Uji Validasi Skor A2DS2 sebagai Prediktor Insiden Pneumonia pada Pasien Stroke Iskemik Akut

Toman Nababan, Ceva Wicaksono Pitoyo, Salim Harris, Cleopas Martin Rumende

Abstract

Pendahuluan. Pneumonia menjadi penyebab utama morbiditas dan mortalitas pada pasien stroke iskemik akut yang dirawat di rumah sakit. Diperlukan suatu sistem skor yang valid dan mudah diterapkan sebagai alat untuk memprediksi dan menstratifikasi risiko timbulnya pneumonia pada pasien stroke iskemik akut. Penelitian ini dilakukan untuk menilai kemampuan skor A2DS2 dalam memprediksi timbulnya pneumonia pada pasien stroke iskemik akut.

Metode. Penelitian ini merupakan studi kohort retrospektif terhadap pasien stroke iskemik akut yang dirawat di Rumah Sakit dr. Cipto Mangunkusumo, Jakarta. Usia, fibrilasi atrium, disfagia, jenis kelamin (laki-laki), dan tingkat keparahan stroke (dinilai dengan National Institute of Health Stroke Scale/NIHSS), dinilai pada awal perawatan di rumah sakit dan kemudian diikuti hingga tujuh hari sejak onset stroke iskemik untuk dilihat outcome-nya (pneumonia atau tidak). Analisis data dilakukan menggunakan program SPSS for windows versi 20.0. Performa kalibrasi skor A2DS2 dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor A2DS2 dinilai dengan area under the curve (AUC).

Hasil. Sebanyak 281 subjek diikutsertakan pada penelitian ini dengan angka kejadian pneumonia dalam tujuh hari sejak onset timbulnya stroke iskemik sebanyak 118 subjek  (42%). Uji Hosmer-Lemeshow menunjukkan p = 0,222 dengan plot kalibrasi menunjukkan koefisien korelasi r = 0,982. Nilai AUC yang didapatkan sebesar 0,885 (IK 95% 0,845-0,924).

Simpulan. Skor A2DS2 memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi timbulnya pneumonia pada pasien stroke iskemik akut.

 

Kata Kunci: Skor A2DS2, Stroke iskemik akut, Validasi


Validation of A2DS2 Score as Predictor of Pneumonia among Patients Hospitalized for Acute Ischemic Stroke

Introduction. Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. This study aimed to assess the performance of calibration and discrimination of A2DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke.

Methods. A retrospective cohort study was conducted among adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Age, atrial fibrillation, dysphagia, sex (male), and stroke severity (rated with National Institute of Health Stroke Scale/NIHSS) were obtained at the beginning of admission. The subjects were followed up for up to seven days after the onset of ischemic stroke to assess the outcome (pneumonia). Calibration properties of the A2DS2 score were assessed by Hosmer-Lemeshow test and calibration plot. Discrimination properties of the A2DS2 score were assessed by the area under the curve (AUC).

Results. A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients (42%). Hosmer Lemeshow test of A2DS2 score showed p = 0,222 and calibration plot showed r = 0,982. Discrimination of A2DS2 score was shown by the AUC value of 0,885 (95% CI 0,845-0,924).

Conclusion. The A2DS2 score has a good calibration and discrimination performance in predicting the incidence of pneumonia in patients with acute ischemic stroke.



Keywords

A2DS2 score, Acute ischemic stroke, Validation

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