Besaran Neutrofil dan Kadar C-reactive Protein sebagai Faktor Prognostik Multi Organ Failure pada Pasien Multi-trauma

Abstract

Abstract: Trauma is the leading cause of death among people under 50 years old worldwide. Severe trauma will trigger systemic inflammatory response syndrome (SIRS) which can worsen into multiple organ failure MOF). This study was aimed to evaluate whether there was a correlation between neutrophil count and C reactive protein concentration in multi-traumatic patients and whether both variables could become predictors of the occurence of MOF. This was a correlation study with a cross sectional design. There were 71 multitraumatic patients enrolled in this study, obtained from Surgery Emergency Unit of Prof. Dr. R. D. Kandou Hospital Manado; 31 of them were associated with SIRS, MODS, and MOF. The regression analysis showed that the higher the neutrophil count was, the greater the chance of the patient to suffer from MOF (P < 0.001), as well as the higher the CRP concentration, the greater the chance of the patient to suffer from MOF (P < 0.001). The cut-off point of neutrophil to MOF was 17121.7 and the specifity was higher than the sensitivity. Morover, the cut-off point of CRP to MOF was 169.7 and the specifity was higher than the sensitivity. Conclusion: There were significant correlations between the neutrophil count and MOF as well as between CRP concentration and MOF. Neutrophil count and CRP concentration could become predictors of the occurence of MOF and were significant in sensitivity and specifity in acute multi-traumatic patients.
Keywords: multiple trauma, MOF, neutrophil, CRP

Abstrak: Trauma merupakan penyebab kematian nomor satu pada orang berusia kurang dari 50 tahun. Trauma berat akan memicu timbulnya respons inflamasi sistemik berat (Systemic Inflammatory Response Syndrome, SIRS) yang dapat memburuk menjadi kegagalan multi-organ. Penelitian ini bertujuan untuk mengetahui ada tidaknya korelasi antara besaran neutrofil dan kadar CRP pada pasien multi-trauma, dan apakah keduanya dapat digunakan sebagai faktor prediktor dalam mendeteksi terjadinya multi-organ failure (MOF). Jenis penelitian ialah korelasi dengan desain potong lintang. Hasil penelitian mendapatkan 71 pasien multi-trauma yang dirawat di Instalasi Gawat Darurat Bedah RSUP Prof. Dr. R. D. Kandou Manado; 31 di antaranya disertai SIRS, MODS dan MOF. Hasil analisis regresi menyatakan bahwa makin tinggi besaran neutrofil maka makin besar peluang pasien untuk terjadi MOF (P < 0,001), dan makin tinggi CRP maka makin besar peluang pasien untuk terjadi MOF (P < 0,001). Cut-off point neutrofil terhadap MOF ialah 17121,7 dengan nilai spesifisitas lebih besar dari sensitivitas sedangkan cut-off point CRP terhadap MOF ialah 169,7 dengan nilai spesifisitas lebih besar dari sensitivitas. Simpulan: Terdapat hubungan bermakna antara besaran neutrofil dan MOF serta antara CRP dan MOF. Besaran neutrofil dan CRP merupakan prediktor terjadinya MOF yang mempunyai signifikansi dalam sensitivitas dan spesifisitas pada pasien dengan multi- trauma akut.
Kata kunci: multi-trauma, MOF, neutrofil, CRP