Gambaran Kadar Bilirubin dan Enzim Transaminase pada Penderita Demam Berdarah Dengue

Tahun 2003 Volume 38 Nomor 2
Oleh : Elly D, Tatty ES, Bambang S’ Soemantri AG, Supriatna M ‘, Mairuhu ATA, van Gorp ECM, ten Cate M, Brandjes DPM,

Latar belakang: Palogenesis virus dengue belum sepenuhnya dipahami. Disfungsi organ multipel lermasuk disfungsi hepar diketahui sebagai salah salu penyebab kematian. Pada Demam Berdarah Dengue (DBD) berat / Sindrom Syok Dengue (SSD) keterlibatan hepar merupakan tanda khas yang terbukti berakibat fatal, tetapi mekanisme pastinya be mm diketahui . Tujuan penelitian ini untuk mengetahui keterlibatan hepar pada DBD/SSD dengan memeriksa bilirubin dan enzim transaminase.
Metode: Dilakukan penelilian cohort pada penderita DBD atau SSD yang dirawat di bangsal anak dan Pediatric Intensive Care Unit (‘PICU,) RSUP Dr. Kariadi dan bulan Februari 2001 sampai Februari 2002 yang berumur anlara 3 sampai 7 lahun. Diagnosis dilegakkan berdasarkan kniteria WHO lahun 1997. Diperiksa secara serial kadar biiru bin, ALT, dan ASTpada han ke-0, 2, dan 7. Kadar bilirubin, ALT, dan AST dibandingkan dengan nilai normal atau abnormal berdasarkan umur dan jenis kelamin. Data dianalisis dengan menggunakan program SPSS versi 10.0, nilai signifikan bila p <0,05.
Hasil: Pada penelitian ini didapatkan 110 penderita yang terdiri dan 55 SSD dan 55 non SSD. Kadar bilirubin tidak a.eningkat secara bermakna pada han ke-0, 2, dan 7 pada kelompok SS.D maupun non SSD. Kadar ALT dan AST meningkai pada han ke-0 dan hurl ke-2 dan peningkatannya secara bermakna lebih tin ggi pada kelompok SSD (p < 0,05). Padu han ke- 7 kadar kedua enzym transaminase kembali normal tanpa pengelolaun khusus. Per) alanan DBD dapat menjadi beart bila kadar AST> 41,0 unit/L (p=0,001 ; sensivitas = 0,69; spesifitas = 0,70; OR = 5,55; confidence interval = 2,410- 12,320) kadar ALT > 21,5 unit/L (p=0,022; sensivitas =0,60 ; spesifitas= 0,60 ; spesifitas 0,63; OR = 2,63; confidence interval = 1,215 – 5,669)
Kesimpulan : Terdapat keterlibatan hepar dalam perjalanan penyakit DBD .derajat berat ringan DBD berkolerasi secara signifikan denan kadar enzim transaminase.Deteksi dini disfungsi hepar meliputi pemeriksaan enzim transaminase sebaiknya dikrjakan untuk menganisispasi DBD berat /SSD

Background: Pathogenesis of den gue virus is not completely understood. Multiple organ dysfunclions, included liver dysfunction, are known as the of cause of death. In severe Dengue Hemoragic Fever (DHF) or Dengue Shock Syndrome (DSS) liver involvement is characteristic and proven to be fatal, although the exact mechanism is still unknown. The objective of this study is to define the liver involment in DHF/DSS by bilirubin and transaminase enz examination.
Methods: A cohort study was done oii patients with DHF or DSS confirmed by WHO 1997 criteria, hospitalized in the paediatric ward or Pediatric Intensive Care U 4 Dr. Kariadi General Hospital from February 2001 until February 2002, age 3 — 14 years old. Bilirubin, alanine aminotransf erase (ALT), and aspartate aminotrasferase (AST,) series examination were done on day 0, 2, and 7. The level of biirubin, ALT, and AST were defined according to age and sex. Data were analyzed using SPSS version 10.0 program, the significant level wasp < 0.05.
Results: A cohort study was done on 110 patients consist of 55 DSS and 55 non DSS patients. The level of bilirubin were not increased significantly on day 0,2, and 7 on DSS group and no,, DSS group. The level ofALTandAST were increased on day 0 and day 2, and the increase were significantly higher on DSS group (p < 0.05). On day 7 both of Iransaminase enzj’m level returned to normal without specific treatment. DHF can be severe j unitlL (p = 0.001; sensitivity = 0.69; specifiicity = 0.70; OR = 5.55; confidence interval = 2.410 — 12.320) and ALT level > 21.5 until (p = 0.022; sensitivity = 0.60; specificity 0.63; OR = 2.63; confidence interval = 1.215 — 5.669).
Conclusion: There are liver involvement in DHE Severity of DHF is sign jficant correlation with transaminase level. Early detection of liver dysfunction including transaminase level examination should be done to anticipate severe DHF/DSS.