Profil Pasien Demam Neutropenia Tidak Terkait Kemoterapi di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo

Gantira Wijayakusumah Danasasmita, Lie Khie Chen, Robert Sinto, Pringgodigdo Nugroho

Abstract

Pendahuluan. Kondisi neutropenia meningkatkan risiko terjadinya infeksi. Penyebab neutropenia banyak dibahas sebagai efek samping kemoterapi, namun pasien demam neutropenia yang bukan akibat efek samping kemoterapi angka kejadiannya semakin meningkat. Penelitian ini bertujuan untuk memberikan gambaran karakteristik populasi demam neutropenia tidak terkait kemoterapi.

Metode. Penelitian dilakukan secara retrospektif pada rekam medis pasien demam neutropenia yang bukan terkait kemoterapi di ruang perawatan RSUP Nasional dr. Cipto Mangunkusumo pada bulan Januari 2018-November 2019.  Variabel yang diteliti meliputi karakteristik demografi, klinis, klasifikasi skor multinational association of supportive care in cancer (MASCC) dan etiologinya, serta luaran mortalitas dalam lima hari perawatan.

Hasil. Subjek penelitian sebanyak 68 pasien yang terdiri dari 50% perempuan dan 50% laki-laki dengan median usia 38,5 tahun (rentang interkuartil [RIK] 27). Data diagnosis menunjukkan sebanyak 86,8% subjek merupakan pasien dengan kelainan hematologi, 3 pasien menderita tumor padat (limfoma, kanker, kolon dan kanker paru), dan sisanya adalah penyakit nonkeganasan. Onset demam ditemukan pada rawat jalan sebanyak 72,1%, dan sisanya pada rawat inap. Rerata absolute neutrophil count yaitu 201,50 (simpang baku [SB] 173,18), sedangkan rerata skor MASCC adalah 21 (SB 4,54) yang masuk dalam kategori low-risk. Sebanyak 35 subjek (51,5%) memiliki skor MASCC low risk dan 33 subjek (48,5%) high risk. Median prokalsitonin subjek adalah 1,99 ng/mL (rentang 0,11 – 178,30). Pada studi ini, ditemukan insiden mortalitas 5 hari sebanyak 54,4%. Analisis dengan chi-square terhadap kedua kelompok didapatkan perbedaan bermakna pada mortalitas perawatan (p < 0,05). Analisis dengan Independent T-test juga memberikan perbedaan bermakna pada parameter usia dan nilai tekanan darah sistolik antara kelompok risiko tinggi dan risiko rendah.

Kesimpulan. Mayoritas etiologi penyakit pada subjek penelitian adalah kelainan hematologi dan berdasarkan skor MASCC, sebagian besar subjek berada pada kelompok high risk dengan luaran insiden total mortalitas 54,4%.

Kata kunci: demam neutropenia tidak terkait kemoterapi, mortalitas, prokalsitonin, skor MASCC

 

Profile of Patients Neutropenia Fever Unrelated to Chemotherapy in Dr. Cipto Mangunkusumo General Hospital

Introduction. The condition of neutropenia increases the risk of infection. The causes of neutropenia are widely discussed as side effects of chemotherapy, but patients with neutropenia who are not due to side effects of chemotherapy are increasing in number. This study aims to provide an overview of the characteristics of neutropenic fever population unrelated to chemotherapy.

Method. The study was conducted retrospectively on the medical records of neutropenic fever patients who were not chemotherapy-related in the National Hospital Dr. Cipto Mangunkusumo in January 2018-November 2019. Variables studied included demographic, clinical characteristics, classification of multinational association of supportive care in cancer (MASCC) scores and their etiology, and mortality outcomes within 5 days of treatment.

Results. Total of 68 subjects were included in this study, consist of 50% female and 50% male with median age was 38.5 years (interquartile range 27). Diagnosis data showed that 86.8% subjects were patients with hematological abnormalities, 3 patients had solid tumors (lymphoma, colon cancer and lung cancer), and the rest were non-malignant diseases. Analysis showed that 72.1% onset of fever was found in outpatient care, the rest was inpatient care. The mean value of absolute neutrophil count was 201.50 (SD 173.18), meanwhile the mean MASCC score was 21 (SD 4.54) in the low-risk category. A total of 35 subjects (51.5%) had a MASCC low risk score and 33 subjects (48.5%) had a high risk. The median procalcitonin subject was 1.99 ng / mL (range 0.11 - 178.30). The 5-days mortality incidence was 54.4%. Chi-square analysis of the two groups found significant differences in care mortality (p <0.05). Analysis with Independent T-test also showed a significant differences in the parameters of age and systolic blood pressure values between the high risk and low risk groups.

Conclusions. The majority etiologies among subjects were haematological disorders. Based on the MASCC score, most of the subjects were in the high-risk group. Total of mortality incidence was 54.4%.

Keywords

MASCC score, mortality, neutropenic fever not related to chemotherapy, procalcitonin

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