DAFTAR ISI

DAFTAR ISI................................................................................................................i
DAFTAR TABEL.......................................................................................................iii
DAFTAR GAMBAR...................................................................................................iv
DAFTAR SINGKATAN..............................................................................................v
DAFTAR LAMBANG.................................................................................................ix
BAB I PENDAHULUAN.............................................................................................1
1.1 Latar belakang..........................................................................................1
1.2 Rumusan masalah...................................................................................2
1.3 Tujuan Penelitian......................................................................................3
1.3.1 Tujuan umum..................................................................................3
1.3.2 Tujuan khusus................................................................................3
1.4 Hipotesis...................................................................................................3
1.4.1 Hipotesis Penelitian........................................................................3
1.4.2 Hipotesis Statistik...........................................................................3
1.5 Manfaat.....................................................................................................4
BAB II TINJAUAN PUSTAKA....................................................................................5
2.1 Sepsis............................................................................................................5
2.1.1. Definisi..................................................................................................5
2.1.2. Epidemiologi.........................................................................................5
2.1.3. Etiologi..................................................................................................7
2.1.4. Patogenesis dan patofisiologi..............................................................7
2.1.5. Diagnosis............................................................................................26
2.2 Laktat serum................................................................................................30
2.2.1. Biokimiawi Laktat................................................................................31
2.2.2. Patofisiologi peningkatan laktat pada sepsis.....................................33
2.2.3. Hubungan hantaran dan kebutuhan oksigen.....................................34
2.2.4. Dasar pemikiran pemeriksaan laktat pada sepsis.............................35
2.2.5. Pemeriksaan laktat pada sepsis........................................................36
2.3 Albumin........................................................................................................38

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 2.3.1. Hubungan antara kadar albumin dan sepsis....................................42
2.4 Hubungan rasio laktat albumin terhadap luaran pasien sepsis..................47
2.5 Kerangka teori.............................................................................................53
2.6 Kerangka konsep.........................................................................................57
BAB III METODE PENELITIAN...............................................................................59
3.1 Rancangan penelitian..................................................................................59
3.2 Tempat dan waktu penelitian.......................................................................59
3.3 Populasi dan sampel penelitian...................................................................59
3.3.1 Populasi penelitian.............................................................................59
3.3.2 Sampel penelitian...............................................................................59
3.3.3 Besar sampel.....................................................................................61
3.3.4 Cara pengambilan sampel.................................................................61
3.4 Persetujuan Komite Etik...............................................................................62
3.5 Variabel penelitian........................................................................................62
3.6 Definisi operasional......................................................................................62
3.7 Instrumen penelitian.....................................................................................67
3.8 Metode pengumpulan data..........................................................................68
3.9 Analisis data.................................................................................................70
3.10 Personalia penelitian..................................................................................71
3.11 Jadwal Penelitian.......................................................................................71
3.12 Alur penelitian.............................................................................................72
BAB IV HASIL PENELITIAN....................................................................................73
4.1 Karakteristik sampel penelitian....................................................................73
4.2 Hubungan antara kadar rasio laktat albumin dengan mortalitas
sepsis pada anak.........................................................................................77
4.3 Hubungan antara kadar rasio laktat albumin dengan lama rawat di
PICU pasien anak dengan sepsis yang hidup............................................78
BAB V PEMBAHASAN............................................................................................79
BAB VI KESIMPULAN DAN SARAN.......................................................................89
6.1 Kesimpulan...................................................................................................89
6.2 Saran............................................................................................................89

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DAFTAR PUSTAKA.................................................................................................90
LAMPIRAN ...........................................................................................................102

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 DAFTAR TABEL

Tabel 1. Mediator pada sepsis................................................................................16

Tabel 2. Skor Pediatric Logistic Organ Dysfunction (PELOD) 2.............................29
Tabel 3. Jadwal Penelitian......................................................................................67
Tabel 4. Karakteristik sampel penelitian.................................................................75
Tabel 5. Karakteristik kadar rasio laktat albumin sampel penelitian.......................76

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 DAFTAR GAMBAR

Gambar 1. Respon pejamu terhadap sepsis berat..................................................9

Gambar 2. Efek LPS dan LTA pada pelepasan mediator inflamasi
oleh makrofag................................................................................... 12
Gambar 3. Respon terhadap patogen, meliputi interaksi antara
berbagai sel imun, meliputi makrofag, sel dendrit, dan sel
T CD4+.................................................................................................13
Gambar 4. Efek eksotoksin terhadap pelepasan mediator inflamasi....................14
Gambar 5. Sepsis mengganggu keseimbangan homeostasis normal
antara mekanisme prokoagulan dan antikoagulan...............................18
Gambar 6. Patogenesis sepsis dan gagal organ....................................................19
Gambar 7. Glikokaliks endothelial..........................................................................21
Gambar 8. Alur penegakkan diagnosis sepsis.......................................................27
Gambar 9. Kerangka teori.......................................................................................56
Gambar 10. Kerangka konsep................................................................................58
Gambar 11. Bagan alur penelitian..........................................................................72
Gambar 12. Diagram alur pengambilan sampel penelitian....................................74
Gambar 13. Diagram pencar hubungan kadar rasio laktat albumin dengan
besarnya peluang meninggal.............................................................77
Gambar 14. Diagram pencar hubungan kadar rasio laktat albumin dan
lama rawat.........................................................................................78

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 DAFTAR SINGKATAN

ADA : American Diabetes Association

APACHE : Acute Physiology and Chronic Health

Evaluation

AUC : Area under curve

BB : Berat badan

CDC : Centers for disease control and prevention

cfu : Colony-forming unit

CRP : C-reactive protein

CI : Confidence interval

CS : Kondroitin sulfat

CVP : Central Venous Pressure

Da : Dalton

dl : Desiliter

DO2 : Delivery oxygen

EDTA : Ethylenediaminetetraacetic acid

EGDT : Early goal directed therapy

FK : Fakultas Kedokteran

g : Gram

GAG : Glikosaminoglikan

GGA : Gangguan ginjal akut

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HA : Asam hialuronat

HS : Heparin sulfat

ICAM-1 : Intercellular cell adhesion molecule-1

IFN- γ : Interferon gamma

IgA : Imunoglobulin A

IgG : Imunoglobulin G

IL : Interleukin

IMT : Indeks masa tubuh

IQR : Interquartile range

L : Liter

LILA : lingkar lengan atas

LPB : LPS-binding protein

LPB : Luas permukaan badan

LPS : Lipopolisakarida

LTA : Lipoteichoic acid

MAMP : Microbial-associated molecular pattern

MDP : Muramyl dipeptides

mg : Milligram

mmol : Milimole

MMPs : Matriks metalloproteinase

NET : Neutrophil extracellular traps

NK : Sel natural killer

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NPV : Negative predictive value

NO : Nitrit oksida

OR : Odds ratio

O2ER : Oxygen extraction ratio

PAI-1 : Plasminogen activator inhibitor type 1

PAMPs : Patogen associated molecular patterns

PCR : Polymerase chain reaction

PELOD : Pediatric Logistic Organ Dysfunction

pH : Potensial hidrogen

PICU : Pediatric Intensive Care Unit

PPV : Positive predictive value

ROC : Receiver Operating Characteristic

ROS : Reactive oxygen species

RNSs : Reactive nitrogen species

RSCM : Rumah Sakit Cipto Mangunkusumo

RSUP : Rumah Sakit Umum Pusat

SAPS : Simplified Acute Physiology Score

SB : Simpangan baku

SIRS : Systemic Inflammatory Response Syndrome

SOD : Superoksida dismutase

SPE : Streptococcal Pyrogenic Exotoxin

SPROUT : Sepsis Prevalence Outcomes and Therapies

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SPSS : Statistical Product and Service Solution

ScVO2 : Central venous oxygen saturation

SVO2 : Mixed venous oxygen saturation

TB : Tinggi badan

Th 1 : Sel T helper tipe 1

Th 2 : Sel T helper tipe 2

TLR : Toll-like receptors

TM : Thrombomodulin

TNF-α : Tumor necrosis factor-α

TSST : Staphylococcal Toxic Shock Syndrome Toxin

VCAM-1 : Vascular cell adhesion molecule-1

VO2 : Volume oksigen

WHO : World Health Organization

μg : Microgram

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 DAFTAR LAMBANG

% : persen

< : kurang dari

> : lebih dari

≥ : lebih dari sama dengan

≤ : kurang dari sama dengan

/ : per

- : sampai/ hingga

= : sama dengan

ᵒ
c : derajat celcius

µ : mikro

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 DAFTAR LAMPIRAN

Lampiran 1. Informed Consent

Lampiran 2. Formulir penelitian

Lampiran 3. Data Dasar Sampel Penelitian

Lampiran 4. Hasil Pengolahan Data Statistik

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