Sensitifitas dan Spesifisitas Pemeriksaan Procalcitonin, C-Reactive Protein (CRP), dan Hitung Leukosit untuk Memprediksi Infeksi Bakterial pada Sindrom Syok Dengue di Pediatric Intensive Care Unit

Henny Rosita Iskandar, Antonius Pudjiadi, Dharma Mulyo, A. Pratiwi, Y. Suryatin

Sari


Latar belakang. Pada sindrom syok dengue (SSD) dapat terjadi iskemia usus yang dapat menyebabkan
gangguan gut barrier sehingga terjadi translokasi bakteri dan produknya (endotoksin) ke dalam sirkulasi
sistemik. Di Indonesia, terdapat beberapa pemeriksaan laboratorium yang tersedia untuk mendeteksi infeksi
bakteri antara lain procalcitonin (PCT), CRP, hitung leukosit, dan biakan bakteri, sedangkan pemeriksaan
neoptrin dan endotoksin belum tersedia secara komersial. Biakan darah memerlukan waktu yang lama dan
dapat memperburuk prognosis bila pemberian antibiotik harus menunggu hasil pemeriksaan.
Tujuan. Mengetahui sensitivitas dan spesifisitas pemeriksaan PCT, CRP, dan hitung leukosit untuk memprediksi
infeksi bakteri pada pasien SSD yang dirawat di pediatic intensive care unit (PICU).
Metode. Studi prospektif kasus SSD yang dirawat di PICU RSAB Harapan Kita Jakarta dari Januari sampai
dengan Desember 2006. Diagnosis SSD sesuai dengan kriteria WHO 1997 dikonfirmasi dengan pemeriksaan
serologi Dengue blot pada hari kelima demam. Pemeriksaan PCT, CRP, biakan darah, dan hitung leukosit
pada hari pertama masuk PICU. Data dianalisis dengan program SPSS versi 17.
Hasil. Subyek penelitian didapatkan 28 pasien dengan umur 12 bulan sampai 180 bulan (rerata 86 bulan,
SD 39 bulan). Seluruh kasus merupakan infeksi dengue sekunder. Kematian terjadi pada 3 dari 28 pasien
(10,7%). PCT (cut of point >0,5 ng/ml), CRP (cut of point >6mg/l) dan hitung leukosit (cut of point >11.000/
IU) tidak berkorelasi secara bermakna dengan hasil biakan. Receiver operating characteristic curves (ROC)
PCT 0.400 dengan p=0.490 dan CRP 0,422 dengan p=0,549, hitung leukosit 0,500 dengan p=1,000.
Perbandingan sensitifitas dan spesifisitas PCT ,CRP, dan hitung leukosit masing-masng 20% dan 30,4 %
CRP 60% dan 69,6 % sedangkan leukosit 20% dan 21,7%
Kesimpulan. Pemeriksaan PCT, CRP, dan hitung leukosit tidak dapat digunakan untuk memprediksi infeksi
bakterial pada pasien SSD di PICU.


Kata Kunci


PCT; CRP,;infeksi bakterial; SSD; PICU

Teks Lengkap:

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DOI: http://dx.doi.org/10.14238/sp12.4.2010.233-40

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