Perbandingan Mortalitas, Lama Rawat, Perbaikan Fungsi Ginjal, dan Kebutuhan Hemodialisis Selama Perawatan pada Pasien Acute Kidney Injury (AKI) dengan dan Tanpa Sepsis, Serta Faktor yang Memengaruhi Mortalitas Pasien

Mochammad Jalalul Marzuki, Nursamsu Nursamsu, Achmad Rifai

Abstract

Pendahuluan. Acute kidney injury (AKI) merupakan komplikasi utama pada pasien dengan kondisi kritis yang berpengaruh terhadap mortalitas. Sepsis merupakan faktor predisposisi utama terjadinya AKI serta memberikan prognosis yang buruk dan angka mortalitas yang tinggi. Penelitian ini dilakukan untuk mengetahui perbandingan mortalitas selama perawatan, lama rawat, perbaikan fungsi ginjal, dan kebutuhan hemodialisis antara pasien AKI akibat sepsis dan non-sepsis, serta faktor-faktor yang berpengaruh terhadap mortalitas pasien AKI.
Metode. Penelitian observasional analitik dilakukan pada pasien usia ≥40 tahun yang didiagnosis AKI berdasarkan kriteria KDIGO. Data diambil dari rekam medis pasien di Rumah Sakit dr. Saiful Anwar Malang selama Januari - Juni 2019. Pasien dikelompokkan ke dalam kelompok sepsis dan non-sepsis berdasarkan kriteria diagnostik di instalasi gawat darurat. Kemudian, dilakukan pemantauan luaran yaitu mortalitas selama perawatan, lama rawat, perbaikan fungsi ginjal, dan kebutuhan hemodialisis, serta analisis faktor yang berpengaruh terhadap mortalitas pasien. Perbedaan kejadian mortalitas, perbaikan fungsi ginjal, dan kebutuhan hemodialisis antarkelompok dianalisis dengan analisis bivariat chi square, sedangkan perbedaan lama rawat dianalisis dengan uji Mann Whitney. Faktor risiko yang berpengaruh terhadap mortalitas diuji dengan analisis multivariat regresi logistik berganda.
Hasil. Didapatkan 135 subjek yang terdiri dari 80 (59,25% ) subjek kelompok sepsis dan 55 (40,74%) subjek non-sepsis. Pasien AKI akibat sepsis mempunyai tingkat mortalitas selama perawatan yang lebih tinggi (p=0,002), kebutuhan hemodialisis yang lebih tinggi (p=0,017), perbaikan fungsi ginjal yang lebih rendah (p=0,022), dan durasi rawat inap yang lebih lama (p=0,004) secara bermakna dibandingkan dengan non-sepsis. Faktor yang paling berpengaruh terhadap mortalitas pada pasien AKI dari hasil analisis multivariat adalah kondisi sepsis [OR 3,468 (IK 95% 1,438-8,366); p=0,006], oligoanuria [OR 2,923 (IK 95% 0,950-8,990); p=0,041], dan penurunan kesadaran [OR 3,817 (IK 95% 1,589-9,168); p=0,003].
Kesimpulan. Pasien AKI dengan sepsis memiliki tingkat mortalitas selama perawatan yang lebih tinggi, durasi rawat inap yang lebih lama, perbaikan fungsi ginjal yang lebih rendah, serta kebutuhan hemodialisis yang lebih tinggi dibandingkan dengan AKI non-sepsis. Kondisi sepsis, oligoanuaria, dan penurunan kesadaran memberikan pengaruh yang bermakna terhadap mortalitas pasien AKI.
Kata Kunci: AKI, hemodialisis, lama rawat, mortalitas, non-sepsis, perbaikan fungsi ginjal, sepsis

Comparison of Hospital Mortality, Length of Stay, Renal Recovery, and Needs for Hemodialysis in Acute Kidney Injury (AKI) Patients due to Septic and Non-septic, and Factors Affecting Patients’ Mortality

Introduction. Acute kidney injury (AKI) is a major complication in critically ill patients that affects mortality. Sepsis is a major predisposing factor for AKI and provides a poor prognosis and high mortality rate. This study aimed to identify the difference of hospital mortality, length of stay, renal recovery, and needs for hemodialysis between AKI patients due to sepsis and non-sepsis, as well as to determine the factors that influence the mortality of patients with AKI.
Methods. An analytical observational study was conducted among patients with AKI according to the KDIGO criteria and aged ≥40 years old. Data were obtained from patients’ medical records in Saiful Anwar Hospital Malang in January-June 2019. Patients were categorized into sepsis or non-sepsis group. Patients were then followed during hospitalization for mortality, length of stay, renal recovery, and need of hemodialysis outcome. The difference in the incidence of mortality, renal recovery, and need of hemodialysis between the two groups were analyzed by Chi Square bivariate analysis, while the difference in length of stay was analyzed by Mann Whitney test. Risk factors that influence mortality will be tested by multivariate analysis of binary logistic regression
Results. There were 135 subject consist of 80 (59.25%) subjects of AKI due to sepsis and 55 (40.74%) subjects of AKI non-sepsis. Patients with AKI due to sepsis has higher hospital mortality (p=0.002), increased needs for hemodialysis (p=0.017), low renal recovery (p=0.022), and longer length of stay (p=0.004) compared to non-sepsis. From multivariate analysis, we revealed that the contributing factors for mortality in patients with AKI were sepsis [OR 3.468 (IK 95% 1.438-8.366); p=0.006], oligoanuria [OR 2.923 (IK 95% 0.950-8.990); p=0.041], and decreased of consciousness [OR 3.817 (IK 95% 1.589-9.168); p=0.003].
Conclusion. Higher hospital mortality, longer length of stay, increased needs for hemodialysis, and lower renal recovery in patients with AKI due to sepsis compared to those without sepsis. The conditions of sepsis, oligoanuria and decreased of consciousness have a very significant influence on the mortality of AKI patients.


Keywords

AKI, hemodialysis, hospital mortality, length of stay, non-sepsis, sepsis, renal recovery

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