Hubungan Kadar Laktat dan Albumin dengan Mortalitas dan Morbiditas Pasien Perforasi Ulkus Peptikum

Abstract

Background: Peptic ulcer perforation is an emergency condition worldwide, with associated mortality rates up to 30%. Expected lactate and albumin value could be used to predict mortality and morbidity in perforated peptic ulver patient.

Methods: Prospective cohort study with analytics correlation design to assess whether there was a correlation between lactate and albumin value with mortality and morbidity in perforated peptic ulcer patient. The population of this study was all patients who came to the emergency department of Surgery of Hasan Sadikin Hospital Bandung with clinical diagnosis of perforated peptic ulcer, between February 2018 - February 2019 that meet the inclusion criteria and exclusion criteria. Bivariate logistic regression analysis was used to analyses the data.

Results: There were 40 patients who met the inclusion criteria. The majority of patients were male (35 patients), the rest were female with age range 22 – 80 years old. There were 11 patients passed away (27.5%) . Mean lactate value was 6,4 ± 3,7 mmol/L and mean albumin value was 2,1 ± 0,4 mg/dL. Morbidity that was found in this research was hospital acquired pneumonia. Based on Wald test, lactate value was positively corelated significant with mortality of peptic ulcer perforation patient with p = 0.024 (p < 0.05) and albumin value correlated negatively significant with mortality of peptic ulcer perforation patients p = 0.032 (p<0.05)

Conclusion: Lactate value was positively corelated with mortality in peptic ulcer perforation patient but not with morbidity. Albumin value was negatively corelated with mortality in peptic ulcer perforation patient but not with morbidity. Higher lactate value and lower albumin value, the higher probability of mortality in perforated peptic ulcer patients.

Latar Belakang.Perforasi ulkus peptikum merupakan kondisi emergensi di seluruh dunia, dengan tingkat mortalitas sampai dengan 30%. Penilaian kadar laktat dan albumin dalam darah diharapkan dapat menjadi suatu perangkat penilai untuk memperkirakan tingkat mortalitas dan morbiditas pasien perforasi ulkus peptikum.3,5

Metode. Desain analitis menggunakan metode kohort prospektif dengan analisis korelasi hubungan kadar albumin dan laktat terhadap kejadian mortalitas dan morbiditas pasien perforasi ulkus peptikum di RS. Hasan Sadikin. Subjek penelitian dilakukan dengan cara consecutive sampling. Populasi terjangkau adalah pasien dengan diagnosis klinis perforasi ulkus peptikum yang datang ke Unit Gawat Darurat RSHS pada periode 1 Februari 2018 – 28

Hasil. Didapatkan 40 pasien, mayoritas berjenis kelamin laki – laki (35 pasien), sisanya perempuan dengan rentang usia 22 – 80 tahun. Didapatkan 11 pasien meninggal (27.5% dari sampel). Pasien mati memiliki rata – rata kadar laktat 6,4 ± 3,7 mmol/L dan rata – rata kadar albumin 2,1 ± 0,4 mg/dL. Morbiditas pada penelitian ini ialah komplikasi hospital acquired pneumonia pasca operasi. Hasil uji Wald membuktikan bahwa kadar laktat berhubungan positif secara signifikan dengan mortalitas pasien perforasi ulkus peptikum dengan probabilitas kesalahan statistik sebesar p = 0,024 (p < 0,05) dan kadar albumin berhubungan negatif secara signifikan dengan mortalitas pasien perforasi ulkus peptikum dengan probabilitas kesalahan statistik sebesar p = 0,032 (p < 0,05).

Kesimpulan: Kadar laktat berhubungan positif dengan mortalitas pasien namun tidak dengan morbiditas pasien, sedangkan kadar albumin berhubungan negatif dengan mortalitas pasien namun tidak dengan morbiditas pasien.. Semakin tinggi kadar laktat dan semakin rendah kadar albumin, semakin tinggi probabilitas pasien untuk mati.