two dengue groups. One hundred and twenty patients with dengue infection were included in this study, in which 50 patients (41.7%) were women and 70 patients (58.3%) were men. Thirty nine patients (32.5%) without hypoalbuminemia and 81 (67.5%) patients had hypoalbuminemia. Hemoconcentration with a cut-off point of ≥9.77% had an accuracy of 67.8% (95% confidence interval (CI), 58.2−77.4), with a sensitivity of 72.8%, and specificity of 46.2% in predicting hypoalbuminemia. Thrombocyte levels with a cutoff point of ≤44×103/μL had an accuracy of 80% (95% CI, 71.7−88.4), with a sensitivity of 70%, and specificity of 74.4% in predicting hypoalbuminemia. Multivariate analysis showed that thrombocyte concentration ≤44×103/μL was a predictor of hypoalbuminemia with an odd ratio (OR) of 6.49 (95% CI, 2.75−15.34). In conclusion, thrombocytopenia in patients with dengue infection is a predictor for hypoalbuminemia

Konsentrasi Prokalsitonin Penderita Bakteremia Gram Negatif pada Usia Lanjut Dibandingkan Bukan Usia Lanjut

  Konsentrasi prokalsitonin yang tinggi dapat digunakan untuk mendiagnosis bakteremia gram negatif. Pada usia lanjut terjadi penurunan sistem imun yang dapat memengaruhi respons tubuh terhadap penyakit infeksi. Penelitian ini dilakukan untuk mengetahui perbedaan konsentrasi prokalsitonin penderita bakteremia gram negatif pada usia lanjut dibandingkan bukan usia lanjut. Penelitian dengan desain retrospektif dilakukan di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo (RSCM) pada bulan Desember 2013-Januari 2018. Penderita dengan bakteremia gram negatif berusia >18 tahun dimasukkan dalam penelitian ini. Penderita dikelompokkan menjadi bukan usia lanjut (<60 tahun) dan usia lanjut (≥60 tahun). Uji chi-square digunakan untuk menganalisis variabel kategorik, sedangkan uji Mann Whitney untuk menganalisis variabel nonparametrik. Penelitian ini melibatkan 247 penderita bakteremia gram negatif, yang terdiri atas 142 (57,5%) perempuan dan 105 (42,5%) laki-laki. Tidak terdapat perbedaan bermakna pada jenis kelamin, darah perifer lengkap, fungsi hati dan jenis mikroorganisme pada kedua kelompok. Tiga jenis mikroorganisme terbanyak adalah Klebsiella pneumoniae, Acinetobacter baumannii dan Escherichia coli. Bakteremia Salmonella spesies hanya pada kelompok bukan usia lanjut. Konsentrasi ureum (p=0,027), kreatinin (p=0,049) lebih tinggi secara bermakna pada kelompok usia lanjut dibandingkan dengan bukan usia lanjut. Konsentrasi prokalsitonin lebih tinggi secara bermakna pada penderita bukan usia lanjut dibandingkan usia lanjut (p=0,005). Penderita bakteremia gram negatif pada usia lanjut mempunyai fungsi ginjal lebih buruk disertai konsentrasi prokalsitonin lebih rendah dibandingkan penderita bukan usia lanjut

Comparison of Survival Prediction with Single versus Combination Use of Microcirculation End Point Resuscitation in Sepsis and Septic Shock

Background: lactate clearance and central venous oxygen saturation (ScvO2) are two methods for determining tissue oxygenation adequacy. There is a controversy regarding method better associates with and predicts sepsis and septic shock patients’ mortality. This study address the association of achieving one or two targets of microcirculatory resuscitation endpoints and early mortality in sepsis and septic shock. Methods: a cohort study was conducted in adult sepsis and septic shock patients in Intensive Care Unit, Cipto Mangunkusumo Hospital, Indonesia. Patients’ resuscitation endpoints data and outcome were observed during the first 120 hours of hospitalization. Cox’s proportional hazard regression analysis was used to analyse the early mortality risk in subject groups achieving lactate clearance target only, ScvO2 target only, both targets, and not achieving any target in 6 hours after onset of resuscitation adjusted for number of organ dysfunction. Results: subjects consisted of 268 patients. There were significant differences in the mortality risk between subjects who achieved both targets with subjects who achieved ScvO2 target only (adjusted hazard ratio [aHR] 13.47; 95% confidence interval [CI] 5.17-35.08) and subjects who not achieve any target (aHR 16.12; 95%CI 7.43-34.95). There were insignificant difference the early mortality risk between subjects who achieved both targets with subjects achieved lactate clearance target only (aHR 2.29; 95%CI 0.83-6.32). Conclusion: in patients with sepsis and septic shock, achievement of lactate clearance and ScvO2 targets associates with similar early mortality risk compared to achievement of lactate clearance target only. However, it associates with lower early mortality risk compared with ScvO2 target only

Parameter Akhir Resusitasi Makrosirkulasi dan Mikrosirkulasi pada Sepsis Berat dan Renjatan Septik

Sepsis berat dan renjatan septik telah menjadi masalah kesehatan yang utama di seluruh dunia. Untuk menekan angka mortalitas dini, upaya resusitasi yang dilakukan pada keadaan sepsis berat dan renjatan septik harus ditujukan pada pencapaian target parameter makrosirkulasi maupun mikrosirkulasi, khususnya yang telah terbukti berhubungan dengan mortalitas dini. Parameter tersebut meliputi tekanan vena sentral, rerata tekanan arteri, produksi urin, saturasi oksigen vena sentral, hematokrit, laktat, bersihan laktat, dan ekses basa standar. Kelebihan dan keterbatasan tiap parameter harus dipahami dengan baik dalam upaya interpretasi yang tepat terhadap hasil pemeriksaan parameter tersebut

The Association between D-dimer Concentration and Laboratory Parameters for Plasma Leakage in Dengue Infection

Introduction. Plasma leakage and activation of the coagulation system are the pathological hallmark of dengue hemorrhagic fever (DHF) that causes an increase in D-dimer concentration due to the degradation of fibrin clots. This study was conducted to determine the association between of D-dimer and laboratory parameters of plasma leakage, namely: thrombocytopenia, hypoalbuminemia, hemoconcentration and concentration of serum glutamic oxaloacetic transaminase (SGOT) in dengue infected patients. Methods. A retrospective study was conducted at private hospitals in Jakarta, from December 2016 to March 2018. Patients >14 years with dengue infection and positive NS-1 were included in this study, and were classified into dengue fever (DF) group or DHF group. The Mann Whitney test was used for non-parametric variables and the Spearman test was used for the correlation for non-normally distributed numeric variables. Results. Seventy-three dengue infected patients included in this study consists of 29 (39.7%) female and 44 (60.3%) male. Total of 43 (58.9%) were classified as DD group, 30 (41.1%) were classified as DHF group. The D-dimer concentration of the DHF group in the fever phase was higher compared to the DD group (p = 0.004). There was a weak correlation in the fever phase between D-dimer concentration and the degree of thrombocytopenia (r = 0.35; p = 0.003) and weak inverse correlation in the fever phase between D-dimer concentration and albumin concentration (r = -0.34; p = 0.049). We found a weak correlation in the critical phase between D-dimer concentration and the degree of thrombocytopenia (r = 0.39; p = 0.034) and the moderate inverse correlation in the critical phase between the D-dimer concentration and albumin concentration (r = -0.43; p = 0.032). Conclusions. D-dimer concentrations in DHF patients in the fever phase are higher compare to DD patients. D-dimer concentration correlates with the degree of thrombocytopenia and hypoalbuminemia

Perbedaan Hasil Pemeriksaan Bioelectric Impedance Analysis antara Status Nutrisi Baik dan Malnutrisi pada Penderita Penyakit Gastrointestinal dan Hati yang Dirawat Inap di RSCM Tahun 2013

Pendahuluan. Bioelectric Impedance Analysis (BIA) mulai banyak digunakan dalam mengevaluasi status nutrisi. Belum ada data penelitian nutrisi di Indonesia yang menggunakan BIA. Penelitian ini dilakukan untuk mengetahui perbedaan rerata hasil pemeriksaan BIA antara status nutrisi baik dan malnutrisi pada penderita penyakit gastrointestinal dan hati yang dirawat inap. Metode. Penelitian potong lintang retrospektif terhadap penderita yang dirawat inap di ruang perawatan interna RSCM periode 1 Juni-31 Desember 2013, untuk mengetahui perbedaan rerata hasil pemeriksaan BIA penderita status nutrisi baik dan malnutrisi pada penyakit gastrointestinal dan hati yang dirawat inap. Hasil. Dari 28 penderita dengan status nutrisi baik, 71,57% laki-laki, dan 21,47% wanita. Dari 28 penderita malnutrisi, 53,60% laki-laki, dan 46,40% wanita. Rerata hasil pemeriksaan BIA antara penderita nutrisi baik dan malnutrisi adalah: lean body mass, 49,5 ± 8,59 v s39,68 ± 6,28kg, p<0,001; body cell mass, 32,19 (20,49-40,95) vs 25,23 (17,83-31,64) kg, p=0,003; total body water, 35,69±1,17 vs 28,58±0,85 kg, p<0,001; dan phase angle 6,18◦(3,73-10,11)◦ vs 3,46◦ (0,40-6,51)◦; , p<0,001. Simpulan. Pada penderita penyakit gastrointestinal dan hati yang dirawat inap dengan status nutrisi baik, memiliki nilai body mass, body cell mass,total body water dan phase angle hasil pemeriksaan BIA yang lebih tinggi dibandingkan dengan penderita malnutrisi

Diagnostic and antibiotic use practices among COVID-19 and non-COVID-19 patients in the Indonesian National Referral Hospital

Background: Little is known about diagnostic and antibiotic use practices in low and middle-income countries (LMICs) before and during COVID-19 pandemic. This information is crucial for monitoring and evaluation of diagnostic and antimicrobial stewardships in healthcare facilities. Methods: We linked and analyzed routine databases of hospital admission, microbiology laboratory and drug dispensing of Indonesian National Referral Hospital from 2019 to 2020. Patients were classified as COVID-19 cases if their SARS-CoV-2 RT-PCR result were positive. Blood culture (BC) practices and time to discontinuation of parenteral antibiotics among inpatients who received a parenteral antibiotic for at least four consecutive days were used to assess diagnostic and antibiotic use practices, respectively. Fine and Grey subdistribution hazard model was used. Results: Of 1,311 COVID-19 and 58,917 non-COVID-19 inpatients, 333 (25.4%) and 18,837 (32.0%) received a parenteral antibiotic for at least four consecutive days. Proportion of patients having BC taken within ±1 calendar day of parenteral antibiotics being started was higher in COVID-19 than in non-COVID-19 patients (21.0% [70/333] vs. 18.7% [3,529/18,837]; p<0.001). Cumulative incidence of having a BC taken within 28 days was higher in COVID-19 than in non-COVID-19 patients (44.7% [149/333] vs. 33.2% [6,254/18,837]; adjusted subdistribution-hazard ratio [aSHR] 1.71, 95% confidence interval [CI] 1.47–1.99, p<0.001). The median time to discontinuation of parenteral antibiotics was longer in COVID-19 than in non-COVID-19 patients (13 days vs. 8 days; aSHR 0.73, 95%Cl 0.65–0.83, p<0.001). Conclusions: Routine electronic data could be used to inform diagnostic and antibiotic use practices in LMICs. In Indonesia, the proportion of timely blood culture is low in both COVID-19 and non-COVID-19 patients, and duration of parenteral antibiotics is longer in COVID-19 patients. Improving diagnostic and antimicrobial stewardship is critically needed

Association of Hematocrit and Thrombocyte Concentration with Hypoalbuminemia in Patient with Dengue Infection

Hypoalbuminemia is the hallmark of plasma leakage in patients with dengue infection. However, serum albumin measurement is not routinely performed. This study was conducted to determine the role of hematocrit and thrombocyte concentration as a predictor of hypoalbuminemia in dengue infection. This retrospective study was conducted in private hospital in Jakarta from January 2015 until June 2016. Patients older than 17 years old who were infected with dengue were included in this study. Subjects were classified as dengue infection with hypoalbuminemia and without hypoalbuminemia. Mann-Whitney test was performed to analyze the different concentration of hematocrit and thrombocyte in both group. The area under the curve was used to determine the optimal cut-off point of hematocrit and thrombocyte concentration in predicting hypoalbuminemia. Multivariate analysis was used to analyze the association of hematocrit and thrombocyte concentration with the two dengue groups. One hundred and twenty patients with dengue infection were included in this study, in which 50 patients (41.7%) were women and 70 patients (58.3%) were men. Thirty nine patients (32.5%) without hypoalbuminemia and 81 (67.5%) patients had hypoalbuminemia. Hemoconcentration with a cut-off point of &ge;9.77% had an accuracy of 67.8% (95% confidence interval (CI), 58.2&minus;77.4), with a sensitivity of 72.8%, and specificity of 46.2% in predicting hypoalbuminemia. Thrombocyte levels with a cutoff point of &le;44&times;103/&mu;L had an accuracy of 80% (95% CI, 71.7&minus;88.4), with a sensitivity of 70%, and specificity of 74.4% in predicting hypoalbuminemia. Multivariate analysis showed that thrombocyte concentration &le;44&times;103/&mu;L was a predictor of hypoalbuminemia with an odd ratio (OR) of 6.49 (95% CI, 2.75&minus;15.34). In conclusion, thrombocytopenia in patients with dengue infection is a predictor for hypoalbuminemia

Procalcitonin Levels in Elderly Compare with Non Elderly Patients with Gram Negative Bacteremia

&nbsp;High level of procalcitonin can be used to diagnose gram negative bacteremia. In elderly, there is a decline in the immune system that can affect the body&rsquo;s response to infection. This study was conducted to investigate difference of procalcitonin levels between elderly and non-elderly patients. Retrospective study was conducted at Dr. Cipto Mangunkusumo General Hospital (RSCM) from December 2013 to January 2018. Patients with gram negative bacteremia age of &gt;18 years were included in this study. Patients were categorized into two groups: non-elderly (&lt;60 years) and elderly patients (&ge;60 years). Chi-Square test is used to analyze categorical variables, Mann Whitney test is used to analyze nonparametric variables. The study enrolled 247 gram negative bacteremia patients, consisting of 142 (57.5%) women and 105 (42.5%) men. There were no significant differences in sex, complete blood count, liver function test and microorganisms in both groups. The three most common of microorganisms were Klebsiella pneumoniae, Acinetobacter baumannii and Escherichia coli. Bacteremia Salmonella species were found only in non-elderly group. Concentrations of ureum (p=0.027), creatinine (p=0.049) were significantly higher in the elderly group than in the non-elderly group. Procalcitonin concentrations were significantly higher in the non-elderly group compared with the elderly group (p=0.005). Elderly patients with gram negative bacteremia have decline in kidney function and lower procalcitonin levels compared with non-elderly patients.&nbsp