Risiko kematian pada kasus-kasus leptospirosis: data dari kabupaten Bantul 2012-2017

https://doi.org/10.22146/bkm.34878

Meliana Depo(1*), Hari Kusnanto(2)

(1) Departemen Biostatistik, Epidemiologi dan Kesehatan Populasi, Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada
(2) Departemen Biostatistik, Epidemiologi dan Kesehatan Populasi, Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Purpose: Leptospirosis is a major public health problem in tropical countries with potentially fatal systemic complications and multi-organ dysfunction. Leptospirosis is endemic in Bantul area. This study aimed to identify the major risk of the factors which contribute to the mortality of leptospirosis patient in Bantul area during 2012-May 2017. Methods: This study using case-control study design with ratio 1:3, 32 cases and 96 controls. The collected data were the manifestation of clinic and laboratory findings from the medical records of leptospirosis patient during 2012-May 2017 in Bantul District Hospital. The inclusion criteria in this study was based on pertinent clinical and epidemiological data and positive serology, patient who domiciled and living in Bantul District Area. The data were analyzed using Fisher test, Chi-square, and multiple logistic regression. The data processed using STATA Software version 13.1. Results: A total of 128 patients were included, with mean age 50.9±12.5 years; 75% (n=96) were male. The mean length from onset symptoms to admission was 4.5±2.27 days. Multivariate logistic regression demonstrated that four dominant factors were significantly independent associated with mortality, icteric, myalgia, dyspnea and thrombocytopenia. Conclusion: The presence of dyspnea, myalgia, icterus, and thrombocytopenia (<100.000/µL) on admission in patients with leptospirosis indicated high risk of death.

Abstrak

Tujuan: Leptospirosis adalah masalah utama kesehatan masyarakat yang dapat mengakibatkan komplikasi dan disfungsi multi organ yang berpotensi fatal. Bantul merupakan wilayah endemik leptospirosis. Penelitian ini bertujuan untuk mengetahui faktor dominan dan mengidentifikasi besarnya risiko dari faktor yang berkontribusi terhadap terjadinya kematian pada pasien leptospirosis di Kabupaten Bantul pada periode 2012-Mei 2017. Metode: Penelitian ini menggunakan rancangan desain kasus kontrol dengan perbandingan 1:3 yaitu 32 kasus dan 96 kontrol. Data yang dikumpulkan adalah manifestasi klinik dan hasil pemeriksaan laboratorium menggunakan rekam medis pasien leptospirosis pada periode 2012-Mei 2017 di rumah sakit Kabupaten Bantul. Kriteria inklusi dalam penelitian ini adalah ada riwayat terpapar lingkungan yang terkontaminasi leptospirosis, hasil positif pemeriksaan serologi, dan pasien berdomisili dan menetap di wilayah Kabupaten Bantul. Analisis data menggunakan uji fisher test, Chi square dan multivariate logistik regresi. Pengolahan data menggunakan software STATA versi 13.1. Hasil: Total sampel adalah 128 pasien leptospirosis, 96 (75%) adalah laki-laki, rata-rata umur pasien leptospirosis adalah 50.9±12.5 tahun. Rata-rata lama demam sebelum masuk rumah sakit yaitu 4.5±2.27 hari. Analisis multivariat dengan logistik regresi menunjukkan terdapat 4 variabel dominan yang berhubungan dengan kematian pada pasien leptospirosis di Kabupaten Bantul yaitu ikterik (p-value=0.006; OR=7.78; 95%CI=1.786-33.925), myalgia (p-value=0.005; OR=5.20; 95%CI=1.659-16.317), sesak (p-value=0.028; OR=3.176; 95%CI=1.130-8.920) dan trombositopenia (p-value=0.019; OR=3.99; 95%CI=1.261-12.639). Simpulan: Keberadaan sesak, myalgia, ikterik, dan trombositopenia (<100.000/µL) merupakan faktor risiko prognosis buruk (meninggal) pada pasien leptospirosis di Kabupaten Bantul.


Keywords


clinical manifestation; laboratory findings; leptospirosis; mortality



References

  1. Dirjen P2PL. Petunjuk Teknis Pengendalian Leptospirosis. Jakarta; 2014.
  2. Hardhana B, Kurniasih N, Susetyoaji E, Sari DM, Budiono CS, Manullang E V, et al. Data dan Infomasi Kementrian Kesehatan RI 2016. 2016;
  3. Zainiyah AA. Faktor-Faktor yang Berhubungan Dengan Kejadian Leptospirosis di Kabupaten Bantul. 2012;1.
  4. Dinas Kesehatan Kabupaten Bantul. Profil Kesehatan Dinas Kabupaten Bantul. 2016;1–45.
  5. Amin LZ. Leptospirosis. 2016;43(8):576–80.
  6. Daher EF, Lima RSA, Silva Júnior GB, Silva EC, Karbage NNN, Kataoka RS, et al. Clinical presentation of leptospirosis: A retrospective study of 201 patients in a metropolitan city of Brazil. Brazilian J Infect Dis. 2010;14(1):3–10.
  7. KS Y, AK B, K R. Serum Creatinine Phosphokinase [Cpk] an Early Marker in Human Leptospirosis. Int J Med Clin Res [Internet]. 2011;2(2):29–33. Available from: http://www.bioinfopublication.org/viewhtml.php?artid=BIA0000952
  8. Goswami RP, Goswami RP, Basu A, Tripathi SK, Chakrabarti S, Chattopadhyay I. Predictors of mortality in leptospirosis: An observational study from two hospitals in Kolkata, eastern India. Trans R Soc Trop Med Hyg. 2014;108(12):791–6.
  9. Kannan R, Alex AG. Clinical profile and prognostic factors of leptospirosis: a study of 50 cases from North Kerala, India. Int J Res Med Sci Int J Res Med Sci Kannan R Int J Res Med Sci. 2017;55(11):4793–6.
  10. Wasiński B, Dutkiewicz J. Leptospirosis-current risk factors connected with human activity and the environment. Ann Agric Environ Med [Internet]. 2013;20(2):239–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23772568
  11. Velusamy GPB, Subronto YW, H T. LEPTOPSPIROSIS IN DR . SARDJITO GENERAL HOSPITAL , YOGYAKARTA 2009 – 2014. 2015;
  12. Rampengan NH. Leptospirosis. J Biomedik. 2016;8(3):143–50.
  13. Divakar A, Pillai MGK, Thomas E. Clinical profile of mortality predictors in Leptospirosis:a prospective study in a tertiary care center. Int J Med Res. 2016;1–13.
  14. Daher E, Silva Junior G, Silveira C, Falcao F, Alves M, Mota J, et al. Factors associated with thrombocytopenia in severe leptospirosis (Weil’s disease). Clinics [Internet]. 2014;69(2):106–10. Available from: http://clinics.org.br/article.php?id=1286
  15. Najafi N, Davoudi AR, Alian S, Ahangarkani F, Asghari E. Clinical and laboratory findings on complication in patients with leptospirosis in Mazandaran Province, Iran. Arch Clin Infect Dis. 2015;10(3).
  16. Sucipto MPG, Nababan RM, Falamy R. Ikterus yang Disebabkan oleh Suspek Leptospirosis Jaundice caused by Suspect Leptospirosis. 2017;7(November):20–5.
  17. Tubiana S, Mikulski M, Becam J, Lacassin F, Lef??vre P, Gourinat AC, et al. Risk Factors and Predictors of Severe Leptospirosis in New Caledonia. PLoS Negl Trop Dis. 2013;7(1).



DOI: https://doi.org/10.22146/bkm.34878

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