Akurasi Diagnostik Fibrosis Hati berdasarkan Rasio Red Cell Distribution Width (RDW) dan Jumlah Trombosit Dibanding dengan Fibroscan pada Penderita Hepatitis B Kronik

Abstract

Hepatitis B kronik merupakan masalah global dan Indonesia termasuk negara yang memiliki prevalensi tinggi. Keterbatasan biopsi hati untuk mendiagnosis fibrosis hati karena invasif membangkitkan penelitian metode noninvasif. Dilakukan penelitian uji diagnostik potong lintang untuk mengetahui akurasi rasio red cell distribution width (RDW) terhadap jumlah trombosit untuk memprediksi derajat fibrosis hati penderita hepatitis B kronik. Terhadap subjek penelitian dilakukan pemeriksaan HBsAg, darah rutin, dan fibroscan di RSUP H. Adam Malik, Medan sejak Januari sampai Maret 2015. Nilai rasio RDW terhadap trombosit dihitung dari hasil pemeriksaan darah rutin. Derajat fibrosis hati dinilai berdasarkan hasil fibroscan dari skala F0–F4. Prosedur analisis adalah receiver operating characteritic (ROC) dan area under the curve (AUC). Dari 34 kasus, 20 orang termasuk kelompok fibrosis hati ringan-sedang (F≤2) dan 14 orang kelompok fibrosis berat (F>2). Nilai akurasi sebesar 72,3% (IK 95%:84,1–97%). Dengan nilai cut-off 0,0591 didapatkan sensitivitas 71,4%; spesifisitas 60%; nilai prediksi positif (NPP) 55,6%; nilai prediksi negatif (NPN) 75%; rasio kemungkinan positif (RKP) 1,79; dan rasio kemungkinan negatif (RKN) 0,48. Simpulan, rasio RDW terhadap jumlah trombosit mampu memprediksi derajat fibrosis hati penderita hepatitis B kronik dengan tingkat akurasi sedang (72,3%).

DIAGNOSTIC ACCURACY OF LIVER FIBROSIS BASED ON RED CELL DISTRIBUTION WIDTH (RDW) TO PLATELET COUNT WITH FIBROSCAN IN CHRONIC B HEPATITIS

Chronic hepatitis B is a global problem and Indonesia has a high prevalence. Limitation of liver biopsy as an invasive method, initiates many studies on non invasive diagnosing method for liver fibrosis. The cross sectional study was conducted to determine the accuracy of red cell distribution width (RDW) to platelet count ratio (RPR) in predicting liver fibrosis degree in chronic hepatitis B. HBsAg, complete blood count, and fibroscan were examined in H. Adam Malik Hospital, Medan from January to March, 2015. RPR was calculated. The degree of liver fibrosis assessed by fibroscan on a scale of F0–F4. The accuracy was evaluated by constructing receiver operating characteritic (ROC) and area under the curve (AUC). From 34 cases, 20 subjects were in mild-moderate liver fibrosis (F≤2) and 14 subjects in severe liver fibrosis (F>2). The accuracy was 72.3% (95% CI: 84.1–97%) with a cut-off value 0.0591. Sensitivity was 71.4%, specificity 60%, positive predictive value (PPV) 55.6%, negative predictive value (NPV) 75%, positive predictive ratio (PPR) 1.79, and negative predictive ratio (NPR) was 0.48. RDW to platelet count ratio can predict liver fibrosis grade in chronic hepatitis B with a moderate degree of accuracy (72.3%).