Peran suplementasi sinbiotik dalam terapi nutrisi terhadap kadar prokalsitonin dan skor prognosis pasien luka bakar berat dan sepsis: Sebuah laporan kasus

Abstract

Introduction: Severe burns cause tissue damage and systemic hyperinflammation. Gastrointestinal barrier dysfunction, dysbiosis and immune dysregulation in burn patients contribute to sepsis. Procalcitonin is used as a biomarker of sepsis in burn patients. Synbiotic supplementation, a combination of probiotics and prebiotics, can reduce dysbiosis and inflammation and is thought to influence procalcitonin levels and the prognosis scores of patients with severe burns and sepsis. Methods: A 54-year-old female patient with fire burns and grade II-III scald 34% body surface area and sepsis. The patient's nutritional status was normal weight (body mass index 20.1 kg/m2). The patient experienced septic shock and was on mechanical ventilation. The patient received high protein enteral nutrition therapy and synbiotic supplementation, each capsule containing Lactobacillus acidophillus and Bifidobacterium longum 5 billion colony forming units (CFU) and 60 mg fructo-oligosaccharide (FOS), which was given 2 times 1 capsule per day for 21 days from the day treat 7th. Results: Observation results showed a decrease in procalcitonin levels and SOFA scores during synbiotic supplementation for 21 days. Conclusion: Synbiotic supplementation containing 10 billion CFU probiotics and 120 mg FOS per day for 21 days in nutritional therapy can support a reduction in procalcitonin levels and prognosis scores in patients with severe burns.   Pendahuluan: Luka bakar berat menyebabkan kerusakan jaringan dan hiperinflamasi sistemik. Disfungsi barrier gastrointestinal, disbiosis dan disregulasi imun pada pasien luka bakar berkontribusi menyebabkan sepsis. Prokalsitonin digunakan sebagai biomarker sepsis pada pasien luka bakar. Suplementasi sinbiotik, kombinasi probiotik dan prebiotik, dapat mengurangi disbiosis dan inflamasi sehingga diduga mempengaruhi kadar prokalsitonin dan skor prognosis pasien luka bakar berat dan sepsis. Metode: Pasien perempuan berusia 54 tahun dengan luka bakar api dan scald derajat II-III 34% luas permukaan tubuh dan sepsis. Status gizi pasien adalah berat badan normal (indeks massa tubuh 20,1 kg/m2). Pasien mengalami syok septik dan menggunakan ventilasi mekanik. Pasien mendapat terapi nutrisi enteral tinggi protein dan suplementasi sinbiotik, tiap kapsul mengandung Lactobacillus acidophillus dan Bifidobacterium longum 5 milyar colony forming unit (CFU) serta 60 mg frukto-oligosakarida (FOS), yang diberikan 2 kali 1 kapsul per hari selama 21 hari sejak hari rawat ke-7. Hasil: Hasil observasi menunjukkan adanya penurunan kadar prokalsitonin dan skor SOFA saat suplementasi sinbiotik selama 21 hari. Simpulan: Suplementasi sinbiotik mengandung probiotik 10 milyar CFU dan FOS 120 mg per hari selama 21 hari dalam terapi nutrisi dapat mendukung penurunan kadar prokalsitonin dan skor prognosis pada pasien luka bakar berat.