Perbandingan Nilai Red Cell Distribution Width terhadap Mortalitas pada Pasien Hospital-Acquired Pneumonia Lansia dan Dewasa

Desty Gusti Sari, Rizka Humardewayanti Asdie, Heni Retnowulan

Abstract

Pendahuluan. Pneumonia nosokomial merupakan salah satu penyabab mortalitas dan morbiditas terbesar. Red cell distribution width (RDW) dihubungkan dengan kematian pada pasien syok sepsis dan community acquired pneumonia (CAP). Namun, sedikit diketahui mengenai efek peningkatan RDW dengan kematian pasien hospital-acquired pneumonia (HAP), terutama pada populasi lansia yang memiliki prognosis lebih buruk. Penelitian bertujuan untuk mengetahui perbandingan proporsi pasien HAP lansia dan dewasa yang memiliki peningkatan nilai RDW serta hubungan peningkatan nilai RDW dengan peningkatan risiko mortalitas selama perawatan di rumah sakit.
Metode. Penelitian menggunakan metode potong lintang dan kohort retrospektif. Subjek penelitian adalah pasien rawat inap terdiagnosis HAP di RSUP Dr. Sardjito periode Maret 2014 hingga Maret 2015 yang dipilih dengan metode konsekutif. Data dikumpulkan menggunakan data rekam medis yang kemudian dianalisis dengan menggunakan uji chi-square dan regresi logistik.
Hasil. Terdapat 106 pasien HAP yang memenuhi kriteria pemilihan sampel. Pasien yang hidup berjumlah 64 orang (64,15%) sedangkan pasien yang meninggal berjumlah 38 orang (35,84%). Median nilai RDW adalah 15,3% (rentang 11,4-29,8%). Tidak didapatkan perbedaan proporsi antara pasien HAP dewasa dan lansia dengan peningkatan nilai RDW (p=0,331). Faktor yang memengaruhi peningkatan RDW pada pasien HAP adalah hemoglobin (p<0,001; RR 5,617 (IK 95% 2,294-13,756)) dan trombosit (p=0,002; RR 4,471 (IK 95% 1,720-11,625). Terdapat perbedaan proporsi antara peningkatan nilai RDW dengan mortalitas pasien HAP (p=0,043). Namun, peningkatan nilai RDW tidak memengaruhi peningkatan mortalitas pasien HAP. Mortalitas pasien HAP dipengaruhi oleh komorbid sepsis (p<0,001; RR 7,121 (IK 95% 2,599-19,509)) dan angka leukosit yang tinggi (p=0,031; RR=3,077 (IK 95% 1,108-8,546)).
Simpulan. Tidak terdapat perbedaan yang signifikan antara peningkatan nilai RDW pada kelompok lansia dan dewasa. Studi ini juga tidak mendapati hubungan yang signifikan antara peningkatan nilai RDW dengan risiko mortalitas pasien HAP selama perawatan di rumah sakit. Namun demikian, studi ini mendapati faktor-faktor lain yang memengaruhi peningkatan nilai RDW yaitu kadar hemoglobin dan trombosit pasien, sementara faktor yang memengaruhi mortalitas pasien HAP adalah komorbid sepsis dan kadar leukosit yang tinggi.
Kata Kunci: Dewasa, hospital-acquired pneumonia (HAP), lansia, mortalitas, red cell distribution width (RDW)

 

Comparison of Red Cell Distribution Width Values towards Mortality in Adult and Elderly Hospital-Acquired Pneumonia Patients in Dr. Sardjito Hospital

Introduction. Hospital-acquired pneumonia (HAP) is a major cause of morbidity and mortality. Red cell distribution width (RDW) is associated with mortality in patients with septic shock and community-acquired pneumonia (CAP). However, little is known about the effect of elevation of RDW value on mortality in HAP patients, especially in the elderly population who have a worse prognosis. This study aimed to determine the proportion of adult and elderly HAP patients who have an increase in RDW value and the relation between the increase in RDW value to the risk of mortality in HAP patients during hospitalization.
Methods. A cross-sectional and retrospective cohort study was performed using medical records of inpatients diagnosed with HAP in RSUP Dr. Sardjito Yogyakarta from March 2014 until March 2015. The study’s sample was chosen by a consecutive sampling method. The data were analyzed with chi-square and logistic regression.
Results. During the study period, a total of 106 patients were diagnosed with HAP with fulfilled the inclusion and exclusion criteria. Sixty-eight subjects (64.15%) survived, and 38  subjects (35.84%) died. The median RDW value was 15.3% (range 11.4 – 29.8%). The proportion of adult and elderly HAP patients toward the increase in RDW value was not statistically significant (p=0.331). Factor contributing to the increase of RDW value was haemoglobin (p<0.001; RR 5.617 (95% CI 2.294 – 13.756)  and thrombocyte  (p=0.002; RR 4.471 (95% CI 1.720 – 11.625). There was a proportion difference between RDW value and HAP mortality (p=0.043), but it was not statistically significant. Factor contributing to the increase of HAP mortality was sepsis (p<0.001; RR 7.121 (95% CI 2.599-19.509)) and leucocyte  (p=0.031; RR=3.077 (95% CI 1.108 – 8.546)).
Conclusions. There is no proportion difference in increasing RDW value between adult and elderly HAP patients. We also found that RDW value was not contributing to make the increase in mortality among HAP patients. However, this study found other factors, including haemoglobin and platelet level which correlated with the increase of RDW. We also found that sepsis and high leukocyte levels are significantly correlated with the incidence of mortality among HAP patients.

Keywords

Adult, Elderly, hospital-acquired pneumonia (HAP), mortality, red cell distribution width (RDW)

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