Fungsi Adrenal pada Sepsis di Unit Perawatan Intensif Pediatrik

R. Irma Rachmawati, Dwi Putro Widodo, Bambang Tridjaja AAP, Antonius H. Pudjiadi

Sari


Latar belakang. Insufisiensi adrenal sering dijumpai pada pasien syok septik dan berhubungan dengan
kejadian syok refrakter katekolamin dan peningkatan mortalitas.
Tujuan. Mengetahui profil fungsi adrenal pada anak yang menderita sepsis di Unit Perawatan Intensif
Pediatrik RSCM.
Metode. Penelitian deskriptif dengan desain potong lintang. Semua subjek menjalani uji stimulasi
kortikotropin dosis standar. Insufisiensi adrenal (IA) ditegakkan jika respons peningkatan kortisol terhadap
uji (ô€€§ maks) ô€¤9 μg/dl dan dikelompokkan menjadi absolut (IAA) jika kortisol pra-uji t0 <20 μg/dl dan
relatif (IAR) jika t0 ô€´20 μg/dl.
Hasil. Tiga puluh anak sepsis (18 laki-laki) diikutsertakan dalam penelitian. usia median adalah 29 (1-153)
bulan dan median skor PELOD 12,5 (0-33). Insufisiensi adrenal dijumpai pada 8 (26,7%) pasien (2 IAA and
6 IAR), lebih sering pada perempuan (p=0,003), serta cenderung lebih sering pada syok septik (p=0,682).
Median t0 32,75 (4,23-378) μg/dl, t30-60 48,20 (16,70-387) μg/dl, dan 􀀧 maks 15,40 (0,90-60,80) μg/
dl. Kadar t0 dan t30-60 lebih tinggi pada kelompok syok septik (p=0,03 dan p=0,01) namun tidak berbeda
antara subjek dengan dan tanpa IA. Terdapat kecenderungan korelasi positif antara skor PELOD dengan
t0 dan t30-60 (r=0,7; dan r=0,6; pô€¤0,001). Hipotensi sistolik dijumpai pada seluruh subjek dengan IA dan
syok refrakter katekolamin cenderung lebih sering pada kelompok IA (p=0,67). Mortalitas 36,7%, tidak
berbeda antara subjek dengan dan tanpa IA.
Kesimpulan. Insufisiensi adrenal sering dijumpai pada yang menderita anak sepsis dan harus dipertimbangkan
pada kondisi syok septik. Penelitian lanjutan diperlukan untuk menentukan efektivitas terapi steroid.


Kata Kunci


insufisiensi adrenal; sepsis; syok septik; kortisol

Teks Lengkap:

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Referensi


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DOI: http://dx.doi.org/10.14238/sp12.6.2011.426-32

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