FAKTOR-FAKTOR RISIKO KEMATIAN PADA PENDERITA LEPTOSPIROSIS BERAT DI RUMAH SAKIT SE-KOTA SEMARANG

Abstract

Background • Human leptospirosis, a worldwide zoonosis, is endemic in Indonesia. Clinical manifestation of human leptospirosis vary from mild as flu-like syndrome to severe disease with multi-organs involvement such as jundice, renal failure,haemorrhagic pneumonitis, myocarditis etc, In general, the reported mortality rates of severe leptospirosis range between 5% and 40% or even higher. What is the risk factors associated with mortality patients with severe leptospirosis admitted to the hospitals of Semarang city. Objective of study : Identification the kind and big about demography factors, clinical spectum, and laboratory findings associated with mortality patients with severe leptospirosis admitted to the hospitals of Semarang. Methods : A cross sectional study was done during period of November 2002 to Mei 2005. Subjects were patients with confirmed diagnosis of severe leptospirosis admitted to the hospitals (Dr. Kariadi, Telogorejo, St. Elisabeth, Roemani. Pantiwilasa and Municipal) located in Semarang city. All of the subject do anamnesis, fisical examinations, ECG, and laboratory (hematology, LFT, renal function test, and serology). Results : A total of 56 patients included in the study consited of 38 males, with mean age 43,5 years. Bivariate analysis showed that risk factors associated with mortality patients with severe leptospirosis (p < 0,05) are : age, the long fever, cough (OR 5,0; 95% CI 1,32-18,81), dyspneu (25,5; 95% CI 4,7 - 137,2), hematemesis (OR 5.55; 95% CI 1,35 -22,76), echymosis (OR 5,20; 95% CI 0,9 - 27,1) , gum bleeding ( OR 5,45; 95% CI 0,81 - 36,81), delirium (OR 10,3; 95% CI 2,4 - 44,1), rales (OR 16,9; 95% CI 3.25 - 87,8), oliguri (OR 4,1; 95% CI 0,9 - 17,3), leukositosis (OR 0,18; 95% CI 0.04 - 0.8). DIC (OR 30,7; 95% CI 3,2 - 271), haemoptoe (OR 0,2; 95% CI 0,1- 0,3), gastrointestinal bleeding (OR 3,75; 95% CI 0,9 - 14,2), shock (OR 54,6; 95% CI 5,7 - 517), EKG change (OR 9; 95% CI 2,3 - 35,1), enchepalophaty (OR 15,0; 95% CI 2,5 - 88), sepsis (OR 57; 95% CI 9,2 - 350). Multivariate logistic regression demonstrated that four factors were independently assosiated with mortality : ECG change (OR 14,1; 95% CI 1.70 - 115,29), leukositosis (OR 0,10; 95% CI 2,10 - 1,09), rales (OR 56,12; 95% CI 2,06 - 690,09), hematemesis (OR 8,97;95% CI 0,96 - 83,06). Conclution : ECG change, rales, leukositosis, and hematemesis, that prognostic risk factors associated with mortality patients with severe leptospirosis. The prediction probable mortality 0,93, that thing can used as the important point for more alert and accurate in manage patients with severe leptospirosis. Latar Belakang : Leptospirosis pada manusia, suatu penyakit zoonosis yang menyebar diseluruh dunia, endemik di Indonesia. Manifestasi klinik pada manusia bervariasi dari yang ringan seperti sindroma flu sampai yang berat dengan kelainan multi organ berupa ikterik, gagal ginjal, pneumonitis haemorrhagic, miokarditis dan lain-lain, secara umum angka kematian antara 5 - 40 % bahkan sampai Iebih. Faktor — faktor risiko apakah yang berpengaruh terhadap kematian pada penderita leptospirosis berat yang dirawat di rumah sakit se-Kota Semarang. Tujuan : Mengidentifikasi jenis dan besar pengaruh faktor — faktor demografi, klinis dan laboratorium terhadap kematian pada penderita leptospirosis berat yang di rawat di rumah sakit se-Kota Semarang. Metodologi : Cross sectional selama November 2002 sampai Mei 2005, dengan subyek yang terdiagnosis pasti leptospirosis berat yang dirawat di rumah sakit ( Dr. Kariadi, Telogorejo, St. Elisabeth, Roemani, Panti Wilasa, RSU Kodya dan RSI. Demak ) yang berada di Kota Semarang. Semua subyek dilakukan anamnesis, pemeriksaan fisik, EKG dan laboratorium ( hematologi, tes fungsi ginjal, tes fimsi liver dan serologi ). Hasa : 56 penderita masuk dalam penelitian ini terdiri 38 laki-laki dengan rata-rata usia 43,5 tahun. Analisis Bivariat didapatkan bahwa faktor-faktor risiko yang berpengaruh terhadap kematian pada penderita leptospirosis berat (p < 0,05) adalah : usia, lama demam, batuk (OR 5,0; 95% CI 1,32-18,81), dyspneu (25,5; 95% CI 4,7-137,2), hematemesis (OR 5,55; 95% CI 1,35¬22,76), echymosis (OR 5,20; 95% CI 0,9-27,1) , perdarahan gusi ( OR 5,45; 95% CI 0,81-36,81), delirium (OR 10,3; 95% CI 2,4-44,1), ronkhi basah (OR 16,9; 95% CI 3,25-87,8), oliguri (OR 4,1; 95% CI 0,9-17,3), leukositosis (OR 0,18; 95% CI 0,04-0,8), DIC (OR 30,7; 95% CI 3,2¬271), perdarahan paru (OR 0,2; 95% CI 0,1-0,3), perdarahan gastrointestinal (OR 3,75; 95% CI 0,9-14,2), shock (OR 54,6; 95% CI 5,7 - 517), kelainan EKG (OR 9; 95% CI 2,3 - 35,1), enchepalophaty (OR 15,0; 95% CI 2,5 - 88), sepsis (OR 57; 95% CI 9,2 - 350). Analisis multivariat dengan regresi logistik ganda didapatkan 4 faktor risiko prognosis yang sangat berpengaruh terhadap kematian ; kelainan EKG (OR 14,1; 95% CI 1,70 - 115,29), leukositosis (OR 0,10; 95% CI 2,10 - 1,09), ronkhi basah (OR 56,12; 95% CI 2,06 - 690,09), hematemesis (OR 8,97;95% CI 0,96 - 83,06). Kesimpulan : Kelainan EKG, ronkhi basah, leukositosis, hematemesis, merupakan faktor-faktor risiko prognosis kematian pada penderita leptospirosis berat dengan prediksi probabilitas kematian 0,93. Hal tersebut dapat digunakan sebagai petunjuk penting untuk lebih waspada dan seksama dalam mengelola penderita leptospirosis berat.