Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, dan D-dimer Sebagai Prediktor Decompensated Disseminated Intravascular Coagulation Sisseminated pada Sepsis - Fenny, -; Dalimoenthe, Nadjwa Zamalek; Noormartany, -; Pranggono, Emmy; Dewi, Nina Susana (Faculty of Medicine, Universitas Padjadjaran)
AbstrakSepsis adalah respons sistemik terhadap infeksi dan terutama terjadi pada pneumonia. Sepsis dapat menyebabkan komplikasi disseminated intravascular coagulation (DIC) yang dibedakan menjadi compensated dan decompensated DIC. Tujuan penelitian ini adalah untuk menentukan apakah nilai prothrombin time (PT), activated partial thromboplastin time (aPTT), kadar fibrinogen, dan D-dimer dapat digunakan sebagai prediktor decompensated DIC pada penderita sepsis. Penelitian dilakukan di Laboratorium Patologi Klinik Rumah Sakit Hasan Sadikin Bandung mulai September 2008 sampai Juni 2010. Subjek penelitian adalah penderita sepsis yang disebabkan pneumonia. Nilai PT, aPTT, kadar fibrinogen, dan D-dimer semua subjek sepsis dicatat kemudian dilakukan pengamatan sampai subjek dinyatakan mengalami decompensated atau non-decompensated DIC; selanjutnya dilakukan analisis nilai PT, aPTT, kadar fibrinogen, dan D-dimer pada kelompok decompensated dan non-decompensated DIC. Penelitian menggunakan rancangan cohort. Subjek berjumlah 39 orang (58%) penderita sepsis dengan luaran decompensated DIC dan 28 orang (42%) penderita sepsis dengan luaran non-decompensated DIC. Dari parameter hemostasis yang diperiksa, didapatkan bahwa nilai PT, aPTT, dan fibrinogen merupakan prediktor decompensated DIC pada penderita sepsis dengan risiko relatif (RR) masing-masing 240,500; 7,157; dan 6,421. Simpulan, prothrombin time, aPTT, dan fibrinogen merupakan pemeriksaan untuk mengetahui aktivasi koagulasi. Parameter hemostasis yang merupakan prediktor decompensated DIC pada penderita sepsis adalah nilai PT dan aPTT yang memendek serta kadar fibrinogen yang meningkat. [MKB. 2011;43(1):49–54].Kata kunci: Activated partial thromboplastin time, D-dimer, disseminated intravascular coagulation, fibrinogen, prothrombin time, sepsisProthrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, and D-dimer as a Predictor of Decompensated Disseminated Intravascular Coagulation in SepsisSepsis is a systemic response to infection especially in pneumonia case. Sepsis can cause complications such as disseminated intravascular coagulation (DIC) which can be divided into compensated and decompensated DIC. The purpose of this study was to assess whether the value of prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer levels can be used as predictors of decompensated DIC in sepsis patients. This study was conducted at the Laboratory of Clinical Pathology Rumah Sakit Hasan Sadikin Bandung since September 2008 to June 2010. Subjects were patients with sepsis caused by pneumonia. PT and aPTT values, fibrinogen, and D-dimer levels was recorded from all sepsis patients then patients were observed until diagnosed decompensated or non-decompensated DIC, then the value of PT, aPTT, fibrinogen and D-dimer levels in the group of decompensated DIC and non-decompensated DIC were analysed. This study used cohort design. Subjects were 39 sepsis patients (58%) with outcome decompensated DIC and 28 sepsis patients (42%) with outcome non-decompensated DIC. From the hemostasis parameter test out, it was found that PT, aPTT, and fibrinogen were the predictor of decompensated DIC in patients with sepsis with relative risk 240.500, 7.157, and 6.421; respectively. Conclusions, prothrombin time, aPTT, fibrinogen are the test to know coagulation activation. Hemostasis parameter to predict decompensated DIC in sepsis patients are the shorten PT, aPTT, and the increased fibrinogen. [MKB. 2011;43(1):49–54].Key words: Activated partial thromboplastin time, D-dimer, disseminated intravascular coagulation, fibrinogen, prothrombin time, sepsi DOI: http://dx.doi.org/10.15395/mkb.v43n1.44