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All Journal Acta Interna : The Journal of Internal Medicine Ina Kidney
Prasanto, Raden Heru
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Change in Serum Cystatin C Level as Predictor for Length of Hospital Stay in Patients Undergoing Primary Percutaneous Coronary Intervention Putra, Andika; Prasanto, Raden Heru; Puspitasari, Metalia
Acta Interna The Journal of Internal Medicine Vol 12, No 1 (2023): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.98162

Abstract

Background. Percutaneous Coronary Intervention (PCI) is one of the most frequently performed medical procedures. Length of stay for patients after undergoing PCI should be standardized to achieve the best quality of health services. The existence of complications is one of the main factors considering the length of stay after PCI. Cystatin C has the ability as a predictor of complications in patients with acute coronary syndrome, especially those undergoing PCI, as well as the increase in length of stay associated with complications after the PCI procedure.Objectives. To determine the average changes in serum cystatin C levels, the correlation between serum cystatin C levels and length of treatment, and changes in serum cystatin C levels as predictors of length of stay in patients undergoing primary PCI at Dr. Sardjito Hospital.Methods. Analytical observational study with a prospective cohort method conducted on patients with a STEMI diagnosis who underwent primary PCI procedures in Emergency Room, Cardiovascular Care Unit (CVCU) of Dr. Sardjito Hospital, treated from November 2020 to April 2021. The data was then analyzed for normality, multicollinearity, bivariate, and multivariate tests to see the effect of changes in cystatin C and other variables on the length of stay for patients after primary PCI (p <0.05 is significant).Results. Of the 111 patients, 92 patients were subjected to further analysis. Patients included in the study had an average age of 59.55 (+10.80) years, majority of men, reduced LVEF, using trans-radial PCI access, Killip I, average eGFR of 64 ml / 1.73m2, length of stay in hospital is 5 days, delta cystatin C and creatinine 0.10 and 0.04 U / L, respectively. The increase in cystatin C had a moderate positive correlation (0.502) with the length of hospital stay (p<0.001), in multivariate analysis serum cystatin C does not correlate with length of hospital stay (p=0.590). Other variables including LVEF, eGFR, infection, and contrast-induced acute kidney injury had a significant correlation with length of stay (p<0.001). The multivariate test showed that LVEF, eGFR, and infection had the most significant correlation (p = 0.034; 0.001; 0.005 respectively) to the length of hospital stay with a regression coefficient of 0.72; -0.04; and 1.93.Conclusion. An increase of cystatin C serum does not correlate significantly with the length of hospitalization in STEMI patients undergoing PCI procedure in Dr. Sardjito Hospital.
The Determinants of Detrimental Changes in Pulse Pressure During Maintenance Hemodialysis Treatments Damayanti, Ratna; Kuswadi, Iri; Prasanto, Raden Heru; Puspitasari, Metalia; Wardhani, Yulia; Kuswadi, Danny Pratama
Indonesian Journal of Kidney and Hypertension Vol 1 No 3 (2024): Volume 1 No. 3, December 2024
Publisher : PERNEFRI (PERHIMPUNAN NEFROLOGI INDONESIA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32867/inakidney.v1i3.128

Abstract

Background: Studies indicate that large fluctuations in pulse pressure during hemodialysis are associated with cardiovascular events, cardiovascular mortality, and all-cause mortality. Objective: We investigated the determinants of detrimental changes in pulse pressure (ΔPP) during hemodialysis. Methods: This prospective, observational cohort study was conducted from 1 to 30 April 2023 at Dr. Sardjito Hospital Yogyakarta, involving maintenance hemodialysis patients for ≥ 6 months. Patients were categorized into group 1 (detrimental ΔPP, ΔPP >5 mmHg or <−25 mmHg) and group 2 (stable ΔPP, −25 to 5 mmHg). Mann-Whitney, independent-t, chi-square, Fisher exact tests, and logistic regression were applied to evaluate associations between ΔPP groups and clinical variables. Results: This study involved 136 patients, 75 males (55.1%) with a mean age of 52 (18-87). The most common comorbid was hypertension, present in 85 patients (62.5%). The mean hemodialysis vintage of patients was 47.2 (6.5-330.7) months. We found significant difference between group in post-dialysis systolic blood pressure (SBP) (p=0.003), pre-dialysis diastolic blood pressure (DBP) (p=0.015), post-dialysis DBP (p=0.007), ultrafiltration (p=0.041), pre-dialysis mean-arterial-pressure (MAP) (p=0.013), post-dialysis MAP (p=0.002), and alpha-blocker treatment (p=0.037). Multivariate logistic regression analysis shows a significant association between groups of ΔPP with pre-dialysis DBP (p=0.035; OR=1.153; OR=Exp(10xℬ) =4.137) and post-dialysis SBP (p=0.007; OR=1.052; OR=Exp(10xℬ) =1.6487). Conclusion: Our study demonstrates that group 1, with detrimental changes in pulse pressure during hemodialysis, was found to have higher post-dialysis DBP, pre-dialysis DBP, post-dialysis SBP, pre-dialysis MAP, post-dialysis MAP, alpha-blocker treatment, and ultrafiltration, with significant association with post-dialysis SBP and pre-dialysis DBP.
Co-Authors Andika Putra Kuswadi, Danny Pratama Kuswadi, Iri Metalia Puspitasari Ratna Damayanti Yulia Wardhani, Yulia