Background: Increased capillary permeability in sepsis is associated with several complications and worse outcomes. Glycocalyx degradation, marked by increased serum syndecan-1 levels, alters vascular permeability, which can manifest as albuminuria in the glomerulus. Therefore, elevated urinary albumin to creatinine ratio (ACR) potentially provides an index of systemic glycocalyx degradation. The aim of this study was to analyze the correlation between urinary ACR and serum syndecan-1 levels.Methods: A longitudinal prospective study with repeated cross-sectional design was conducted on children with sepsis in pediatric intensive care unit, we evaluated serum syndecan-1 levels and urinary ACR on days 1, 2, 3, and 7. A descriptive study on healthy children was also conducted to determine the reference value of syndecan-1 in children.Results: 49 subjects with sepsis were recruited. Based on the data of the healthy children group (n=30), syndecan-1 level of >90th percentile (41.42 ng/mL) was defined as systemic glycocalyx degradation. The correlation coefficients (r) between urinary ACR and syndecan-1 levels were 0.32 (p<0.001) from all examination days (162 specimens), 0.298 (p=0.038) on day 1, and 0.469 (p=0.002) on day 3. The area under the curve of urinary ACR and systemic glycocalyx degradation was 65.7% (95% CI 54.5%–77%; p=0.012). Urinary ACR ≥157.5 mg/g was determined as the cut-off point for glycocalyx degradation, with a sensitivity of 77.4% and a specificity of 48%.Conclusion: Urinary ACR showed a weak correlation with systemic glycocalyx degradation, indicating that the pathophysiology of elevated urinary ACR in sepsis is not merely related to glycocalyx degradation.
Background: Rheumatic heart disease is an acquired disease that has characterized damaged valve and it effects the quality of life in children.
Aim: To asses quality of life in patient with rheumatic heart disease by using Pediatric Quality of Life Inventory (PedsQL) instrument at pediatric cardiologist.
Methods: A descriptive study with cross sectional study conduct among children aged 5 to 18 years old attend the Pediatric Cardiology at Haji Adam Malik Hospital Medan, from 2016 to 2018.
Result: A hundred children with rheumatic heart disease in this study who had affected quality of life-based on group age with 5 to 7 year old in physical function was 6 subjects (85.7%), social function was 1 subject (14.2%), and school function was 2 subjects (28.5%) (Table 3); group age with 8 to 12 year old in physical function was 100 subjects (100%), emotional function was 3 subjects (3%), social function was 1 subject (3%), and school function was 5 subjects (15.1%); group aged 13 to 18 year old in physical function was 60 subjects (100%), emotional function was 1 subject (16.7%), and school function was 51 subjects (85%).
Conclusion: From 100 children with RHD dominant in group aged 13-18 years old and male, mal malnutrition status, using of erythromycin, high senior school of level parents’ education, and valve disorder was mitral regurgitation. The quality of life was affected in all age groups, especially in the domain of physical function, and school functions with RHD.
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