Neopterin Serum sebagai Prediktor Dini Luaran Perburukan pada Sepsis Neonatorum

Ahmad Hafidz, Tetty Yuniati, Purboyo Solek

Abstract


Neopterin telah diketahui sebagai biomarker untuk diagnostik sepsis neonatorum awitan dini. Hingga saat ini belum diketahui peran neopterin sebagai biomarker untuk memprediksi luaran sepsis neonatorum awitan dini maupun awitan lanjut. Tujuan penelitian ini menentukan neopterin serum sebagai biomarker prediktor sepsis neonatorum awitan dini dan lanjut. Penelitian dilakukan pada bulan Mei–Juli 2017 di RSUP Dr. Hasan Sadikin Bandung. Seluruh neonatus yang memenuhi kriteria sepsis neonatorum, yaitu didapatkan skor Tollner ≥10, dilakukan pemeriksaan neopterin serum menggunakan metode ELISA. Subjek kemudian diikuti dan dikelompokkan menjadi luaran perbaikan dan perburukan. Analisis menggunakan receiver operating characteristic (ROC) untuk mendapatkan luas area under curve, menentukan titik potong serta sensitivitas dan spesifisitas. Subjek penelitian terdiri atas 42 neonatus, mayoritas karakteristik neonatus yang mengalami luaran perburukan berjenis kelamin laki-laki (10 subjek), sepsis awitan dini (11 subjek), cara persalinan dengan operasi (11 subjek), dan tempat persalinan di RS (14 subjek). Temuan kadar neopterin pada luaran perburukan lebih tinggi dibanding dengan luaran perbaikan dan disimpulkan terdapat perbedaan yang bermakna (p<0,01). Kadar neopterin rata-rata yang didapatkan pada sepsis luaran perburukan 60,97 ng/mL dengan rentang kadar 40,63–92,04 ng/mL. Luas area di bawah kurva ROC kadar neopterin adalah 0,981 (95% IK=0,882–1,000; p<0,001). Kadar titik potong neopterin >43,13 dengan sensitivitas 94,1% dan spesifisitas 96,0%. Simpulan, kadar titik potong neopterin adalah 43,13 ng/mL serta memiliki sensitivitas 94,1% dan spesifisitas 96,0%. Biomarker ini dapat menjadi salah satu parameter dalam memprediksi dini luaran perburukan sepsis neonatorum awitan dini dan awitan lanjut.


NEOPTERIN SERUM AS EARLY PREDICTOR OF POOR OOUTCOME IN NEONATAL SEPSIS

Neopterin was known as the biomarker for diagnosed early onset neonatal sepsis. Nowadays it has been proven for neopterin as predictors of poor outcome in early and late neonatal sepsis. The objective of this study was to determine serum levels of neopterin as predictors of poor outcome in early and late neonatal sepsis. The study held from May to July 2017 in Dr. Hasan Sadikin General Hospital Bandung. All subjects were neonatal sepsis with Tollner score ≥10 observed for serum levels of neopterin with ELISA method and then followed during hospitalization. The outcome defined as good and poor outcomes. The data were analyzed using receiver operating characteristic (ROC) for getting area under curved, cut-off point and also sensitivity, specificity. Research subjects consisted of 42 neonates, the majority which experienced poor outcomes were male (10 subjects), early onset sepsis (11 subjects), section cesarean procedure (11 subjects) and were born in a hospital (14 subjects). Serum neopterin levels findings significantly correlated with poor outcomes. Mean of poor outcomes in sepsis was 60.97 ng/mL with observed levels 40.63–92.04 ng/mL. Area under the ROC curve of neopterin were 0.981 (95% CI=0.882–1.000; p<0.001). Cut off levels of neopterin >43.13 with sensitivity 94.1% and specificity 96.0%. In conclusion, cut off levels of neopterin >43.13 with sensitivity 94.1% and specificity 96.0%. Neopterin defined as a biomarker for the early predictor of poor outcome in early and late onset neonatal sepsis.


Keywords


luaran; neonatal sepsis; neopterin; outcome; sepsis neonatorum

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DOI: https://doi.org/10.29313/gmhc.v5i3.3101

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