Research Article

Lactate Dehydrogenase (LDH) dan prokalsitonin merupakan parameter pembeda yang lebih spesifik dan sensitif dibandingkan dengan Laju Endap Darah (LED), C-Reactive Protein (CRP), dan Alkaline Phosphatase (ALP) antara osteosarkoma dan osteomielitis di RSUP S

Ivander Purvance , Putu Astawa, Made Bramantya Karna, I Ketut Siki Kawiyana, Ketut Gede Mulyadi Ridia, I Ketut Suyasa, I Wayan Suryanto Dusak, I Gede Eka Wiratnaya

Ivander Purvance
Program Studi Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia. Email: ivander_purvance@hotmail.com

Putu Astawa
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

Made Bramantya Karna
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

I Ketut Siki Kawiyana
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

Ketut Gede Mulyadi Ridia
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

I Ketut Suyasa
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

I Wayan Suryanto Dusak
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia

I Gede Eka Wiratnaya
Departemen Orthopaedi dan Traumatologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Purvance, I., Astawa, P., Karna, M., Kawiyana, I., Ridia, K., Suyasa, I., Dusak, I., Wiratnaya, I. 2020. Lactate Dehydrogenase (LDH) dan prokalsitonin merupakan parameter pembeda yang lebih spesifik dan sensitif dibandingkan dengan Laju Endap Darah (LED), C-Reactive Protein (CRP), dan Alkaline Phosphatase (ALP) antara osteosarkoma dan osteomielitis di RSUP S. Intisari Sains Medis 11(3): 1372-1379. DOI:10.15562/ism.v11i3.784


Background: It is often difficult to distinguish between the clinical presentation of osteosarcoma and osteomyelitis in the early stages. Histopathological review, requiring planning, delaying early treatment, is the golden standard diagnosis for this disorder. This research aimed to find out if it is possible to use simple laboratory examinations to distinguish these diseases. Early treatment can also be carried out, which can lead to a stronger prognosis.

Methods: A medical database of patients with reported osteosarcoma and osteomyelitis was used to collect data. Initial laboratory test results, including erythrocyte sedimentation rate, C-reactive protein, dehydrogenase lactate, alkaline phosphatase, and procalcitonin, were obtained. Statistical analysis was then conducted to determine the most useful laboratory parameter for distinguishing these two diseases. SPSS version 21 for Windows analyzed the results.

Results: The results showed that there was a significant difference between osteosarcoma and osteomyelitis patients' age and body mass index (BMI) (p <0.05). Important variations between all test parameters were found, but the lactate dehydrogenase and procalcitonin parameters were considered to be the most sensitive and specific parameters for the distinction between the two diseases (p<0.05). A sensitivity level of 92.5 % and a specificity of 100% with an AUC value of 0.963 (P = 0.05) were shown to have cut points of 840 U/L for LDH and 0.465 ng/mL for PCT.

Conclusion: Lactate dehydrogenase and procalcitonin have been shown to distinguish between early-stage osteomyelitis and osteosarcoma, making early treatment possible.

 

 

Latar Belakang: Gambaran klinis osteosarkoma dan osteomielitis seringkali sulit dibedakan pada fase-fase awal. Pemeriksaan gold standard untuk kedua penyakit ini adalah dengan pemeriksaan histopatologi, namun pemeriksaan ini memerlukan persiapan yang cukup lama, sedangkan tatalaksana kedua penyakit ini optimal bila dilakukan seawal mungkin. Penelitian ini bertujuan untuk melihat apakah pemeriksaan laboratorium sederhana dapat membedakan kedua penyakit ini, sehingga terapi dapat dilakukan sedini mungkin, dan menghasilkan prognosis sebaik mungkin.

Metode: Dilakukan pengambilan data pasien sesuai desain cross sectional analytics, yaitu pasien yang telah terkonfirmasi osteosarkoma dan osteomielitis dari rekam medis. Kemudian dilakukan penelusuran data laboratorium saat awal pasien masuk, yaitu laju endap darah, C-reactive protein, lactate dehydrogenase, alkaline phosphatase, dan prokalsitonin. Kemudian dilakukan analisis statistik untuk menentukan parameter manakah yang paling berperan membedakan kedua penyakit ini. Data dianalisis dengan SPSS versi 21 untuk Windows.

Hasil: Hasil penelitian menunjukkan terdapat perbedaan yang bermakna antara usia dan Indeks Masa Tubuh (IMT) pasien kelompok osteosarkoma dengan osteomielitis (p<0,05). Didapatkan perbedaan yang bermakna dari semua parameter yang diuji, namun parameter lactate dehydrogenase dan prokalsitonin dinilai yang paling sensitif dan spesifik dalam membedakan kedua penyakit tersebut (p<0,05). Titik potong 840 U/L untuk LDH dan 0.465 ng/mL untuk PCT terbukti memiliki tingkat sensitivitas sebesar 92.5% dan spesifisitas 100% dengan nilai AUC 0,963 (P=0,05).

Kesimpulan: Pemeriksaan kadar lactate dehydrogenase dan prokalsitonin terbukti dapat membedakan osteomielitis dan osteosarkoma pada awal proses penyakitnya, sehingga terapi dapat dilakukan lebih dini.

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