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All Journal Jurnal Neuroanestesi Indonesia Folia Medica Indonesiana
Pranggono, Emmy Hermiyanti
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Neuroscience Public Health

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Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung Muhafidzah, Novi Fatni; Mansur, Sobaryati; Pranggono, Emmy Hermiyanti; Wibisono, Yusuf; Juli, Cep; Gamayani, Uni; Gunadharma, Suryani; Cahyani, Aih
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (88.417 KB) | DOI: 10.24244/jni.v10i3.269

Abstract

Latar Belakang dan Tujuan: Pneumonia adalah komplikasi non neurologis paling sering pada stroke akut (22%) yang meningkatkan angka kematian, lama rawat inap dan biaya perawatan. Perlu dilakukan identifikasi faktor-faktor risiko terjadinya pneumonia salah satunya neurogenic pulmonary edema (NPE) agar dapat dilakukan pencegahan dan intervensi dini. Tujuan penelitian ini untuk mengetahui gambaran faktor-faktor risiko terjadinya pneumonia (termasuk NPE) pada pasien stroke akut di RSUP Dr Hasan Sadikin Bandung.Subjek dan Metode: Deskriptif observasional prospektif, metode consecutive sampling, periode September - Oktober 2019, mengumpulkan data primer pasien stroke akut yaitu derajat keparahan stroke, tipe, lokasi dan ukuran lesi stroke, terapi dan tindakan selama perawatan, komorbiditas (termasuk NPE). Pneumonia ditegakkan berdasarkan kriteria Centers for Disease Control and Prevention (CDC), NPE berdasarkan kriteria Davison.Hasil: 30 orang mengalami pneumonia pada pasien stroke akut (28,30%). Kejadian pneumonia, lebih sering ditemukan pada pemakaian Nasogastric Tube (NGT) (90%), disfagia (64,71%), lokasi infark Sirkulasi Anterior Total (SAT) (61,54%), ukuran infark besar (61,54%), GCS 9-12 (50%) dan NIHSS 16-20 (50%). NPE didapatkan pada 6,60% pasien stroke akut, 54,17% diantaranya menjadi pneumonia.Simpulan: Kejadian pneumonia pada pasien stroke akut lebih banyak ditemukan pada pemakaian NGT, disfagia, stroke infark lokasi SAT, ukuran infark besar, GCS lebih rendah dan derajat keparahan stroke lebih berat.Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital BandungAbstractBackground and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung.Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria.Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia.Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.
The Combination of NLCR and Enhances the Sepsis-3 Strategy Pranggono, Emmy Hermiyanti; Aini, Endah Nurul; Sumardi, Uun; Hartranti, Yovita; Sugianli, Adhi Kristianto
Folia Medica Indonesiana Vol. 58, No. 2
Publisher : Folia Medica Indonesiana

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Abstract

Highlights: • The combination of NLCR and PLR will improve the ability to distinguish infection rather than noninfection in the emergency setting for early antibiotic prescribing as well as the sepsis-3 strategy. • The diagnostic value of PLR in adult bacterial sepsis patients has never been studied. Abstract: According to Sepsis-3, antibiotics should be administered in the first hour of diagnosis of sepsis. Still, there is difficulty in differentiating between bacterial and nonbacterial infections and a lack of a rapid diagnostic tool to distinguish them. This study evaluated the diagnostic value of NLCR and PLR in suspected bacterial sepsis. The diagnostic value of PLR in adult bacterial sepsis patients has never been studied. This study was a retrospective study from the medical record of Dr. Hasan Sadikin Hospital Bandung. All patients at age ≥ 18 years diagnosed with sepsis based on ICD-10 code and qSOFA ≥ 2 were included. We calculated sensitivity, specificity, NPV, PPV, positive LR, and AUC of NLCR and PLR. There were 177 patients included in this study. The sensitivity of NLCR was 69.5%, specificity was 34.7%, NPV was 56.9%, PPV was 47.9%, and LR+ was 1.06, while the sensitivity of PLR was 62.2%, specificity was 38.9%, NPV was 54.4%, PPV was 46.8%, and LR+ was 1.02. We obtained cut-off values for NLCR 11.06, AUC 0.500, PLR 222.41, and AUC 0.497. The low value of AUC NLCR and PLR was due to prior antibiotic use. The combination of NLCR and PLR had higher positive LR (1.16) and specificity (54.7%), and also, according to NLCR, we had the highest sensitivity (69.5%). The combination of NLCR and PLR enhances the sepsis-3 strategy because it can be used as screening tools for bacterial sepsis, and antibiotics can also be administered in the first hour of managing sepsis, particularly in the emergency ward.
Co-Authors Adhi Kristianto Sugianli Aih Cahyani Aini, Endah Nurul Cep Juli Gunadharma, Suryani Hartranti, Yovita Mansur, Sobaryati Muhafidzah, Novi Fatni Uni Gamayani, Uni Uun Sumardi, Uun Yusuf Wibisono