Peran Estimasi Laju Filtrasi Glomerulus (eGFR) sebagai Prediktor Mortalitas pada Pasien Sindrom Koroner Akut selama Perawatan di ICCU

Abstract

Pendahuluan. Pasien sindrom koroner akut (SKA) seringkali mengalami gangguan fungsi ginjal yang berhubungan dengan peningkatan risiko kematian SKA. Tatalaksana optimal dapat memperbaiki angka mortalitas, namun pasien dengan gangguan fungsi ginjal seringkali tidak mendapatkan tatalaksana optimal. Sampai saat ini belum ada studi yang meneliti hubungan antara gangguan fungsi ginjal dengan mortalitas selama perawatan di ICCU pada populasi di Indonesia yang berbeda dalam karakteristik klinis dengan populasi di luar negeri. Diperlukan penelitian mengenai hubungan antara gangguan fungsi ginjal dengan mortalitas selama perawatan di ICCU pada populasi Indonesia. Dengan demikian, diharapkan dapat dilakukan identifikasi dan stratifikasi pasien dengan risiko mortalitas tinggi sehingga dapat diberikan tatalaksana yang lebih optimal.Metode. Studi kasus kontrol dengan teknik sampling konsekutif dilakukan di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada bulan Januari-Mei 2008 dengan sampel data rekam medik 300 pasien SKA yang dirawat di ICCU RSCM th 2003-2007. Sampel terdiri dari 100 pasien sindrom koroner akut yang mengalami kematian saat dirawat sebagai kasus dan 200 pasien yang tidak mengalami kematian sebagai kontrol. Analisis statistik menggunakan uji chi square untuk variabel bivariat dan analisis multivariat menggunakan regresi logistik untuk variabel-variabel perancu.Hasil. Didapakan hubungan yang bermakna antara penurunan fungsi ginjal (eGFR <60 ml/menit) dengan mortalitas (OR 2,97; IK 95% 1,726-5,106). Terdapat beberapa variabel lain yang bermakna sebagai prediktor mortalitas yaitu Killip Class (p <0,001), Luas Infark (p <0,001) dan terapi medikamentosa standar (p= 0,005). Pada analisis multivariat didapatkan adjusted OR untuk eGFR terhadap mortalitas sebesar 3,013 ( IK 95% 1,639-5,40)Simpulan. Estimasi Laju Filtrasi Glomerulus (eGFR) merupakan prediktor independen mortalitas pasien SKA selama perawatan di ICCU RSCM. Terdapat prediktor independen lain yang juga memengaruhi mortalitas yaitu Killip class, luas infark, dan terapi medikamentosa standar .Kata Kunci: eGFR, mortalitas, sindrom koroner akut Estimated Glomerular Filtration Rate (eGFR) as an In-Hospital Mortality Predictor in Acute Coronary Syndrome Patients in ICCUIntroduction. Due to the high in-hospital mortality rate of Acute Coronary Syndrome (ACS) patients, with renal dysfunction as one of its negative predictor, it is mandatory to screen renal dysfunction in ACS patients and investigate association between renal dysfunction and in-hospital mortality in ACS patients. To date, there is no such study which has been conducted in Indonesian population, which is different in clinical characteristics aspect with populations abroad. The aim of this study is to determine association between renal dysfunction (eGFR <60 ml/min) and in-hospital mortality in ACS patients who were hospitalized in ICCU Cipto Mangunkusumo Hospital. Methods. A case control study retrospectively was conducted. We investigated 100 ACS patients who were dead during hospitalization as the case group, and 200 ACS patients who were survived as the control group. The study was conducted in RSCM during January-May 2008. The subjects were ACS patients whom their medical records data were recorded since 2006 until 2007. We used consecutive sampling, We calculated the eGFR based on serum creatinine, age, and gender using formula of modified MDRD method for Chinese population. We calculated the odds ratios and the association with chi square test. Results. During the year 2006-2007, 100 ACS patients who were dead during hospitalization and 200 ACS patients who were survived were included in the study. We found significant association between renal dysfunction (eGFR <60 ml/min) and in-hospital mortality (OR 2,969 CI 95% 1,726-5,106). We also calculated other risk factors using multivariate analysis, and we had adjusted OR for eGFR was 3,013 (CI 95% 1,639-5,40). There were other risk factors which were significant as mortality predictors: Killip class (OR 4,046 CI 95% 2,235-7,322), large involvement area of infarct (OR 3,862 CI 95% 2,128-7,006), and non-standardized medical treatment (OR 2,598 CI 95% 1,238-5,452). Conclusions. Estimated GFR (eGFR) is an independent mortality predictor for in-hospital mortality in ACS patients. There are other risk factors which are significant as mortality predictors: Killip class, large involvement area of infarct, and non-standardized medical treatment. Keywords: acute coronary syndrome, eGFR, mortality