Akurasi Total Hitung Leukosit dan Durasi Simtom sebagai Prediktor Perforasi Apendisitis pada Penderita Apendisitis Akut

Abstract

Abstract Komplikasi perforasi pada penderita apendisitis akut cukup tinggi, yang ditandai dengan demam yang tinggi dan peningkatan leukosit. Tujuan penelitian ini adalah untuk mengetahui akurasi total leucocyte count (TLC) dan symptom duration (SD) sebagai prediktor perforasi pada penderita apendisitis akut. Penelitian cross-sectional retrospektive dilakukan terhadap 96 pasien apendisitis akut, yang dipilih secara konsekutif dari register rawat inap pasien apandisitis akut di RSUD Sanjiwani Gianyar tahun 2014-2015. Identitas, SD,TLC dikumpulkan dari catatan medis sampel. Penegakan diagnose perforasi didasarkan kepada hasil pemeriksanan patogi anatomi. Uji chi-square dan regresi Poisson dipakai menganalisis hubungan TLC dan SD dengan kejadian perforasi, sedangkan kemampuan prediksi dinilai dari nilai duga positif (PPV) dan negatif (NPV). Dari hasil penelitian didapatkan Risiko Relatif (RR) dari TLC (>18.000/ml:≤18.000/ml) adalah 2,9 (1,2 – 6,7) dan SD (>24jam:≤24jam) adalah 2,3 (1,1 – 4,9). PPV/NPV dari TLC, SD dan kombinasi TLC&SD adalah 59,4/93,8; 52,9/91,9; dan 82,4/88,4 secara berurutan. Dari penelitian ini disimpulkan bahwa kombinasi TLC&SD mempunyai tingkat prediksi yang baik sebagai prediktor kejadian perforasi pada penderita apendisitis akut. Kata kunci: Apendisitis perforasi, Total Leucocyte Count, Time Duration Abstract Perforation is frequently observed among acute appendicitis patients, which characterized by high fever and increased leucocyte level. The aim of this study is to determine the accuracy of total leucocyte count (TLC) and symptom duration (SD) as predictors of perforation in acute appendicitis patients. A retrospective cross sectional study was conducted and 96 acute appendicitis patients were enrolled in the study. The subjects were selected based on consecutive method taken from inpatient register of 2014 -2015 of Sanjiwani Hospital at Gianyar. Demographic data, SD and TLC were collected from medical record. Perforation was diagnosed based on the result of pathology and anatomy examinations. Chi square test and Poisson regression method were performed to analyze the association between TLC, SD and incidence of perforation. Positive predictive value (PPV) and Negative predictive value (NPV) were also calculated to measure the level of accuracy of the predictors. Results show that Relative Risk (RR) of TLC (>18.000/ml:≤18.000/ml) was 2.9 (1.2 – 6.7) whereas RR of SD (>24hours:≤24hours) was 2.3 (1.1 – 4.9). PPV/NPV of TLC, SD and TLC&SD combination were 59.4/93.8; 52.9/91.9; and 82.4/88.4, respectively. As conclusion, TLC&SD combined has high accuracy as predictor of perforation in acute appendicitis patients. Key word: Apendisitis perforation, Total Leucocyte Count, Time Duration