Research Article

Transient Elastography sebagai Alat Skrining Kecurigaan Hipertensi Portal pada Penderita Sirosis Hepatis

I Made Wisnu Wardhana , Gde Somayana, Ketut Mariadi, I Dewa Nyoman Wibawa

I Made Wisnu Wardhana
Program Studi Pendidikan Dokter Spesialis Penyakit Dalam, Fakultas Kedokteran Universitas Udayana / RSUP Sanglah, Denpasar, Bali, Indonesia. Email: megaloblastik@yahoo.com

Gde Somayana
Departemen/ KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP Sanglah, Denpasar, Bali, Indonesia

Ketut Mariadi
Departemen/ KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP Sanglah, Denpasar, Bali, Indonesia

I Dewa Nyoman Wibawa
Departemen/ KSM Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP Sanglah, Denpasar, Bali, Indonesia
Online First: August 01, 2020 | Cite this Article
Wardhana, I., Somayana, G., Mariadi, K., Wibawa, I. 2020. Transient Elastography sebagai Alat Skrining Kecurigaan Hipertensi Portal pada Penderita Sirosis Hepatis. Intisari Sains Medis 11(2): 493-496. DOI:10.15562/ism.v11i2.620


Background: Portal hypertension was causes by extensive fibrosis on liver cirrhosis. The diagnosis of portal hypertension can only be identified by invasive procedure. Transient elastography (TE) is a non-invasive examination to determine the level of liver fibrosis by liver stiffness (LS).

Objective: Transient elastography is expected to predict the possibility of portal hypertension in liver cirrhosis.

Methods: The study used a cross-sectional design, where data were analyzed using a receiver operating curve (ROC) to determine the area under the curve (AUC). Data was collected from 2015 to 2018 using consecutive sampling. Analysis were done using SPSS and Medcalc to determine the cut-off point that has the best sensitivity, specificity, positive likelihood ratio (+ LR) and negative likelihood ratio (-LR).

Results: In this study we found 69 patients with hepatic cirrhosis which consisted of 57 men (82.6%) and 12 women (17.4%) with a mean age of 48.57. From 69 patients with cirrhosis, portal hypertension manifestations were found by endoscopy in 45 patients (65.2%), while 24 (34.8%) were absent. TE was examined to determine LS, where the lowest value was 11.0 kPa, the highest value was 75.0 kPa, with mean value of 29.89 kPa. AUC results for LS were 0.763 (95% CI 0.645-0.857, p <0.001). The best cut-off point for LS is above 17.5 kPa with a sensitivity of 82.22% (95% CI 67.9-92.0%), specificity 62.50% (95% CI 40.6-81.2%), + LR 2.19 (95% CI 1.3-3.7), and -LR 0.28 (95% CI 0.1-0.6).

Conclusion: Transient elastography with liver stiffness above 17.5 kPa can be used as a screening tool to predict manifestations of portal hypertension in patients with liver cirrhosis.

 

Latar belakang: Hipertensi portal adalah dampak fibrosis ekstensif pada sirosis hepatis. Dimana diagnosis hipertensi portal hanya dapat ditegakkan melalui prosedur invasif. Transient elastography (TE) merupakan pemeriksaan non invasif untuk mengetahui tingkat fibrosis hati dengan hasil berupa liver stiffness (LS).

Tujuan: TE diharapkan dapat digunakan sebagai alat screening bagi penderita sirosis hepatis yang memerlukan tindakan endoskopi.

 

Metode: Penelitian menggunakan desain potong lintang, dimana data dianalisis dengan menggunakan receiver operating curve (ROC) untuk menentukan area under curve (AUC). Data dikumpulkan dari tahun 2015 hingga 2018 secara konsekutif. Analisis menggunakan SPSS dan Medcalc untuk menentukan titik potong yang memiliki sensitivitas, spesifisitas, positive likelihood ratio (+LR) dan negative likelihood ratio (-LR).

Hasil: Pada penelitian ini didapatkan 69 penderita sirosis hepatis yang terdiri dari 57 orang laki-laki (82,6%) dan 12 orang perempuan (17,4%) dengan rata-rata usia 48,57 tahun. Dari 69 penderita sirosis hepatis dilakukan dievaluasi dengan menggunakan endoskopi dimana didapatkan 45 orang (65,2%) mengalami manifestasi hipertensi portal, sedangkan 24 orang (34,8%) lainnya tidak. Kemudian dilakukan pemeriksaan TE untuk mengetahui LS, dimana didapatkan nilai terendah adalah 11,0 kPa, nilai tertinggi 75,0 kPa, dengan rata-rata 29,89 kPa. Analisis kurva ROC terhadap LS yang diperoleh dari TE, diperoleh hasil AUC 0,763 (95% CI 0,645-0.857, p<0,001). Titik potong untuk LS adalah >17,5 kPa dengan sensitivitas 82,22% (95% CI 67,9-92,0%), spesifisitas 62,50% (95% CI 40,6-81,2%), +LR 2,19 (95% CI 1,3-3,7), dan -LR 0,28 (95% CI 0,1-0,6).

Simpulan: TE dengan LS>17,5 kPa dapat digunakan sebagai alat screening untuk memprediksi adanya manifestasi hipertensi portal dengan interpretasi sedang.

 

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