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Rasio Mean Platelet Volume (MPV) terhadap hitung trombosit dan Interleukin-6 (IL-6) sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia

Abstract

Background: Neonatal sepsis is a clinical syndrome in infants aged less than 28 days that arises from a systemic inflammatory response (SIRS) by various infectious causes. Both Interleukin-6 (IL-6) and Mean Platelet Volume (MPV) levels are known to play an important role in worsening neonatal sepsis. This study aims to determine the relationship between MPV ratio to platelet count and IL-6 as an early predictor of death in neonatal sepsis at Sanglah General Hospital, Bali, Indonesia.

Methods: This prospective observational cohort study was conducted from November 2019 to February 2020 at Sanglah General Hospital Denpasar, involving 54 pediatric patients diagnosed with neonatal sepsis for less than 28 days. The research samples were collected consecutively. Statistical analysis is the survival analysis, Receiver Operating Characteristic (ROC) curve, linear regression, and Fisher exact test using SPSS software version 20 for Windows.

Results: Most of the respondents had an average age of 3.46 ± 7,065 days, followed by male gender (72.22%), SNAD type of sepsis (88.89%), birth weight 2,126.6 ± 794.1 grams, normal birth weight (38.89%), and premature birth (61.11%). The mean MPV level in all subjects was 7.11 ± 1.85 fL, followed by a platelet count (218.511 ± 121.085) cells / µL, MPV / PLT ratio (5.404 ± 5.351), IL-6 levels (215.32 ± 444, 48 pg / mL), and as much as 12.95% died within 28 days of treatment. The results of the survival analysis showed a significant relationship between the MPV value (Cut-off: 6.745 (AUC: 0.650: HR: 4.353; p = 0.033) and the MPV / PLT ratio (Cut-off: 3.73; AUC: 0.690; HR: 4.535; p = 0.033) as an early predictor of mortality in neonatal sepsis at Sanglah General Hospital, Bali, Indonesia.

Conclusion: MPV / PLT and MPV ratios can be used as predictors of early mortality within 28 days in patients with clinical neonatal sepsis at Sanglah General Hospital, Bali, Indonesia.

 

Latar Belakang: Sepsis neonatal adalah sindrom klinis pada bayi berumur kurang dari 28 hari yang timbul akibat respon inflamasi sistemik (SIRS) oleh berbagai penyebab infeksi. Kadar Interleukin-6 (IL-6) maupun Mean Platelet Volume (MPV) diketahui berperan penting terhadap perburukan pada sepsis neonatal. Penelitian ini bertujuan untuk mengetahui  hubungan rasio MPV terhadap hitung trombosit maupun IL-6 sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia.

Metode: Penelitian Kohort prospektif observasional dilakukan sejak November 2019 sampai Februari 2020 di RSUP Sanglah Denpasar dengan melibatkan 54 pasien anak yang terdiagnosis sepsis neonatal kurang dari 28 hari. Sampel penelitian dikumpulkan secara konsekutif. Analsis statistik yaitu dengan analisis kesintasan, kurva Receiver Operating Characteristic (ROC), regresi linier, dan tes Fisher exact menggunakan piranti lunak SPSS versi 20 untuk Windows..

Hasil: Sebagian besar responden rata-rata berusia 3.46±7.065 hari, diikuti dengan jenis kelamin laki-laki (72,22%), jenis sepsis tipe SNAD (88,89%), berat lahir 2.126,6±794,1 gram, berat badan lahir normal (38,89%), dan lahir prematur (61,11%). Rerata kada MPV pada seluruh subjek adalah 7,11±1,85 fL, diikuti dengan hitung trombosit (218.511±121.085) sel/µL, rasio MPV/PLT (5,404±5,351), kadar IL-6 (215,32±444,48 pg/mL), dan sebanyak 12,95% meninggal dalam 28 hari perawatan.  Hasil analisis kesintasan menunjukkan hubungan bermakna antara nilai MPV (Cut-off: 6,745 (AUC: 0,650: HR: 4,353; p=0,033) dan rasio MPV/PLT (Cut-off: 3,73; AUC: 0,690; HR: 4,535; p=0,033) sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia.

Kesimpulan: Rasio MPV/PLT dan MPV dapat digunakan sebagai prediktor awal kematian dalam 28 hari pada pasien dengan klinis sepsis neonatal di RSUP Sanglah, Bali, Indonesia

References

  1. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-1780.
  2. UNICEF. Maternal and Newborn Health Disparities: Indonesia. Unicef for every child. 2017; 1-7
  3. Putra PJ. Insiden dan Faktor-Faktor yang Berhubungan dengan Sepsis Neonatus di RSUP Sanglah Denpasar. Sari Pediatri. 2012;14(3):205-10
  4. Oleksowicz L, Mrowiec Z, Zuckerman D, Isaacs R, Dutcher J, Puszkin E. Platelet activation induced by interleukin-6: evidence for a mechanism involving arachidonic acid metabolism. Thromb Haemost. 1994;72(2):302-308.
  5. Senchenkova EY, Komoto S, Russell J, Almeida-Paula LD, Yan LS, Zhang S, et al. Interleukin-6 mediates the platelet abnormalities and thrombogenesis associated with experimental colitis. Am J Pathol. 2013;183(1):173-181.
  6. Claushuis TA, van Vught LA, Scicluna BP, Wiewel MA, Klouwenberg PMCK, Hoogendijk AJ, et al. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood. 2016;127(24):3062-3072.
  7. Gao Y, Li Y, Yu X, Guo S, Ji X, Sun T, et al. The impact of various platelet indices as prognostic markers of septic shock. PLoS One. 2014;9(8):e103761.
  8. Kim CH, Kim SJ, Lee MJ, Kwon YE, Kim YL, Park KS, et al. An increase in mean platelet volume from baseline is associated with mortality in patients with severe sepsis or septic shock. PLoS One. 2015;10(3):e0119437.
  9. Oh GH, Chung SP, Park YS, et al. Mean Platelet Volume to Platelet Count Ratio as a Promising Predictor of Early Mortality in Severe Sepsis. Shock. 2017;47(3):323-330.
  10. Kaushik R, Gupta M, Sharma M, Jash D, Jain N, Sinha N, et al. Diagnostic and Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Early and Late Phase of Sepsis. Indian J Crit Care Med. 2018;22(9):660-663.
  11. Prabawa IPY, Bhargah A, Liwang F, Tandio DA, Tandio AL, Lestari AAW, et al. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pac J Cancer Prev. 2019;20(3):863-868.
  12. Dharma BDA, Mulyantari NK, Prabawa IPY. Analisis korelasi kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis. 2020;11(1):179-182.
  13. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21-47.
  14. Khan A, Ali Z. Normal Ranges for Acute Phase Reactants (Interleukin-6, Tumour Necrosis Factor-alpha and C-reactive Protein) in Umbilical Cord Blood of Healthy Term Neonates at the Mount Hope Women's Hospital, Trinidad. West Indian Med J. 2014;63(5):465-469.
  15. Shaaban HA, Safwat N. Mean platelet volume in preterm: a predictor of early onset neonatal sepsis. J Matern Fetal Neonatal Med. 2020;33(2):206-211.
  16. Tajarernmuang P, Phrommintikul A, Limsukon A, Pothirat C, Chittawatanarat K. The Role of Mean Platelet Volume as a Predictor of Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis. Crit Care Res Pract. 2016;2016:4370834.
  17. Venkata C, Kashyap R, Farmer JC, Afessa B. Thrombocytopenia in adult patients with sepsis: incidence, risk factors, and its association with clinical outcome. J Intensive Care. 2013;1(1):9.
  18. Ates S, Oksuz H, Dogu B, Bozkus F, Ucmak H, Yanıt F. Can mean platelet volume and mean platelet volume/platelet count ratio be used as a diagnostic marker for sepsis and systemic inflammatory response syndrome?. Saudi Med J. 2015;36(10):1186-1190.
  19. TamelytÄ— E, VaiÄekauskienÄ— G, Dagys A, Lapinskas T, JankauskaitÄ— L. Early Blood Biomarkers to Improve Sepsis/Bacteremia Diagnostics in Pediatric Emergency Settings. Medicina (Kaunas). 2019;55(4):99.
  20. Burstein SA, Downs T, Friese P, Lynam S, Anderson S, Henthorn J, et al. Thrombocytopoiesis in normal and sublethally irradiated dogs: response to human interleukin-6. Blood. 1992;80(2):420-428.
  21. Braekkan SK, Mathiesen EB, Njølstad I, Wilsgaard T, Størmer J, Hansen JB. Mean platelet volume is a risk factor for venous thromboembolism: the Tromsø Study, Tromsø, Norway. J Thromb Haemost. 2010;8(1):157-162.
  22. Greinacher A, Selleng S. How I evaluate and treat thrombocytopenia in the intensive care unit patient. Blood. 2016;128(26):3032-3042.
  23. Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions. Mediators Inflamm. 2019;2019:9213074.
  24. Kral JB, Schrottmaier WC, Salzmann M, Assinger A. Platelet Interaction with Innate Immune Cells. Transfus Med Hemother. 2016;43(2):78-88. doi:10.1159/000444807
  25. Linke B, Schreiber Y, Picard-Willems B, Slattery P, Nusing RM, Harder S, et al. Activated Platelets Induce an Anti-Inflammatory Response of Monocytes/Macrophages through Cross-Regulation of PGE2 and Cytokines. Mediators Inflamm. 2017;2017:1463216.
  26. Wirtz DC, Heller KD, Miltner O, Zilkens KW, Wolff JM. Interleukin-6: a potential inflammatory marker after total joint replacement. Int Orthop. 2000;24(4):194-196.
  27. Marino A, Giotta N. Cinacalcet, fetuin-A and interleukin-6. Nephrol Dial Transplant. 2008;23(4):1460-1462.
  28. Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice?. Platelets. 2016;27(7):607-612.

How to Cite

Karyana, I. P. S. R., Mahartini, N. N., & Kardana, I. M. (2020). Rasio Mean Platelet Volume (MPV) terhadap hitung trombosit dan Interleukin-6 (IL-6) sebagai prediktor awal kematian pada sepsis neonatal di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis, 11(2), 839–844. https://doi.org/10.15562/ism.v11i2.755

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