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Herdiman T. Pohan
Division of Tropical and Infectious Disease, Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia.
Medicine & Pharmacology

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The Role of Lactate Clearance in Severe Septic Patients Survival Hambali, Wirawan; Chen, Lie Khie; Widodo, Djoko; Dewiasty, Esthika; Pohan, Herdiman T.; Suhendro, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
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Introduction. Severe Sepsis is a major health problem that known to results high mortality rate, and still its incidents continue to rise. Lactate clearance represents kinetics alteration of anaerobic metabolism in severe septic patients that makes it to become a potential parameter to evaluate severity of one’s illness and intervention adequacy that received by the patient. However, the relationship between lactate clearance and occurrence of death in severe septic patients is still unknown. Methods. This is a prospective cohort study that conducted in Ciptomangunkusumo Hospital, from March to May 2011. Patients were categorized into high lactate clearance group if there were differences in lactate levels ≥ 10% in which occurred within the first 6 hours of the treatment, and contrary were categorized into low lactate clearance group. Occurrences of death were observed within the first 10 days. Afterward, the data were analyzed by means of survival analysis, Kapplan Meier curve were made, survival rate and median survival rate were determined, statistical test were calculated using log-rank test, and hazard ratios were calculated using Cox regression model test. Analysis of Confounder Variable was also performed using multivariate Cox regression test. Results. The survival rate for high and low lactate clearance group were 60.0% vs. 26.7%, respectively (p=0,004). In low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in high lactate clearance group. The first Interquartile for these two groups was 1 day and 4 days, respectively. The hazard ratio that obtained from the analysis was 2.87 (95% CI, 1.41 - 5.83). On multivariate analysis the presence of septic shock, SOFA score, the use of vasopresor/inotropic, blood transfusion, fluid resuscitation didn’t change the hazard ratio value more than 10%. For that reason, these parameters were not considered as confounder. Conclusions. Patients with high lactate clearance have a better survival rate compared to patients with low lactate clearance, and its relationship is not influenced by confounder.
Faktor-Faktor yang Mempengaruhi Keberhasilan Terapi Antibiotik Empirik pada Pasien Sepsis Berat dan Syok Sepsis di Bangsal Rawat Inap Penyakit Dalam Rumah Sakit Cipto Mangunkusumo Katu, Sudirman; Suwarto, Suhendro; Pohan, Herdiman T.; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 2
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Pendahuluan. Salah satu faktor utama yang berperan pada keberhasilan terapi pada pasien sepsis berat dan syok sepsis adalah penggunaan antibiotika empirik yang adekuat. Penelitian ini ditujukan untuk mengetahui faktor utama apa yang paling berpengaruh terhadap keberhasilan pengobatan antibiotika empirik pada pasien sepsis berat dan syok sepsis. Metode. Studi kohort retrospektif dengan subjek dari data rekam medik (RM) pasien yang telah di rawat inap di ruang ICU dan perawatan Penyakit dalam RSCM Jakarta antara bulan Januari 2011 - Juni 2012. Kriteria inklusi adalah semua data RM pasien dewasa dengan sepsis, sepsis berat dan syok sepsis yang di rawat di ruang rawat inap penyakit dalam/HCU/ICU RSCM. Kriteria eksklusi adalah data tidak lengkap dan SOFA skor >14. Analisis multivariat dilakukan untuk menilai kuat hubungan relative risk (RR) di antara masing-masing variabel determinan yang memiliki kemaknaan statistik sebagai prediktor kesesuaian dosis, jenis, kombinasi dan waktu pemberian antibiotika empirik terhadap akhir perawatan sepsis berat dan syok sepsis dengan ROC (receiver operator curve) dan nilai AUC (area under curve) serta mencari faktor yang paling berperan dari variabel determinan tersebut. Hasil. Waktu pemberian antibiotika empirik lebih dari 6 jam, pemberian jenis antibiotika empirik yang tidak sesuai berdasarkan sumber infeksi, pemberian dosis antibiotika empirik yang tidak sesuai, pemberian antibiotika empirik tunggal, jumlah disfungsi organ yang lebih dari 3 berdasarkan skor SOFA berpengaruh terhadap meningkatnya angka kematian pada pasien sepsis berat dan syok sepsis. Dari faktor tersebut di atas yang paling berpengaruh terhadap meningkatnya angka kematian adalah waktu pemberian antibiotika lebih dari 6 jam, dosis antibiotika yang tidak sesuai, penggunaan antibiotika empirik tunggal dan skor SOFA yang lebih dari 8. Simpulan. Hal yang paling berpengaruh terhadap meningkatnya angka kematian adalah waktu pemberian antibiotika lebih dari 6 jam, dosis antibiotika yang tidak sesuai, penggunaan antibiotika empirik tunggal dan skor SOFA yang lebih dari 8.
Co-Authors Asnath Matondang Djoko Widodo Erni J. Nelwan, Erni J. Esthika Dewiasty, Esthika Hendarwanto Hendarwanto Juferdy Kuniawan, Juferdy Karmel L. Tambunan Katsuya Inada Khie Chen Mirna N. Praptini, Mirna N. Muljono Muljono Murdani Abdullah R. H.H. Nelwan Rika Bur Samsuridjal Djauzi Shigeatsu Endo Sudirman Katu, Sudirman Suhendro Suhendro Suhendro Suwarto, Suhendro Taufiq M. Waly Wirawan Hambali, Wirawan