GANGGUAN FUNGSI HATI PADA DEMAM BERDARAH DENGUE (DBD)

Abstract

Background: The pathogenesis of severe dengue virus infections is not completely understood. Multiple organ dysfunctions are considered to be an important cause of death. In severe Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS), liver involvement may be an important prognostic indicator. Objective: To defme differences of liver dysfunction between DHF / Non DSS and DSS patients. Methods: From February 2001 until February 2002 we performed an observational study on the pediatric ward and Pediatric Intensive Care Unit (PICU) of the Dr. Kariadi Hospital, Semarang, Indonesia. Patients, aged 3 — 14 years old, with DHF or DSS according to WHO criteria were enrolled in this study. Bilirubin, SGOT, SGPT, PT, APTT, total protein, and albumin value as parameters of liver function disorder were examined on day of admission, day-2, and day-7. Data were analyzed using MANOVA, MANCOVA, and repeated measure with SPSS 11.5 for Windows soft ware. A P-value 5 0.05 was considered to indicate significance. Results: One hundred patients were included in our analysis and consisted of 49 Non DSS and 51 DSS patients. Using MANCOVA analysis, there was a significant difference of liver dysfunction between Non DSS and DSS patients on day of admission (F = 3.337; p = 0.003; a2 = 0.273), day-2 (F = 2.316; p = 0.029; e = 0.205), and day-7 observation (F = 2.190; p = 0.041; c2 = 0.226). On day of admission, there was a significant difference of SGOT (F = 8.894; p = 0.004), SGPT (F = 6.324; p= 0.014), PT (F = 4.448; p = 0.038), APTI- (F = 6.449; p = 0.013), total protein (F = 16.801; p = < 0.001), and albumin (F = 15.821; p < 0.001). On day-2, there was a sipificant difference of SGOT (F = 3.328; p = 0.024), total protein (F = 3.868; p = 0.053), and albumin (F = 11.585; p = 0.001). On day-7, there was a significant difference of direct bilirubin (F = 9.509; p = 0.003). Using repealed measure analysis, a significant difference of total bilirubin, SGOT, SGPT, APTT, total protein, and albumin (p < 0.05) was found, but no significant difference of direct bilirubin and PT (p > 0.05). The alteration of liver function disorder parameters showed different pattern and kinetic between Non DSS and DSS patients. Several liver function parameters are significantly associated with severity. Conclusion: There was significant difference in liver dysfunction between Non DSS and DSS patients during hospitalization measured by several liver function parameters. Since several liver function parameters showed different pattern and kinetic between Non DSS and DSS patients the combination of parameters may serve as prognostic indicators of disease severity. Latar belakang: Patogenesis infeksi virus dengue belum sepenuhnya diketahui. Disfungsi organ multipel dipertimbangkan sebagai penyebab kematian penting. Pada demam berdarah dengue (DBD) berat atau sindrom syok dengue (SSD), keterlibatan hati mungkin merupakan indikator prognosis penting. Tujuan: Untuk mengetahui perbedaan gangguan fungsi hati pada penderita DBD tanpa syok (Non SSD) dan SSD. Metode: Dari Februari 2001 sampai Februari 2002 dilakukan penelitian observasional di bangsal anak dan Pediatric Intensive Care Unit (PICU) Rumah Sakit Dr. Kariadi Semarang Indonesia Pasien-pasien berusia 3 — 14 tahun dengan diagnosis DBD atau SSD berdasarkan criteria WHO dilibatkan dilibatkan dalam penelitian ini. Kadar bilirubin, SGOT, SGPT, PT, APT'', protein total, dan albumin sebagai parameter gangguan fungsi hati diperisa pada saat masuk rumah sakit, hari ke-2, dan hari-7 perawatan. Data dianalisis dengan uji MANOVA, MANCOVA, dan repeated measure menggunakan program SPSS 11.5 for Windows. Bermakma apabila p < 0,05. Hasil: Didapatkan 100 penderita, terdiri dari 49 penderita Non SSD dan 51 penderita SSD. Hasil analisis MANCOVA menunjukkan terdapat perbedaan gangguan fungsi hati antara penderita Non SSD dan SSD pada saat masuk rumah sakit (F = 3,337; p = 0,003; e = 0,273), hari ke-2 (F = 2,316; p = 0,029; a = 0,205), dan hari ke-7 pengamatan (F = 2,190; p = 0,041; 82 = 0,226). Pada saat masuk terdapat perbedaan bermakna nilai SGOT (F = 8,894; p = 0,004), SGPT (F = 6,324; p = 0,014), PT (F = 4,448; p = 0,038), APTT (F = 6,449; p = 0,013), protein total (F = 16,801; p = < 0,001), dan albumin (F = 15,821; p < 0,001). Pada hari ke-2 terdapat perbedaan bermakna nilai SGOT (F = 3,328; p = 0,024), protein total (F = 3,868; p = 0,053), dan albumin (F = 11,585; p = 0,001). Pada hari ke-7, terdapat perbedaan bermakna nilai bilirubin direk (F = 9,509; p = 0,003). Menggunakan analisis repeated measure, diperoleh perbedaan bermakna nilai bilirubin total, SGOT, SOPT, APTT, protein total, dan albumin (p < 0,05), tetapi tidak terdapat perbedaan bermakna nilai bilirubin direk dan PT (p > 0,05). Perubahan nilai parameter gangguan fungsi hati menunjukkan pola dan kinetik berbeda antara penderita Non SSD dan SSD. Beberapa parameter fungsi hati berhubungan bermakna dengan derajat penyakit. Kesimpulan: Terdapat perbedaan gangguan fungsi hati antara penderita Non SSD dan SSD pada tiap hari pengamatan berdasarkan pemeriksaan parameter fungsi hati. Sejak beberapa parameter fungsi hati menunjukkan pola dan kinetik yang berbeda antara penderita Non SSD dan SSD, gabungan (kombinasi) parameter-parameter tersebut dapat dijadikan sebagai indikator prognosis derajat penyakit.