Frekuensi dan Mortalitas Pasien Sepsis dan Syok Septik di ICU Rumah Sakit Swasta Tipe B, di Tangerang Selatan

Abioso Wicaksono, Asri C. Adisasmita, Eddy Harijanto

Abstract


Syok septik, yang didefinisikan sebagai sepsis dengan abnormalitas pada system sirkulasi and selular atau metabolic, masih merupakan salah satu penyebab kematian di Intensive Care Unit (ICU) secara global (20%). Studi kros-seksional ini bertujuan untuk mengetahui frekuensi, faktor risiko syok septik dan mortalitas pada pasien sepsis yang dirawat di ICU di Indonesia. Sampel dikumpulkan dari RS tipe B di Tangerang Selatan, Banten tahun 2020. Data yang dikumpulkan terdiri dari tempat infeksi, komorbiditas: Diabetes Melitus (DM) II, hipertensi, penyakit paru obstruksi kronis dan penyakit ginjal Kronis, asal unit sebelum masuk ICU, Glasgow Coma Score (GCS), acute respiratory distress syndrome (ARDS), lama rawat di ICU, syok septik dan mortalitas. Prevalens, frekuensi faktor risiko untuk syok septik dan kematian secara umum diantara pasien sepsis di ICU diukur dengan persentase, dan untuk perbedaan karakteristik diukur menggunakan chi-square untuk kemaknaannya. Terdapat 110 pasien di ICU dengan diagnosis sepsis di tahun 2020. Sumber infeksi tertinggi adalah pulmoner (39,1%) dan intra-abdominal (31,8%). Komorbiditas tersering pada pasien sepsis adalah hipertensi (53.6%), diikuti oleh DM (44.5%). Mayoritas lama rawat di ICU adalah melebihi 7 hari (67.3%). Risiko terjadinya syok sepsis tertinggi didapatkan pada para pengguna BPJS1.53 (95%CI, 0.83-2.82), pasien dengan gizi lebih: 1.59 (95%CI, 0.63-4.03), pasien alih rawat dari ruang rawat non-intensif: 2.28 (95%CI, 1.19-4.35), penyakit paru  obstruksi kronis: 1.95 (95%CI, 0.55-6.90), dan penyakit urogenital kronis.: 1.93 (95%CI, 0.78-4.78) dibandingkan dengan referensnya masing-masing. Penelitian serupa di negara LMIC diperlukan untuk mendapatkan informasi mengenai beban riel karena sepsis dan syok septik secara regional.

Keywords


Sepsis, Syok Septik, ICU, Mortalitas

References


Singer, M. et al. The Third International Consensus Defnitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315, 801–810

Rudd, K. E. et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: Analysis for the Global Burden of Disease Study. Lancet 395, 200–211

Angus D. C. et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7):1303–10

Paoli, C. J. et al. Epidemiology and Cost of Sepsis in the United States – An Analysis based on timing of diagnosis and severity level. Crit Care Med. 2018; 46(12):1889-1897

Wang M, Jiang L, Zhu B, Li W, Du B, Kang Y, et al. The Prevalence, Risk Factors, and Outcomes of Sepsis in Critically Ill Patients in China: A Multicenter Prospective Cohort Study. Front Med. 2020;7(December):1–11.

Abe T, Yamakawa K, Ogura H, Kushimoto S, Saitoh D, Fujishima S, et al. Epidemiology of sepsis and septic shock in intensive care units between sepsis-2 and sepsis-3 populations: sepsis prognostication in intensive care unit and emergency room (SPICE-ICU) Toshikazu Abe1,2,3* , Kazuma Yamakawa4, Hiroshi Ogura5, Shigeki Kushimo. 2020;1–9.

Bauer, M. et al. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019—Results from a systematic review and meta-analysis. Crit. Care (Lond. Engl.) 2020;24, 239

Schultz, M. J. et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future. Intensive Care Med. 2017; 43, 612–624.

Rhodes, A. et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Crit. Care Med. 45, 486–552

Seymour, C. W. et al. Time to treatment and mortality during mandated emergency care for sepsis. N. Engl. J. Med. 2017;376, 2235–2244.

Angus, D. et al. Epidemiology of Sepsis: An update. Crit. Care Med. 2001;29(7), S109-S116

Fleischmann, C. et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am. J. Respir. Crit. Care Med. 2016;193, 259–272.

Phua, J. et al. Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ. 2011, 342.

Southeast Asia Infectious Disease Clinical Research Network. Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study. Lancet Glob. Health 5. 2017, e157–e167.

SepNet Critical Care Trials Group. Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med. 2016;42(12):1980–9.

Chiu C and Legrand M. Epidemiology of Sepsis and Septic Shock. Current Opinion in Anaesthesiology. 2021;34(2), 71-76.

Do SN, Luong CQ, Pham DT, Nguyen MH, Nguyen NT, Huynh DQ, et al. Factors relating to mortality in septic patients in Vietnamese intensive care units from a subgroup analysis of MOSAICS II study. Sci Rep [Internet]. 2021;11(1):1–12. Available from: https://doi.org/10.1038/s41598-021-98165-8

Weng L, Fan J, Yu C, Guo Y, Bian Z, Wei Y, et al. Body-mass index and long-term risk of sepsis-related mortality: A population-based cohort study of 0.5 million Chinese adults. Crit Care. 2020;24(1):1–9.

Bouza C, López-Cuadrado T. Epidemiology and trends of sepsis in young adults aged 20–44 years: A nationwide population-based study. J Clin Med. 2020;9(1).

Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Med. 2019;7:205031211983504.

Juneja D. Severe sepsis and septic shock in the elderly: An overview. World J Crit Care Med. 2012;1(1):23.

Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care [Internet]. 2019;9(1). Available from: https://doi.org/10.1186/s13613-019-0495-x

Stretch B, Shepherd SJ. Criteria for intensive care unit admission and severity of illness. Surg (United Kingdom) [Internet]. 2021;39(1):22–8. Available from: https://doi.org/10.1016/j.mpsur.2020.11.004

Boonmee P, Ruangsomboon O, Limsuwat C, Chakorn T. Predictors of Mortality in Elderly and Very Elderly Emergency Patients with Sepsis: A Retrospective Study. West J Emerg Med. 2020;21(6):210–8.

Li S, Zhao D, Cui J, Wang L, Ma X, Li Y. Prevalence, potential risk factors and mortality rates of acute respiratory distress syndrome in Chinese patients with sepsis. J Int Med Res. 2020;48(2).




DOI: http://dx.doi.org/10.7454/epidkes.v6i1.6031

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