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All Journal Medicina E-Jurnal Medika Udayana Jurnal Anestesiologi Indonesia Bali Journal of Anesthesiology Medicinus : Jurnal Kedokteran Bioscientia Medicina : Journal of Biomedicine and Translational Research PREPOTIF : Jurnal Kesehatan Masyarakat Neurologico Spinale Medico Chirurgico JOURNAL LA MEDIHEALTICO Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
Putu Pramana Suarjaya
Faculty Of Medicine Anesthesiology & Therapy Intensif Universitas Udayana Denpasar
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Physics Public Health Veterinary Other

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Journal : Medicina

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Osmolalitas plasma sebagai alternatif acute physiologic and chronic health evaluation II untuk memprediksi mortalitas pada pasien kritis yang dirawat di Intensive Care Unit RSUP Sanglah Wardani, Ni Putu; Wiryana, Made; Suarjaya, Putu Pramana
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

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Abstract

Prediksi mortalitas bersifat esensial pada manajemen perawatan intensif. Acute Physiologic and Chronic Health Evaluation II merupakan sistem skor kompleks yang umum digunakan di Intensive Care Unit (ICU), sedangkan osmolalitas plasma merupakan salah satu sistem skor parameter tunggal yang diketahui dapat menjadi alternatif prediktor mortalitas di ICU. Tujuan penelitian untuk mengetahui besar nilai area undercurve (AUC), sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif dari kedua prediktor dan mengetahui adanya perbedaan bermakna dari nilai AUC kedua prediktor tersebut. Penelitian merupakan uji diagnostik metode cross sectional yang melibatkan 134 subjek. Uji diagnostik menggunakan kurva ROC dan tabel 2x2. Perhitungan data didapatkan nilai AUC osmolalitas plasma sebesar 75,9% (IK95% 67,7 sampai 84,3%), dengan cut off point 297 mOsm/kg, sensitifitas 70,0%, spesifisitas 79,7%. Tabel 2x2 menghasilkan NDP sebesar 79,0% (IK95% 66,8 sampai 88,3%), NDN 70,8% (IK95% 58,9 sampai 81%). Nilai AUC APACHE II sebesar 83,4% (IK95% 76,5 sampai 90,3%) dengan cut off point sebesar 24, sensitifitas 72,9%, spesifisitas 81,3%. Tabel 2x2 menghasilkan NDP 81,0% (IK95% 69,1 sampai 89,8%), NDN 73,2% (IK95% 61,4 sampai 83,1%). Analisis ROC didapatkan nilai P=0,19. Nilai AUC osmolalitas plasma tergolong level sedang (>70-80%), APACHE II tergolong level baik (>80-90%). Analisis ROC dengan P>0,05 menyatakan tidak terdapat perbedaan bermakna antara kurva ROC kedua prediktor. Sekalipun osmolalitas plasma memiliki nilai diagnostik sedang, dibandingkan APACHE II dengan nilai diagnostik baik tetapi perbedaan nilai tersebut tidak bermakna sehingga osmolalitas plasma dapat digunakan sebagai alternatif APACHE II untuk prediktor mortalitas di ICU. Prediction of in-hospital mortality is essential for management of intensive care. Complex scoring system commonly used is APACHE II, meanwhile plasma osmolality is a single parameter scoring system that has known to be an alternative for mortality predictors in the Intensive Care Unit (ICU). The objective of this study was to determine the area undercurve (AUC) value, sensitivity, specificity, positive predictive value, negative predictive value for both predictors and to determine significant differences in AUC values in both scoring system. This was a diagnostic test with cross-sectional method that included 134 subjects. Diagnostic test using ROC curves and 2x2 tables. Result of plasma osmolality with AUC 75.9% (95%CI 67.7 to 84.3%). Cut off point was 297 mOsm/kg, sensitivity was 70.0%, and specificity was 79.7%. Two point two table with PPV 79.0% (95%CI 66.8 to 88.3%) and NPV 70.8% (95%CI 58.9 to 81%). The AUC for APACHE II was 83.4% (95%CI: 76.5 to 90.3%). Cut off point was 24, sensitivity was 72.9%, and specificity was 81.3%. Two point two table with PPV 81.0% (95%CI 69.1 to 89.8%) and NPV 73.2% (95%CI 61.4 to 83.1%). ROC analysis with P value=0.19. AUC values of plasma osmolality was at moderate level (>70 to 80%), APACHE II at good level (>80 to 90%). ROC analysis with P>0.05 states there was no significant difference between the ROC curves in both predictors. Although plasma osmolality has moderate diagnostic value, compared with APACHE II, with a good diagnostic value but the value differences was unsignificant thus plasma osmolality can be used as an alternative of APACHE II for mortality predictors in critically ill patients in the ICU.
Co-Authors A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Himendra Wargahadibrata Adi, Made Septyana Parama Adinda Putra Pradhana Adityawarma, Anak Agung Ngurah Agung Harawikrama Agung Bagus S. Satyarsa Aldy, Aldy Andika Metrisiawan Aryasa EM, Tjahya Aulyan Syah, Bau Indah Aulyan Syah, Bau Indah Brillyan Jehosua Toar Budiarta, Gede Chandra, Steven Okta Christanto, Sandhi Christanto, Sandhi Christopher Ryalino Christopher, Michael Chriswidarma, Dewa Gede Cynthia Dewi Sinardja D.H., Asterina Damayanti, Elok Demoina, I Gede Patria Dewi, Dewa Ayu Mas Shintya Dewi, I Dewa Ayu Mas Shintya Eka Nantha Kusuma, Putu Eric Makmur, Eric Firdaus, Riyadh Firdaus, Riyadh Gd. Harry Kurnia Prawedana Gde Agung Senapathi, Tjokorda Giovanni, Malvin Hartawan, IGAG Utara Hendrikus Gede Surya Adhi Putra Hengky Hengky, Hengky I Gede Catur Wira Natanagara I Gusti Agung Gede Utara Hartawan I Gusti Ngurah Mahaalit I Ketut Sinardja I Made Gede Widnyana I Made Stepanus Biondi Pramantara I Putu Agus Surya Panji I Wayan Ade Punarbawa I Wayan Niryana I Wayan Suranadi I. D. G. Tresna Rismantara Ida Bagus Alit Saputra Ida Bagus Krisna Jaya Sutawan J Sutawan, Ida Bagus Krisna J. Sutawan, IB Krisna J. Sutawan, Ida Bagus Krisna Jeanne, Bianca Jimmy Wongkar Johanes, Kevin Paul Juwita, Nova Kadek Agus Heryana Putra, Kadek Agus Katipana, Madyline Victorya Ketut Yudi Arparitna, Ketut Yudi Khamandanu, Kadek Fabrian Kharisma, Chau Febriani Krisna J. Sutawan, Ida Bagus Krisnayanti, Ida Ayu Arie Kumaat, Garry D. Chrysogonus Kurniawan Komala, Tomas Ari Kurniawan Komala, Tomas Ari Kurniyanta, I Putu Kusuma, Oscar Indra Laksono, Buyung Hartiyo Lauren, Christopher Made Septyana Parama Adi Made Wiryana Marilaeta Cindryani Lolobali, Marilaeta Cindryani MD, Burhan MD, Patricia Michael Humianto Muhammad Aris Sugiharso, Muhammad Aris Muliadi, Win Mulyadi, Win Narakusuma, Fajar Ni Made Supradnyawati, Ni Made Ni Putu Wardani Nova Juwita Nyoman Golden Paramartha, Bagus Patricia, Yoshie Permatasari, Endah Permatasari, Endah Pontisomaya Parami Prabowo, Pratama Yulius Pranata, I Made Harry Pratana, Yolanda Jenny Purwanto, Osmond Putu Herdita Sudiantara, Putu Herdita Putu Kurniyanta Ratu, Tiffani Richard Richard Saleh, Siti Chasnak Saleh, Siti Chasnak Santo, Budi Sidabutar, Beny Pratama Sidemen, IGP Sukrana Sista Satyarsa, Agung Bagus Sista Soerodjotanojo, Simson Samuel Sri Maliawan Sri Rahardjo Suastika, I Gede Juli Sucandra, I Made Agus Kresna Supradnyana, I Nyoman Novi Suranadi , I Wayan Sutawan, IB Krisna Krisna Jaya Taopan, Damatus Try Hartanto Tatang Bisri Tini, Kumara Tirta, Ian Tjokorda Gde Agung Senapathi Tjokorda Gde Bagus Mahadewa Virayanti, Luh Putu Diah Wanda, Aprilia Wargahadibrata, A. Hmendra Widyana, I Made Gede Wiryawan, I Nyoman Wundiawan, Kristian Felix Yani, Jancolin Yani