Uji diagnostik pemeriksaan kadar D-dimer plasma pada diagnosis stroke iskemik

Abstract

ABSTRACT Background : Ischemic stroke is one type of stroke which is caused by thrombus. Early diagnose can reduce morbidity and mortality. CT scan is an objective test for ischemic stroke. CT scan has some limitation such as could not give a good result less than 6 hours onset, expensive, depend on radiologist, radiation side effect and not routine. An alternative diagnostic approach is to measure laboratoric marker, D-dimer, a fibrin degradation product which is used to detect trombotic case and fibrinolysis. Objective : This study was designed to investigate the diagnostic value of plasma D-dimer in diagnosing ischemic stroke. Method : Thirty five patients with acute stroke symptoms in Kariadi hospital emergency room between November 2009 and January 2010 had been drawn for plasma blood samples; consecutive sampling and involve inclusion criteria, consist of men and women. CT scan was used as gold standard to diagnose ischemic stroke. The level of plasma D-dimer was measured by latex agglutination method. Statistical analysis was done by two twice two table to determine sensitivity, spesificity, positive predictive value and negative predictive value. Results : D-dimer had 71,4% of sensitivity, 35,7% of spesificity, 62,5% of positive predictive value and 45,5% of negative predictive value, 1,09 of positive likelihood ratio and 0,82 of negative likelihood ratio by the cut off latex agglutination method, 500 µg/L. Conclusion : Plasma D-dimer can be considered as a diagnostic test to investigate trombosis in ischemic stroke. Keywords : Ischemic stroke, D-dimer, CT scan ABSTRAK Latar belakang : Stroke iskemik merupakan stroke akibat gangguan vaskular oleh trombus. Diagnosis yang tepat dapat mengurangi morbiditas dan mortalitas. CT scan merupakan pemeriksaan obyektif stroke iskemik, yang keterbatasannya adalah kurang jelas pada onset kurang dari 6 jam, tidak semua rumah sakit memiliki, mahal, ketergantungan pada operator, efek radiasi dan bukan pemeriksaan rutin. Pemeriksaan diagnostik non-infasif dilakukan dengan petanda laboratorik. D-dimer, suatu produk degenerasi fibrin yang menunjukkan adanya trombosis ataupun fibrinolisis. Tujuan : Mengetahui nilai diagnostik kadar D-dimer plasma pada diagnosis stroke iskemik. Metode penelitian : Tiga puluh lima penderita stroke akut di IGD RSUP. Dr. Kariadi Semarang selama bulan November 2009 hingga Januari 2010 diambil sampel darah plasmanya secara konsekutif; memenuhi kriteria inklusi, terdiri laki-laki dan perempuan. CT scan digunakan sebagai baku emas diagnosis. Kadar D-dimer plasma ditentukan dengan metode latex agglutination. Analisis statistik menggunakan tabel 2x2 untuk menentukan sensitivitas, spesifisitas, nilai ramal positif dan nilai ramal negatif. Hasil : Dengan menggunakan cut off metode latex agglutination sebesar 500 µg/L didapatkan hasil sensitivitas 71,4 %, spesifisitas 35,7 %, nilai ramal positif 62,5 % dan nilai ramal negatif 45,5 %, likelihood ratio positif 1,09 dan likelihood ratio negatif 0,82. Simpulan : Pemeriksaan kadar D-dimer plasma dapat digunakan untuk uji diagnostik (uji saring) terhadap CT scan pada diagnosis stroke iskemik. Kata kunci : Stroke iskemik, D-dimer, CT scan