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Validasi Skor MSOFA dan Nilai Tambah KadarGlukosa Darah sebagai Prediktor Mortalitaspada Pasien Penyakit Kritis Tanpa Riwayat Diabetes Melitus

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ABSTRACT

Background: Modified Sequential Organ Failure Assessment (MSOFA) scoring system has been developed as critical care triage in centers with limited resources. Previous studies evaluated the perprmance of MSOFA only in critically ill surgical patients and showed low precision in predicting mortality. Addition of another variable to improve MSOFA's performance merits firrther investigation. Hyperglycemia in critically ill patients without previous history of diubetes (stress hyperglycemia) has been shown as an independent risk factor of mortality.

Objective: To evaluate the performance of MSOFA and to assess the addition of admission blood glucose to predict mortality in critically ill patient without previous history of diabetes.

Methods: A validation study with prospective cohort design recruited critically ill medical and surgical patients admitted to Cipto Mangunkusumo Hospital, Jakarta during August to December 2013. History taking, physical examination, peripheral oxygen saturation. Glasgow coma scale creatinine,Mood glucose andHbA1C were obtained within 24 hour of admission. Assessed outcome was mortality within 28 days. Performance of MSOFA was evaluated with Hosmer-Lemeshow goodness of fittest and measurement of area under tile curve (AUC).

Results: A total of 150 patients completed the study protocols. Mortality was observed in 52 (34.67%) subjects with sepsis as the most prevaientdiagnosis. Calibration of MSOFA is shown by Hosmer-Lemeshow test x2=13.748 (p=0.05). ReceiverOperating Curve (ROC) of MSOFA shows an AUC of 0.83 (C19516 0.76-0.891. Stress hyperglycemia was evident in 79 (52.67%)subjects. Addition of blood glucose to MSOPA scoring system does not improve its performance.

Conclusion: MSOFA shows good calibration and discrimination in both critically ill medical and surgical patients. Addition of broad glucose to MSOFA scoring system does not improve its performance.

Key words: MSOFA, blood glucose, mortality, critically ill.

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Indonesian Journal of CHEST, 1 (4) 2014 : 172-179

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Jakarta : Indonesian Journal of Chest., 2014

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8p

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2355-4584

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