Prediktor Mortalitas Pasien HIV/AIDS Rawat Inap

Abstract

Pendahuluan. Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) adalah masalah besar yang mengancam Indonesia dan banyak negara di seluruh dunia. Pengetahuan tentang karakteristik dan prediktor mortalitas dapat membantu dalam penatalaksanaan pasien. Penelitian ini bertujuan untuk mengetahui faktor-faktor prediktor mortalitas pasien HIV/AIDS dewasa yang dirawat di RSUPN Dr. Cipto Mangunkusumo (RSCM).Metode. Penelitian ini merupakan studi kohort retrospektif pada pasien rawat inap dewasa RSCM yang didiagnosis HIV/ AIDS selama tahun 2011-2013. Data klinis dan laboratorium beserta status luaran (meninggal atau hidup) dan penyebab mortalitas selama perawatan diperoleh dari rekam medis. Analisis bivariat menggunakan uji Chi-Square dilakukan pada tujuh variabel prognostik, yaitu jenis kelamin laki-laki, tidak dari rumah sakit rujukan, tidak pernah/putus terapi antiretroviral (ARV), stadium klinis WHO 4, kadar hemoglobin <10 g/dL, kadar eGFR <60 mL/min/1,73 m2 dan kadar CD4+ absolut ≤200 sel/ μL. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat dengan regresi logistik.Hasil. Dari 606 pasien HIV/AIDS dewasa yang dirawat inap (median usia 32 tahun; laki-laki 64,2%), sebanyak 122 (20,1%) baru terdiagnosis HIV selama rawat dan 251 (41,5%) dalam terapi ARV. Median lama rawat adalah 11 (rentang 2 sampai 75) hari. Sebanyak 425 (70,1%) pasien dirawat karena infeksi oportunistik. Mortalitas selama perawatan sebesar 23,4% dengan mayoritas penyebabnya (92,3%) terkait AIDS. Prediktor independen mortalitas yang bermakna adalah stadium klinis WHO 4 (OR=6,440; IK 95% 3,701-11,203), kadar hemoglobin <10 g/dL (OR=1,542; IK 95% 1,015-2,343) dan laju filtrasi glomerulus (LFG) estimasi <60 mL/min/1,73 m2 (OR=3,414; IK 95% 1,821-6,402).Simpulan. Proporsi mortalitas selama perawatan sebesar 23,4%. Stadium klinis WHO 4, kadar hemoglobin <10 g/dL dan kadar eLFG <60 mL/min/1,73 m2 merupakan prediktor independen mortalitas pasien HIV/AIDS dewasa saat rawat inap.Kata kunci: HIV/AIDS, prediktor mortalitas Predictors of Mortality in Hospitalized HIV/AIDS PatientsIntroduction. Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is a big problem that threatening in Indonesia and many countries in the world. The knowledge on the characteristics and prediction of outcome were important for patients management. There are no studies on the predictors of mortality in Indonesia. Methods. We performed a retrospective cohort study among hospitalized patients with HIV/AIDS in Cipto Mangunkusumo Hospital between 2011-2013. Datas on clinical, laboratory measurement, outcome (mortality) and causes of death during hospitalization were gathered from medical records. Bivariate analysis using Chi- Square test were used to evaluate seven prognostic factors (male sex, not came from referral hospital, never received/failed to continue antiretroviral therapy (ART), clinical WHO stage 4, hemoglobin level <10 g/dL, eGFR level <60 mL/min/1.73 m2 and CD4+ count ≤200 cell/μL). Multivariate logistic regression analysis was performed to identify independent predictors of mortality. Results. Among 606 hospitalized HIV/AIDS patients (median age 32 years; 64.2% males), 122 (20.1%) were newly diagnosed with HIV infection during the hospitalization and 251 (41.5%) had previously received ART. Median length of stay was 11 (range 2 to 75) days. There were 425 (70.1%) patients being hospitalized due to opportunistic infection. In-hospital mortality rate was 23.4% with majority (92.3%) due to AIDS related illnesses. The independent predictors of mortality in multivariate analysis were clinical WHO stage 4 (OR=6.440; 95% CI 3.701-11.203), hemoglobin level <10 g/dL (OR=1.542; 95% CI 1.015- 2.343) and eGFR level <60 mL/min/1.73 m2 (OR=3.414; 95% CI 1.821-6.402). Conclusions. In-hospital mortality rate was 23.4%. Clinical WHO stage 4, hemoglobin level <10 g/dL and eGFR level <60 mL/ min/1.73 m2 were the independent predictors of in-hospital mortality among hospitalized patients with HIV/AIDS. Keywords: HIV/AIDS, predictors of mortality

Clinical Signs and Laboratory Parameters as Predictors of Mortality among Hospitalized Human Immunodeficiency Virus-Infected Adult Patients at Tertiary Hospital in Surabaya

“…Multivariate analysis done in this study showed that impaired renal function had a significant correlation to HIV/AIDS patients' mortality with an OR 2.646 (95% CI 1.314-5.328). This study supported the research conducted in Jakarta [6] as well as the research conducted by Wyatt et al However, there was a slight difference between the result of this study and a study conducted by Wyatt et al Categorized into acute renal failure and chronic kidney disease, Wyatt et al study stated that acute renal failure ( OR=5.84; 95% CI 5.11-6.65) possessed higher mortality risk compared to chronic kidney disease (OR=1.97%; 95% CI 1.59-2.45) [28].…”

“…This condition can increase the cardiovascular risk which leads to morbidity and mortality [30]. Disorders of electrolytes or acid base and fluid retention in impaired kidney function can also increase the mortality risk [6].…”

“…There have been various studies conducted to deepen the understanding of the characteristics and predictor factors of HIV-infected adult people's mortality. Some mortality predictors reported were platelets, glomerular filtration rate, liver function, serum albumin, CD4 values, and body mass index (BMI) [4], [5], [6]. The previous retrospective and prospective studies showed a variety of data relating to the characteristics of the research subject, socioeconomic conditions, and the length of the study conducted [7], [8], [9], [10].…”

Retracted: Studi Literatur: Status Infeksi Tuberkulosis dan Progresi Penyakit HIV

“…Data Global tuberculosis report 2019 menyebutkan dari 1,2 juta orang yang baru mendaftar perawatan HIV pada 2018, 8% diantaranya didiagnosis TB ditahun yang sama dan secara global tercatat ada 477,461 penderita HIV yang mengalami TB (World Health Organization, 2019). Dalam penelitian yang dilakukan Puspitasari et al, (2016) pada 606 pasien HIV/AIDS di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta dengan HIV/AIDS selama tahun 2011-2013 ditemukan ada 131 kematian akibat AIDS dengan 23,9% diantaranya disebabkan TB paru.…”

Disobedience in Medication and Opportunistic Infection as Lead Factors to HIV/AIDS Mortality at Kencong Public Health Center, Jember

“…The causing factors of HIV transmission are multiple sexual partners, injecting drug users, transmission of homosexual partners, and blood transfusions. As the disease progresses, the immune system decreases so people with HIV / AIDS are susceptible to various opportunistic infections (Puspitasari et al, 2016).…”