Sensitivitas dan Spesifisitas Cystatin C dan Kreatinin Serum dalam Mendiagnosis Cedera Ginjal Akut pada Pasien Sepsis yang Dirawat di Ruang Rawat Intensif RSUP H. Adam Malik Medan

Abstract

Kreatinin serum memiliki banyak keterbatasan dalam mendiagnosis cedera ginjal akut (CGA) terutama dalam ruang lingkup unit perawatan intensif sehingga kurang sensitif untuk menggambarkan tingkat disfungsi ginjal pada pasien sakit kritis. Dari sekian banyak penanda biologis baru yang tersedia, terdapat 4 penanda biologis yang saat ini secara luas digunakan para klinisi di seluruh dunia untuk mendeteksi CGA, antara lain neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, KIM-1, dan interleukin-18. Tujuan penelitian ini adalah mengetahui sensitivitas dan spesifisitas cystatin C dan kreatinin serum dalam mendiagnosis cedera ginjal akut pada pasien sepsis yang dirawat di ruang rawat intensif. Jenis penelitian ini adalah uji diagnostik dengan jumlah sampel 24 pasien dan dikerjakan di ruang rawat intensif Rumah Sakit H. Adam Malik (RSHAM) periode Februari–Maret 2014. Populasi dalam penelitian ini adalah semua pasien dewasa dengan sepsis, sepsis berat, dan syok sepsis di ruang rawat intensif. Uji statistik dilakukan dengan metode receiving operator characteristics (ROC) melalui perangkat lunak SPSS 17. Hasil penelitian ini menunjukkan bahwa cystatin C serum lebih superior dibanding dengan kreatinin serum dalam mendeteksi CGA pada pasien sepsis di ruang rawat intensif. Cystatin C memiliki sensitivitas, nilai prediksi positif, nilai prediksi negatif, dan area under curve -receiving operator characteristics (AUC-ROC) yang lebih tinggi dibanding dengan kreatinin serum. Namun, dari nilai spesifisitas dijumpai nilai yang sama pada kedua penanda biologis. Cystatin C serum memiliki nilai cut-off 1,03 mg/L, sedangkan kreatinin serum mempunyai nilai cut-off 1,0 mg/dL. Simpulan, cystatin C dapat dijadikan penanda biologis alternatif untuk deteksi CGA pada pasien sepsis di RRI (Ruang Rawat Intensif) dengan nilai diagnostik yang lebih baik.

Kata kunci: Cedera ginjal akut, cystatin C serum, kreatinin serum

Sensitivity and Specificity of Serum Cystatin C and Creatinine for Diagnosing Acute Kidney Injury in Sepsis Patients Treated in Intensive Care Unit at H. Adam Malik Hospital Medan

Serum creatinine has many limitations when being used to diagnose acute kidney injury (AKI), especially in the scope of intensive care unit due to its low sensitivity to depict the kidney dysfunctional level of critically-ill patients. Out of numerous new available biological markers, four biological markers are widely used all over the world to detect AKI, e.g. neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, KIM-1, and interleukin-18. The purpose of this study was to determine the sensitivity and specificity of serum cystatin C and creatinine in establishing the diagnosis of acute kidney injury in sepsis patients treated in intensive care room. This study was a diagnostic test to 24 patients and conducted in intensive care room of H. Adam Malik Hospital during the period of February–March 2014. Population in this study is all adult patients with sepsis, severe sepsis, and septic shock in the intensive care room. A statistical test was conducted using receiving operator characteristics (ROC) method using SPSS 17 software. The result of this study showed that serum cystatin C was more superior than serum creatinine in detecting acute kidney injury in sepsis patients treated in intensive care room. In this study, cystatin C had higher sensitivity, positive prediction score, negative prediction score, and area under curve -receiving operator characteristics (AUC-ROC) than serum creatinine. As of specificity, there was no significant difference between these two biological markers. Serum cystatin C had a cut-off point of 1.03 mg/dL, and serum creatinine had 1.0 mg/dL. In conclusion, cystatin C can be an alternative biological marker to detect AKI in sepsis patients treated in intensive care room with a better diagnostic value.

Key words: Acute kidney injury, serum creatinine, serum cystatin C

DOI: 10.15851/jap.v4n2.819