FAKTOR RISIKO PERIOPERATIVE KEJADIAN POSTOPERATIVE DELIRIUM

(POD) PADA OPERASI KATUP JANTUNG DI RSUP DR. KARIADI SEMARANG

Kajian parameter biomarker C-Reactive Protein dan Prokalsitonin
Ali Mufis* Widya Istanto** Aria Dian Primatika**
*PPDS-1 Anestesiologi dan Terapi Intensif FK UNDIP
**Staff Bagian Anestesiologi dan Terapi Intensif FK UNDIP/ RSUP Dr.Kariadi

ABSTRAK

Latar belakang: Delirium postoperatif (POD) merupakan kondisi disfungsi serebral akut yang
bermanifestasi sebagai gangguan pada perhatian dan kesadaran seseorang, yang terjadi pada
pasien yang menjalani operasi besar. Salah satu mekanisme mendasar adalah neuroinflamasi
intraoperasi yang meningkatkan berbagai marker inflamasi. Upaya pencegahan POD dapat
dilakukan dengan mengidentifikasi faktor-faktor perioperatif yang berpotensi menjadi
penyebab.
Tujuan: Mengetahui pengaruh dari faktor risiko perioperatif terhadap kejadian delirium pasca
operasi, kadar marker CRP dan prokalsitonin pasca operasi pada pasien yang menjalani operasi
katup jantung.
Metode: Penelitian nested case-control design dilakukan terhadap 50 pasien yang menjalani
operasi katup jantung elektif di RSUP Dr. Kariadi Semarang. Fungsi kognitif diukur dengan
kuesioner CAM-ICU 24 jam pascaoperatif. Data perioperatif yang terdiri dari usia lanjut, DM
tipe II, aterosklerosis, hipertensi, durasi cardiopulmonary bypass (CPB), durasi cross-clamp,
durasi rewarm, rerata MAP, kadar hemoglobin, dosis sedasi dan durasi ventilator pascaoperasi
diambil dari rekam medis. Pengambilan sampel CRP dan prokalsitonin dilakukan sebelum dan
dalam 24 jam pascaoperasi. Analisis bivariat dan multivariat dilakukan untuk melihat
perbedaan variabel terhadap kejadian POD.
Hasil: Usia lanjut (p=0,006), aterosklerosis (p=0,010), durasi CPB (p=0,035), durasi cross-
clamp (p=0,035), dosis sedasi (p=0,035), durasi ventilator (p=0,023), kadar CRP (p=0,048) dan
kadar prokalsitonin (p=0,025) berpengaruh terhadap kejadian POD. Analisis multivariat
menunjukan bahwa selisih kadar prokalsitonin merupakan faktor yang paling berpengaruh
(p=0,001).
Kesimpulan : Faktor usia lanjut, aterosklerosis, durasi CPB, durasi cross clamp, dosis sedasi,
durasi ventilator, serta peningkatan pada kadar serum marker inflamasi CRP dan prokalsitonin
berpengaruh terhadap kejadian POD pada pasien yang menjalani operasi katup jantung.
Kata Kunci : CRP, prokalsitonin, operasi katup jantung, POD.

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 PERIOPERATIVE RISK FACTORS FOR POSTOPERATIVE DELIRIUM (POD) IN
HEART VALVE OPERATION IN DR. KARIADI SEMARANG
Study of C-Reactive Protein and Procalcitonin biomarker parameters
Ali Mufis* Widya Istanto** Aria Dian Primatika**
*Anesthesiology and Intensive Therapy Resident, Faculty of Medicine, Universitas Diponegoro
**Department of Anesthesiology and Intensive Therapy Resident, Universitas Diponegoro /
Dr.Kariadi Hospital

ABSTRACT

Background: Postoperative delirium (POD) is a condition of acute cerebral dysfunction that

manifests as a disturbance in one's attention and awareness, which occurs in patients
undergoing major surgery. One of the underlying mechanisms is intraoperative
neuroinflammation which increases various inflammatory markers. Efforts to prevent POD can
be done by identifying perioperative factors that have the potential to be the cause.
Objective: To determine the effect of perioperative risk factors on the incidence of
postoperative delirium, C-Reactive protein (CRP), and procalcitonin levels in patients
undergoing heart valve surgery.
Methods: A nested case-control design study was conducted on 50 patients undergoing elective
heart valve surgery at Dr. Kariadi Semarang. Cognitive function was measured with the CAM-
ICU questionnaire 24 hours postoperatively. Perioperative data consisting of elderly, type II
DM, atherosclerosis, hypertension, duration of CPB, duration of cross-clamp, length of
rewarm, average MAP, hemoglobin level, postoperative sedation doses and duration of
ventilator use were taken from medical records. A sampling of CRP and procalcitonin was
performed before and within 24 hours postoperatively. Bivariate and multivariate analyzes
were carried out to see the differences in variables on the incidence of POD.
Results: Older age (p=0,006), atherosclerosis (p=0,010), duration of CPB (p=0,035), duration
of cross-clamp (p=0,035), sedation dose (p=0,035), duration of ventilator (p=0,023), CRP
(p=0,048) and procalcitoin levels (p=0,025) affected the incidence of POD. Multivariate
analysis showed that procalcitonin levels is the most influential factors (p=0,001).
Conclusion: Old age, atherosclerosis, duration of CPB, cross-clamp, duration of ventilator use,
sedation dose, as well as increases in serum levels of the inflammatory markers CRP and
procalcitonin affect the incidence of POD in patients undergoing heart valve surgery.
Keywords : CRP, procalcitonin, heart valve surgery, POD

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