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Red Cell Distribution Width (RDW) sebagai prediktor mortalitas pada sepsis neonatorum

  • Ni Made Sukewanti ,
  • I Wayan Darma Artana ,
  • I Made Kardana ,
  • Made Sukmawati ,
  • Putu Junara Putra ,


Abstract

Pendahuluan: Sepsis merupakan masalah yang umum terjadi pada neonatus, dengan angka mortalitas yang tinggi terutama di negara berkembang. Red cell distribution width (RDW) merupakan suatu penanda yang saat ini sedang diteliti pada sepsis. Peningkatan RDW terjadi pada kondisi produksi sel darah merah yang tidak efektif, atau peningkatan destruksi sel darah yang biasanya terjadi pada kondisi inflamasi atau infeksi. Tujuan: Tujuan penelitian ini adalah untuk mengetahui hubungan RDW terhadap kejadian mortalitas pada neonatus cukup bulan dengan sepsis.

Metode: Penelitian ini adalah suatu studi potong-lintang analitik observasional. Subyek penelitian adalah neonatus cukup bulan dengan sepsis neonatorum yang dirawat di RSUP Sanglah Denpasar pada tahun 2017. Data yang digunakan adalah data sekunder diambil dari rekam medis pasien.

Hasil: Terdapat 62 subyek penelitian dengan median usia 2,5 hari, terdiri dari 36 (58,06%) lelaki dan 26 orang (41,94%) perempuan. Diagnosis Sepsis Neonatal Awitan Dini (SNAD) sebanyak 53 (85,48%) dan SNAL sebanyak 9 (14,52%). Median lama rawat adalah 10 hari, dengan luaran 35,48% meninggal dunia. Rerata RDW didapatkan lebih tinggi pada kelompok subyek yang meninggal (17,14 ±1,69) dibandingkan kelompok yang hidup (15,37 ±1,25) (p<0,001). Pada kelompok yang meninggal dunia juga didapatkan rerata trombosit yang lebih rendah (p=0,044), median IT rasio (p=0,015) serta procalcitonin yang lebih tinggi (p=0,006). Pada analisis ROC didapatkan RDW efektif dalam memprediksi mortalitas (AUC 0,797, IK 95% 0,685 – 0,908, p<0,001). Titik potong nilai RDW 15,79% memiliki sensitivitas 73% dan spesifisitas 70% dalam memprediksi mortalitas.

Kesimpulan: Peningkatan RDW dapat digunakan sebagai prediktor mortalitas pada pasien sepsis neonatorum.

 

Introduction: Sepsis is a serious health problems in newborns with high mortality rate especially in developing countries. Red cell distribution width (RDW) is currently studied prognostic marker in sepsis. RDW increased in conditions of ineffective RBC’s production or increased of RBC’s destruction that occur in inflammation or sepsis.

Objective: Objective of this study is to determine RDW as a predictor of mortality in neonatal sepsis.

Methods: This research is a cross sectional study. Subject of this research is term neonates with neonatal sepsis treated in Sanglah General Hospital on 2017. Data was taken from medical record.

Results: There were 62 eligible subjects with median age 2.5 days, consists of 36 males (58.06%) and 26 females (41.94%). Based on the onset of sepsis, there were 53 (85.48%) subjects with early onset neonatal sepsis (EONS) and 9 (14.52%) with late onset neonatal sepsis (LONS). Median length of stay (LoS) in this study is 10 days, with outcome death in 35.48% subjects. Mean RDW was found significantly higher in the nonsurvivor (17.14 ±1.69) compared to survivor (15.37 ±1.25) (p<0.001). Nonsurvivor subjects had lower platetet (p=0.044), higher IT rasio (p=0.015) and higher procalcitonin (p=0.006) compared to the survived subjects. ROC analysis showed that RDW is effective in predicting mortality (AUC 0.797, 95% CI 0.685 – 0.908, p<0.001). RDW 15.79% as a cut-off point has 73% sensitivity and 70% specificity in predicting mortality.

Conclusion: Conclusion of this study increased RDW can be used as a predictor of mortality in neonatal sepsis.

Keywords: red cell distribution width (RDW) sepsis neonatorum mortalitas

References

  1. Ellahony DM, El-Mekkawy MS, Farag MM. Study of red cell distribution width in neonatal sepsis. Pediatr emerg care. 2017;00(00):1-6.
  2. Cosar H, Yilmaz O, Temur M, Ozun OP, Bulut Y, Karakulak M. Relationship between early-onset neonatal sepsis and red blood cell distribution width (RDW). J Hematol Thrombo Dis. 2017 Sept;5(2):266.
  3. Gomella TL, Cunningham MD, Eyal FG. Sepsis. In: Gomella TL, Cunningham MD, Eyal FG. Neonatology: management, procedures, on-call problems, diseases, and drugs. Seventh edition. 2013. McGraw Hill education. New York: 1149-59.
  4. Chen J., Jin L., Yang T. Clinical study of RDW and prognosis in sepsis new borns. Biomedical research 2015; 25(4):576-579.
  5. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scandinavian Journal of Clinical & Laboratory Investigation 2008; 68: 745-748
  6. Martin SL, Desai S, Nanavati R, Colah RB, Ghosh K, Mukherjee MB. Red cell distribution width and its association with mortality in neonatal sepsis. The journal of maternal-fetal and neonatal medicine 2018. http://doi.org/10.1080/14767058.2017.1421932
  7. Lanzkowsky P. Classification and diagnosis of anemis in children.Dalam Lanzkowsky P, penyunting. Manual of pediatric hematology and oncology. Edisi kelima. San Diego: Elsevier; 2011:9
  8. Kim CH, Park JT, Kim EJ, Han JH, Han JS, Choi JY, dkk. An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock. Crit care 2013;17:R282
  9. Bazick H, Chang D, Mahadevappa K, Gibbons FK, Christoper KB. Red cell distribution width and all cause mortality in critically ill patients. Crit care med 2011;39:13-21
  10. Ramby AL, Goodman DM, Wald EL, et al. Red blood cell distribution width as a pragmatic marker for outcome in pediatric critical illness. PLoS One. 2015;10:e0129258

How to Cite

Sukewanti, N. M., Darma Artana, I. W., Kardana, I. M., Sukmawati, M., & Junara Putra, P. (2019). Red Cell Distribution Width (RDW) sebagai prediktor mortalitas pada sepsis neonatorum. Medicina, 50(3). https://doi.org/10.15562/medicina.v50i3.757
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