EFEK SUPLEMENTASI SINBIOTIK DALAM MENURUNKAN LAMA RAWAT DAN MORTALITAS PADA PASIEN SAKIT KRITIS DENGAN SEPSIS - Afria Beny Safitri; Wiji Lestari (Fakultas Kedokteran Universitas Tarumanagara, 2025)
ABSTRAK Latar Belakang: Sepsis merupakan penyebab utama mortalitas global. Disbiosis usus memperberat respons inflamasi pada sepsis. Suplementasi sinbiotik (kombinasi probiotik dan prebiotik) diusulkan sebagai terapi adjuvan untuk memodulasi mikrobiota usus, namun efektivitasnya dalam menurunkan lama rawat dan mortalitas masih diperdebatkan. Metode: Pencarian sistematis dilakukan pada PubMed, Embase, dan Cochrane Library untuk systematic review (SR) dan randomized controlled trials (RCT) terbaru. Kriteria inklusi adalah pasien sakit kritis dengan sepsis yang mendapat sinbiotik, dengan luaran mortalitas dan lama rawat. Hasil: Dua SR (Gong et al., 2025; Lou et al., 2023) dianalisis. Sinbiotik menunjukkan potensi penurunan mortalitas pada pasien dewasa (Risk Ratio 0,61; 95% CI 0,34–1,08) dan insiden ventilator-associated pneumonia (VAP) (RR 0,52; 95% CI 0,31–0,87). Namun, dampaknya terhadap lama rawat di ICU tidak konsisten antar studi. Terdapat heterogenitas tinggi dalam strain, dosis, dan durasi pemberian. Kesimpulan: Sinbiotik berpotensi menurunkan mortalitas dan komplikasi infeksi pada pasien sepsis sakit kritis. Namun, bukti mengenai pengurangan lama rawat masih belum konklusif. Diperlukan RCT lebih lanjut dengan populasi besar dan protokol yang terstandarisasi untuk memastikan rekomendasi klinis yang optimal. Kata-kata kunci: lama rawat, mortalitas, perawatan intensif, sepsis, sinbiotik ABSTRACT Background: Sepsis is a leading cause of global mortality. Gut dysbiosis exacerbates the inflammatory response in sepsis. Synbiotic supplementation (a combination of probiotics and prebiotics) is proposed as an adjuvant therapy to modulate gut microbiota, but its effectiveness in reducing length of stay and mortality remains debated. Methods: A systematic search was conducted on PubMed, Embase, and Cochrane Library for recent systematic reviews (SRs) and randomized controlled trials (RCTs). Inclusion criteria were critically ill septic patients receiving synbiotics, with outcomes of mortality and length of stay. Results: Two SRs (Gong et al., 2025; Lou et al., 2023) were analyzed. Synbiotics showed a potential reduction in mortality in adult patients (Risk Ratio 0.61; 95% CI 0.34–1.08) and the incidence of ventilator-associated pneumonia (VAP) (RR 0.52; 95% CI 0.31–0.87). However, the effect on ICU length of stay was inconsistent across studies. High heterogeneity was observed in strains, dosage, and duration of administration. Conclusion: Synbiotics may reduce mortality and infectious complications in critically ill septic patients. However, evidence for reducing length of stay remains inconclusive. Further large-scale RCTs with standardized protocols are needed to establish optimal clinical recommendations. Keywords: intensive care, length of stay, mortality, sepsis, synbiotics