Korelasi Modified Nutric Score dengan Mortalitas 28 Hari Pasien Sepsis di Unit Perawatan Intensif RSUP Dr. Mohammad Hoesin Palembang

Rieke Cahyo Budi Utami, Zulkifli Zulkifli, Rizal Zainal, Muhammad Irsan Saleh

Abstract


Malnutrisi merupakan masalah penting pada pasien sepsis karena memperburuk outcome akibat penyembuhan luka terganggu, menurunkan fungsi imun, risiko infeksi tinggi, kelemahan otot sehingga weaning ventilator mekanik lebih sulit, meningkatkan lama tinggal dan biaya tinggi di unit perawatan intensif serta peningkatan mortalitas. Skrining risiko nutrisi saat pasien masuk unit perawatan intensif dengan modified NUTRIC score dapat mengidentifikasi kelompok risiko nutrisi tinggi atau risiko rendah. Penelitian kohort retrospektif untuk mengetahui korelasi antara modified NUTRIC score dengan mortalitas pada pasien sepsis yang dirawat dari Januari‒Desember 2018 di RSUP Dr. Mohammad Hoesin Palembang. Jumlah sampel 100 orang, dibagi 2 kelompok berdasarkan mortalitas, kemudian dilakukan pengukuran modified NUTRIC score yang terdiri dari usia, skor APACHE II, skor SOFA, lama rawat sebelum masuk perawatan intensif, dan jumlah komorbid. Modified NUTRIC score memiliki nilai 0‒9. Hasil analisis ROC curve modified NUTRIC score dengan mortalitas didapatkan sensitiftas sebesar 96%, spesifisitas 71%, nilai area under the curve (AUC) 0,916 dengan nilai cut off >4. Terdapat korelasi antara modified NUTRIC score dengan mortalitas dalam 28 hari pasien sepsis dengan koefisien korelasi (r)=0,716 dan nilai p=0,0001.

 

Correlation of Modified Nutric Score with 28-Day Mortality in Sepsis Patients at Intensive Care Unit of Dr. Mohammad Hoesin General Hospital Palembang

Malnutrition is an essential problem to septic patients because it worsens the outcome due to impaired wound healing, decreases immune function, high risk of infection, and muscle weakness so that mechanical ventilator weaning is more complicated. Also, it increases the patient length of stay and costs in the intensive care unit and increases mortality. Nutrition risk screening on patients’ admission to the intensive care unit with modified NUTRIC score can identify groups of high nutritional risk or low risk. The retrospective cohort study aimed to determine the correlation between modified NUTRIC score and mortality in sepsis patients treated from January-December 2018 at dr. Mohammad Hoesin General Hospital Palembang. The total sample of 100 people was divided into 2 groups based on mortality then measured with modified NUTRIC score consisting of age, APACHE II score, SOFA score, length of stay before admission to the intensive care, and the number of comorbid based on data from medical records. Modified NUTRIC score has a value of 0‒9. The ROC curve modified NUTRIC score with mortality was 96% sensitivity, 71% specificity, area under curve (AUC) value 0.916 with a cut-off value >4. There is a correlation between the modified NUTRIC score and mortality in 28 days in sepsis patients in the Intensive Care Unit of Dr. Mohammad Hoesin General Hospital Palembang with a correlation coefficient (r) = 0,716 and p value <0,05.


Keywords


Modified NUTRIC score, mortalitas, sepsis

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References


Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA J Am Med Assoc. 2016;315(8):801–10.

Lestari MI. Kegagalan resusitasi, kadar protein carbonyl dan kadar reseptor-interacting protein kinase 3 sebagai prediktor kematian pasien sepsis [disertasi]. Universitas Indonesia; 2019.

Wischmeyer PE. Nutrition therapy in sepsis. Crit Care Clin. In press 2017.

Lee ZY, Heyland DK. Determination of nutrition risk and status in critically ill patient: what are our considerations?. Nutrition in Clinical Practice. 2018;00 (0). American Society for Parenteral and Enteral Nutrition.

Vries MC, Koekkoek K, Opdam MH, Blokland D, Zanten A. Nutritional assesment of critically ill patient: validation of the modified NUTRIC score. European J Clin Nutr. 2018;72:428–35.

Mendes R, Policarpo S, Fortuna P, Alves M, Virella D, Heyland DK. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients-a multicenter prospective cohort study. J Crit Care. 2016;37:45–9.

Heighes PT, Doig GS, Simpson F. Timing and indication for enteral nutrition in the critically ill. Dalam: Seres DS, Van Way CW, penyunting. Nutrition support for the critically ill. Springer International Publishing Switzerland. 2016. hlm. 55–62.

Jeong DH, Hong SB, Lim CM, Koh Y, Seo J, Kim Y, dkk. Comparison of accuracy of NUTRIC and modified NUTRIC scores in predicting 28-day mortality in patients with sepsis: a single center retrospective study. Nutrients. 2018;10:911.

Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr. 2016;35(1):158–62.

Mukhopadhyay A, Jeyakumar H, Ong V, Leong CS, Teh AL, Van Dam RM, dkk. Association of modified NUTRIC score with 28-day mortality in critically ill patients. Clin Nutr. 2016;36(4):1143–8.

Kalaiselvan MS, Renuka MK, Arunkumar AS. Use of nutrition risk in critically ill (NUTRIC) score to assess nutritional risk in mechanically ventilated patients: a prospective observational study. Indian J Crit Care Med. 2017;21(5):253–6.

Moretti D, Bagilet DH, Buncuga M, Settecase CJ, Quaglino MB, Quintana R. Study of two variants of nutritional risk score “NUTRIC” in ventilated critical patients. Nutr Hosp. 2014;29(1):166–72.

Lew CCH, Cheung KP, Chong MFF, Chua AP, Fraser RJL, Miller M. Combining 2 commonly adopted nutrition instruments in the critical care setting is superior to administering either one alone. JPEN J Parenter Enteral Nutr. 2018;42(5):872–6.

Prescott HC. The epidemiology of sepsis. Dalam: Wiersinga WJ, Seymour CW, penyunting. Handbook of sepsis. Switzerland: Springer; 2018.

Angele MK, Pratschke S, Hubbard WJ, Chaudry IH. Gender differences in sepsis: Cardiovascular and immunological aspects. Virulence. 2014;5(1):12–9




DOI: https://doi.org/10.15851/jap.v8n1.1980



 

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