Sepsis merupakan penyebab kedua tertinggi kematian di instalasi rawatan intensif dan merupakan 10 penyebab tertinggi kematian di seluruh dunia. Menurut Survival Sepsis Campaign 2012 penanganan awal pada pasien sepsis dengan pemberian cairan memberikan respons yang lebih baik dengan pemberian 30 mL/kgBB cairan kristaloid. Penelitian ini bertujuan membandingkan jenis cairan kristaloid mana yang merupakan pilihan lebih baik untuk resusitasi atau early goal directed therapy (EDGT) pada pasien sepsis. Penelitian ini merupakan uji klinis acak tersamar ganda yang dilakukan pada periode bulan Desember 2016-Januari 2017 di RSUP Haji Adam Malik Medan. Empat puluh pasien yang memenuhi kriteria inklusi dan tidak termasuk eksklusi dinilai perubahan analisis gas darah, elektrolit (natrium, kalium, klorida), dan laktat sebelum dengan sesudah resusitasi cairan Ringer asetat malat dan Ringer laktat. Dari 40 pasien yang memenuhi kriteria, pemberian Ringer asetat malat yang dibandingkan dengan Ringer laktat pada pasien sepsis, nilai analisis gas darah (AGDA) mengalami perbaikan pada nilai HCO 3 (p=0,001), TCO 2 (p=0,002), base excess (BE) (p=0,048). Pemberian cairan ringer asetat malat menunjukkan peningkatan nilai analisis gas darah, natrium, dan laktat yang lebih baik daripada Ringer laktat. Simpulan, pemberian cairan Ringer asetat malat pada EGDT pasien sepsis lebih baik dalam menjaga keseimbangan asam basa di dalam tubuh dibanding dengan pemberian Ringer laktat.

AbstrakSepsis berat merupakan kondisi umum di unit perawatan intensif (UPI) dan rawat inap yang berhubungan dengan mortalitas, morbiditas, dan biaya perawatan yang tinggi. Tujuan penelitian ini ingin mendapatkan skor alternatif yang lebih sederhana, yaitu nilai mean platelet volume (MPV) sebagai prediktor mortalitas pada pasien sepsis berat selain skor APACHE II. Penelitian ini menggunakan desain cross sectional pada 76 pasien sepsis berat dewasa di Rumah Sakit H. Adam Malik Medan pada Oktober 2015-Januari 2016 yang memenuhi kriteria inklusi. Data yang diambil adalah nilai MPV dan skor APACHE II pada saat pertama sekali terdiagnosis sepsis berat, kemudian dilihat mortalitas pasien tersebut. Uji korelasi Spearman menunjukkan bahwa terdapat korelasi lemah yang signifikan (p=0,006) antara MPV dan APACHE II dengan nilai r (korelasi) = 0,314. Nilai MPV pada penelitian ini tidak memiliki kemampuan dalam memprediksi mortalitas (AUC) ROC 58,2% (IK 95%: 45,1-71,2%; p=0,223); sedangkan skor APACHE II memiliki kemampuan yang sedang dalam memprediksi mortalitas (AUC) ROC 70,4% (IK 95%: 58,6-82,2%; p= 0,002 Correlation between Mean Platelet Volume (MPV) and Apache II Score as Mortality Predictors in Severe Sepsis Patients at Haji Adam Malik General Hospital Medan AbstractSevere sepsis is a general condition in the Intensive Care Unit (ICU) and inpatient wards which correlates with mortality, morbidity, and high cost hospitalization. The main point of this study was to explore the possibility to use the mean platelet volume (MPV) as an easier alternative score for mortality predictor in addition to APACHE II score in severe sepsis patients. This study used cross-sectional design on 76 adult severe sepsis patients in Haji Adam Malik General Hospital Medan who met inclusion criteria during the periood of October 2015 to January 2016. Data collected were MPV value and APACHE II score, which were collected the first time patient was diagnosed as having severe sepsis which was then observed for their mortality The Spearman correlation tests showed that there was a weak yet significant correlation (p=0.006) between MPV and APACHE II with r (correlation) = 0.314. The MPV values in this study were unable to predict mortality (AUC) ROC 58.2% (95% CI: 45.1-71.2%, p=0.223). whereas the APACHE II score has a moderate ability to predict mortality (AUC) ROC 70,4% (95% CI: 58,6-82,2%, p= 0.002). The cut-off point of APACHE II was 19 with a sensitivity of 65.9% and a specificity of 65.7%, and a PPV of 69.2% and NPV of 62.2%. Therefore, based on this study the MPV score cannot be used as a mortality predictor in severe sepsis patients.

Introduction: Lactate is an intermediate metabolic that is non-toxic and were produced by all cells. In sepsis patients, increased lactate occurs due to tissue hypoperfusion and represent a sign of tissue hypoxia. A clinical scoring system such as Sequential Organ Failure Assessment (SOFA), was commonly utilized to assess the severity of sepsis periodically based on several clinically significant organ dysfunction. The purpose of this study was to investigate the correlation of lactate levels with SOFA scores on sepsis patients treated in ICU.Method: This is a prospective cohort study, involving 57 patients with sepsis who met the inclusion and exclusion criteria. The blood lactate levels were measured, and the SOFA scores were calculated, which then analyzed with Spearman correlation test.Results: There was a weak but significant correlation between lactate levels and 24-hour SOFA Score (r = 0.303, p = 0.022). An intermediate correlation was obtained with 48 hours SOFA Score (r = 0.449, p = 0.000). Organ dysfunction that plays a significant role in increased lactate in this study were the central nervous system, respiratory system, liver, and kidneys.Conclusion: There was an association between lactate levels and SOFA scores at 24th and 48th hour. SOFA Score can be considered as proper parameters to evaluate the deterioration of septic patients treated in the ICU.

Introduction: Sepsis is a major health problem, and the incidence is still increasing. Generally, sepsis occurs in about 2% of all inpatients in developed countries. The immunologic response that causes sepsis is a systemic inflammatory response that causes activation of the inflammatory and coagulation pathways. If sepsis untreated, it can lead to organ failure then death. Organ dysfunction is expressed as an acute change of Sequential Organ Failure Assesment (SOFA) score >2 points as a consequence of infection.Methods: This is a cohort prospective’s study. Prothrombin time (PT), activated partial thromboplastin time (aPTT), Thrombin time (TT), Fibrinogen, D-dimer were examined 3 times (first, second, third day), and then assessed to see its relation with the corresponding SOFA score. Twenty-four subjects of the study were ICU patients in H. Adam Malik Hospital who matched the inclusion and exclusion criteria.Results: There were significant differences of PT on the first, second and third day (p =0.03). There were no significant differences in aPTT, TT, Fibrinogen, D-dimer on the first, second, third day. There were no significant correlations of PT, aPTT, TT, Fibrinogen with the corresponding SOFA score on the first, second, third day. There was a moderate positive correlation between D-dimer and SOFA score in the first, second and third day of examinations (p <0.05).Conclusion: PT changes occurred significantly on the first, second, third day of sepsis and D-dimers can be used to asses the risk of organ failure in septic patients.

Latar Belakang : Salah satu faktor penyebab infeksi bakteri adalah peralatan yang digunakan, tehnik aseptik yang salah, atau larutan antiseptik yang dipakai. Larutan antiseptik yang biasa digunakan pada pemasangan kateter vena sentral adalah Chlorhexidine 2% dan Povidone Iodine 10%. Efektifitas kedua larutan antiseptik ini berbeda di beberapa penelitian, dimana hal tersebut berpengaruh pada resiko terjadinya CRBSI.Tujuan : Mendapatkan antiseptik yang optimal dalam menurunkan jumlah kepadatan kuman dan menurunkan angka kejadian CRBSI.Metode : Penelitian ini dilakukan dengan metode Analitic Cohort Study Design dengan jumlah sampel 40 pasien UPI Dewasa RSUP HAM yang dibagi dalam dua kelompok, yaitu kelompok A Chlorhexidine 2% - alcohol 70%, dan kelompok B Povidone Iodine 10% - alcohol 70%, dilakukan dengan single blind. Desain penelitian dilakukan perhitungan kepadatan kuman dengan swab lidi steril dengan pre test – post test control grup. Untuk membandingkan perbedaan kepadatan kuman masing – masing grup sebelum dan sesudah pemberian antiseptik, digunakan analisa uji t, sedangkan untuk membandingkan penurunan jumlah kepadatan kuman (respon antiseptik) digunakan analisa uji t – pair. Interval kepercayaan 95% dengan nilai p < 0,05, dianggap bermakna secara signifikan.Hasil : Penurunan jumlah kepadatan kuman terbesar terjadi pada kelompok A dengan rerata 99,87% (SB=0,28%), sedangkan pada kelompok B rerata penurunan 98,83% (SB=1,86%) dengan nilai p = 0,001.Kesimpulan : Chlorhexidine 2% - alcohol 70% lebih efektif menurunkan jumlah kepadatan kuman dan menurunkan angka kejadian CRBSI dibandingkan Povidone Iodine 10% - alcohol 70%.