45
LAMPIRAN 1
LEMBAR PENJELASAN KEPADA CALON SUBYEK PENELITIAN
Saya, dr. Diana Puspita Sari Purba adalah peserta pendidikan dokter
spesialis di Fakultas Kedokteran Sumatera Utara. Saya sedang mengadakan
penelitian dengan judul “Hubungan antara PREDICE score dengan tingkat
mortalitas 90 hari pada pasien gagal jantung”.
Penelitian ini digunakan untuk memprediksi kematian 90 hari pada pasien
– pasien gagal jantung. Prediksi kematian dilakukan dengan menghitung
PREDICE score (Usia, Klirens kreatinin, diagnosis patofisiologi, kadar natrium,
dan ketergantungan aktivitas harian).
Penelitian ini dilakukan dengan pengambilan darah, EKG, Foto toraks,
ekokardiografi dan wawancara mengenai aktivitas harian, kemudian dilakukan
penghitungan nilai PREDICE score.
Saya sangat mengharapkan kesediaan Bapak/Ibu untuk berpartisipasi
dalam penelitian ini. Penelitian ini bersifat sukarela dan tidak akan memberikan
dampak yang membahayakan. Semua informasi yang Bapak/Ibu berikan akan
dirahasiakan dan hanya digunakan dalam penelitian ini. Bila data Bapak/Ibu
dipublikasikan, kerahasiaannya tetap akan dijaga. Bila keterangan yang saya
berikan masih belum jelas, Bapak/ibu dapat langsung bertanya kepada saya:
Nama
: dr. Diana Puspita Sari Purba
Alamat
: Jl. Bunga Terompet No 4, Medan
No Telp
: 081380307832
Atas perhatian Bapak/ Ibu saya ucapkan terima kasih
Demikian informasi ini saya sampaikan. Atas bantuan, partisipasi dan
kesediaan waktu Bapak/Ibu sekalian, saya ucapkan terimakasih.
Peneliti,
46
LAMPIRAN 2
SURAT PERSETUJUAN SETELAH PENJELASAN
(INFORMED CONCERN)
Saya yang bertanda tangan dibawah ini :
Nama
:
Alamat
:
Umur
:
tahun
Jenis kelamin : Laki-laki/Perempuan
*No. telp/HP
:
Setelah mendapat penjelasan dari peneliti tentang kebaikan dan keburukan
prosedur penelitian ini, menyatakan bersedia ikut serta dalam penelitian tentang ”
Hubungan antara PREDICE score dengan tingkat mortalitas 90 hari pada
pasien gagal jantung ”. Apabila sewaktu-waktu saya mengundurkan diri dari
penelitian ini, kepada saya tidak dituntut apapun.
Demikianlah surat persetujuan bersedia ikut dalam penelitian ini saya buat, untuk
dapat digunakan seperlunya.
Medan,
2016
Saksi, Yang memberi pernyataan,
(...) (...)
Penelti
47
LAMPIRAN 3
LEMBAR KERJA PROFIL PESERTA PENELITIAN
Tanggal :
MR :
8.
Riwayat Penyakit yang anda derita:
Diabetes Mellitus/sakit gula
Hipertensi/tekanan darah tinggi
Kelainan darah
Lain-lain:
II. PEMERIKSAAN LABORATORIUM
Parameter
Hari pertama
Hb (g/dl)
Kreatinin (mg/dl)
Kreatinin klirens
(MDRD)
48
III.
Ekokardiografi
Fraksi Ejeksi:
Disfungsi diastolik:+/-
IV.
Indeks Barthel
Skor:
Mandiri/Ketergantungan ringan/ketergantungan sedang/ketergantungan
berat/ketergantungan total
V.
Diagnosis
VI.
Obat – Obat Yang Digunakan
49
LAMPIRAN 4
50
51
52
Descriptives
Statistic Std. Error
usia Mean 58,94 2,364
95% Confidence Interval for Mean
Lower Bound 54,13
Upper Bound 63,75
5% Trimmed Mean 59,28
Median 59,00
Variance 189,936
Std. Deviation 13,782
Minimum 22
Maximum 86
Range 64
Interquartile Range 20
Skewness -,341 ,403
Kurtosis ,224 ,788
imt Mean 23,9191 ,50794
95% Confidence Interval for Mean
Lower Bound 22,8857
Upper Bound 24,9525
5% Trimmed Mean 23,7124
Median 24,1000
Variance 8,772
Std. Deviation 2,96180
Minimum 19,08
Maximum 34,55
Range 15,47
Interquartile Range 3,36
Skewness 1,336 ,403
Kurtosis 3,895 ,788
TDS Mean 136,88 3,944
95% Confidence Interval for Mean
Lower Bound 128,86
Upper Bound 144,91
5% Trimmed Mean 136,86
Median 132,50
Variance 528,955
Std. Deviation 22,999
Minimum 90
Maximum 180
Range 90
Interquartile Range 35
Skewness -,024 ,403
Kurtosis -,734 ,788
TDD Mean 82,06 2,265
95% Confidence Interval for Mean
Lower Bound 77,45
Upper Bound 86,67
5% Trimmed Mean 81,96
Median 85,00
Variance 174,421
Std. Deviation 13,207
Minimum 50
Maximum 120
Range 70
Interquartile Range 20
Skewness ,016 ,403
Kurtosis 1,383 ,788
Hb Mean 10,9559 ,54063
95% Confidence Interval for Mean
Lower Bound 9,8560
Upper Bound 12,0558
5% Trimmed Mean 10,9990
Median 10,9000
Variance 9,938
53
Minimum 3,40
Maximum 16,50
Range 13,10
Interquartile Range 4,45
Skewness -,077 ,403
Kurtosis -,305 ,788
Na Mean 132,4412 1,53810
95% Confidence Interval for Mean
Lower Bound 129,3119
Upper Bound 135,5705
5% Trimmed Mean 132,9281
Median 133,5000
Variance 80,436
Std. Deviation 8,96860
Minimum 102,00
Maximum 150,00
Range 48,00
Interquartile Range 10,25
Skewness -1,214 ,403
Kurtosis 2,891 ,788
K Mean 4,0853 ,12660
95% Confidence Interval for Mean
Lower Bound 3,8277
Upper Bound 4,3429
5% Trimmed Mean 4,1069
Median 4,1000
Variance ,545
Std. Deviation ,73819
Minimum 2,40
Maximum 5,30
Range 2,90
Interquartile Range ,85
Skewness -,406 ,403
Kurtosis -,046 ,788
Cr Mean 1,4744 ,16042
95% Confidence Interval for Mean
Lower Bound 1,1480
Upper Bound 1,8008
5% Trimmed Mean 1,3727
Median 1,1800
Variance ,875
Std. Deviation ,93542
Minimum ,31
Maximum 5,52
Range 5,21
Interquartile Range ,85
Skewness 2,643 ,403
Kurtosis 9,976 ,788
Crklirens Mean 63,0712 7,69359
95% Confidence Interval for Mean
Lower Bound 47,4184
Upper Bound 78,7239
5% Trimmed Mean 57,7387
Median 52,3600
Variance 2012,508
Std. Deviation 44,86098
Minimum 13,83
Maximum 247,32
Range 233,49
Interquartile Range 37,70
Skewness 2,430 .403
Kurtosis 7,953 ,788
FE Mean 45,44 1,938
95% Confidence Interval for Mean
Lower Bound 41,50
Upper Bound 49,38
5% Trimmed Mean 45,29
54
Variance 127,709
Std. Deviation 11,301
Minimum 26
Maximum 68
Range 42
Interquartile Range 19
Skewness ,104 ,403
Kurtosis -1,125 ,788
PREDICEScore Mean 14,8235 .65878
95% Confidence Interval for Mean
Lower Bound 13,4832
Upper Bound 16,1638
5% Trimmed Mean 15,0882
Median 15,0000
Variance 14,756
Std. Deviation 3,84133
Minimum 2
Maximum 20
Range 18
Interquartile Range 6,25
Skewness -1,057 ,403
Kurtosis -2,304 ,788
Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
55
Descriptives
Outcome Statistic Std. Error
usia menninggal Mean 65,63 3,070
95% Confidence Interval for Mean
Lower Bound 59,08
Upper Bound 72,17
5% Trimmed Mean 65,75
Median 68,50
Variance 150,783
Std. Deviation 12,279
Minimum 43
Maximum 86
Range 43
Interquartile Range 19
Skewness -,430 ,564
Kurtosis -,636 1,091
hidup Mean 53,00 2,946
95% Confidence Interval for Mean
Lower Bound 46,78
Upper Bound 59,22
5% Trimmed Mean 53,33
Median 54,00
Variance 156,235
Std. Deviation 12,499
Minimum 22
Maximum 78
Range 56
Interquartile Range 16
Skewness -,552 ,536
Kurtosis 1,398 1,038
imt menninggal Mean 23,4869 ,89863
95% Confidence Interval for Mean
Lower Bound 21,5715
Upper Bound 25,4023
5% Trimmed Mean 23,1171
Median 22,5000
Variance 12,921
Std. Deviation 3,59454
Minimum 19,08
Maximum 34,55
Range 15,47
Interquartile Range 3,54
Skewness 1,998 ,564
Kurtosis 5,669 1,091
hidup Mean 24,3033 ,54241
95% Confidence Interval for Mean
Lower Bound 23,1590
Upper Bound 25,4477
5% Trimmed Mean 24,3037
Median 24,1550
Variance 5,296
Std. Deviation 2,30124
Minimum 19,70
Maximum 28,90
Range 9,20
Interquartile Range 2,95
Skewness ,043 ,536
Kurtosis ,269 1,038
TDS menninggal Mean 137,81 5,183
95% Confidence Interval for Mean
Lower Bound 126,76
Upper Bound 148,86
5% Trimmed Mean 137,01
Median 132,50
56
Std. Deviation 20,734
Minimum 110
Maximum 180
Range 70
Interquartile Range 35
Skewness ,336 ,564
Kurtosis -,555 1,091
hidup Mean 136,06 5,990
95% Confidence Interval for Mean
Lower Bound 123,42
Upper Bound 148,69
5% Trimmed Mean 136,17
Median 140,00
Variance 645,938
Std. Deviation 25,415
Minimum 90
Maximum 180
Range 90
Interquartile Range 42
Skewness -,158 ,536
Kurtosis -,902 1,038
TDD menninggal Mean 82,50 2,327
95% Confidence Interval for Mean
Lower Bound 77,54
Upper Bound 87,46
5% Trimmed Mean 82,22
Median 80,00
Variance 86,667
Std. Deviation 9,309
Minimum 70
Maximum 100
Range 30
Interquartile Range 18
Skewness ,000 ,564
Kurtosis -,915 1,091
hidup Mean 81,67 3,813
95% Confidence Interval for Mean
Lower Bound 73,62
Upper Bound 89,71
5% Trimmed Mean 81,30
Median 90,00
Variance 261,765
Std. Deviation 16,179
Minimum 50
Maximum 120
Range 70
Interquartile Range 20
Skewness ,073 ,536
Kurtosis ,919 1,038
Hb menninggal Mean 11,6688 ,74848
95% Confidence Interval for Mean
Lower Bound 10,0734
Upper Bound 13,2641
5% Trimmed Mean 11,6931
Median 12,0000
Variance 8,964
Std. Deviation 2,99393
Minimum 6,40
Maximum 16,50
Range 10,10
Interquartile Range 5,57
Skewness -,121 ,564
Kurtosis -1,134 1,091
hidup Mean 10,3222 ,76297
95% Confidence Interval for Mean
Lower Bound 8,7125
Upper Bound 11,9320
57
Median 10,3500
Variance 10,478
Std. Deviation 3,23702
Minimum 3,40
Maximum 16,50
Range 13,10
Interquartile Range 2,93
Skewness ,034 ,536
Kurtosis ,480 1,038
Na menninggal Mean 131,1875 2,05795
95% Confidence Interval for Mean
Lower Bound 126,8011
Upper Bound 135,5739
5% Trimmed Mean 130,8194
Median 131,5000
Variance 67,763
Std. Deviation 8,23180
Minimum 119,00
Maximum 150,00
Range 31,00
Interquartile Range 11,25
Skewness ,584 ,564
Kurtosis ,521 1,091
hidup Mean 133,5556 2,27981
95% Confidence Interval for Mean
Lower Bound 128,7456
Upper Bound 138,3655
5% Trimmed Mean 134,8395
Median 136,5000
Variance 93,556
Std. Deviation 9,67241
Minimum 102,00
Maximum 142,00
Range 40,00
Interquartile Range 7,25
Skewness -2,411 ,536
Kurtosis 6,469 1,038
K menninggal Mean 4,2750 ,17830
95% Confidence Interval for Mean
Lower Bound 3,8950
Upper Bound 4,6550
5% Trimmed Mean 4,3000
Median 4,3500
Variance ,509
Std. Deviation ,71321
Minimum 2,80
Maximum 5,30
Range 2,50
Interquartile Range ,75
Skewness -,492 ,564
Kurtosis -,006 1,091
hidup Mean 3,9167 ,17401
95% Confidence Interval for Mean
Lower Bound 3,5495
Upper Bound 4,2838
5% Trimmed Mean 3,9241
Median 4,0000
Variance ,545
Std. Deviation ,73824
Minimum 2,40
Maximum 5,30
Range 2,90
Interquartile Range ,90
Skewness -,395 ,536
Kurtosis ,283 1,038
Cr menninggal Mean 1,3438 ,13341
58
Mean Upper Bound 1,6281
5% Trimmed Mean 1,2975
Median 1,1800
Variance ,285
Std. Deviation ,53365
Minimum ,74
Maximum 2,78
Range 2,04
Interquartile Range ,67
Skewness 1,484 ,564
Kurtosis 2,373 1,091
hidup Mean 1,5906 ,28057
95% Confidence Interval for Mean
Lower Bound ,9986
Upper Bound 2,1825
5% Trimmed Mean 1,4434
Median 1,2950
Variance 1,417
Std. Deviation 1,19034
Minimum ,31
Maximum 5,52
Range 5,21
Interquartile Range 1,21
Skewness 2,257 ,536
Kurtosis 6,699 1,038
Crklirens meninggal Mean 56,1825 5,74157
95% Confidence Interval for Mean
Lower Bound 43,9446
Upper Bound 68,4204
5% Trimmed Mean 55,1128
Median 54,1400
Variance 527,449
Std. Deviation 22,96626
Minimum 18,80
Maximum 112,82
Range 94,02
Interquartile Range 33,68
Skewness .664 ,564
Kurtosis 1,153 1,091
hidup Mean 69,1944 13,65624
95% Confidence Interval for Mean
Lower Bound 40,3823
Upper Bound 98,0066
5% Trimmed Mean 62,3746
Median 49,8900
Variance 3356,874
Std. Deviation 57,93854
Minimum 13,83
Maximum 247,32
Range 233,49
Interquartile Range 62,33
Skewness 1,982 ,536
Kurtosis 4,455 1,038
FE menninggal Mean 42,38 2,745
95% Confidence Interval for Mean
Lower Bound 36,53
Upper Bound 48,22
5% Trimmed Mean 42,31
Median 38,00
Variance 120,517
Std. Deviation 10,978
Minimum 26
Maximum 60
Range 34
59
Skewness ,277 ,564
Kurtosis -1,388 1,091
hidup Mean 48,17 2,634
95% Confidence Interval for Mean
Lower Bound 42,61
Upper Bound 53,72
5% Trimmed Mean 48,02
Median 51,00
Variance 124,853
Std. Deviation 11,174
Minimum 31
Maximum 68
Range 37
Interquartile Range 16
Skewness -,036 ,536
Kurtosis -,908 1,038
Tests of Normality
Outcome
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
*. This is a lower bound of the true significance.
60
NYHA * Kematian90Hr Crosstabulation
Kematian90Hr
Total
hidup meninggal
NYHA NYHA III Count 13 8 21
% within Kematian90Hr 100.0% 100.0% 100.0%
% of Total 52.9% 47.1% 100.0%
Chi-Square Tests
Value df
Asymp. Sig.
(2-sided)
Exact Sig.
(2-sided)
Exact Sig.
(1-sided)
Pearson Chi-Square 1.771a 1 .183
Continuity Correctionb .955 1 .328
Likelihood Ratio 1.783 1 .182
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 6.12.
b. Computed only for a 2x2 table
AktHarian
Frequency Percent Valid Percent
Cumulative
Percent
Valid mandiri 13 38,2 38,2 38,2
ketergantungan 21 61,8 61,8 100,0
Total 34 100,0 100,0
61
Levene's Test for Equality of
Variances t-test for Equality of Means
F Sig. t df
95% Confidence Interval of the
Difference
lamaRawatan menninggal 16 18,47 295,50
hidup 18 16,64 299,50
Crklirens menninggal 16 17,75 284,00
hidup 18 17,28 311,00
62
Test Statisticsa
imt TDD lamaRawatan Na Cr Crklirens
Mann-Whitney U 105,000 143,000 128,500 95,500 140,500 140,000
Wilcoxon W 241,000 314,000 299,500 231,500 276,500 311,000
Z -1,346 -,036 -,537 -1,676 -,121 -,138
Asymp. Sig. (2-tailed) ,178 ,971 ,591 ,094 ,904 ,890
Exact Sig. [2*(1-tailed Sig.)] ,187b ,986b ,597b ,095b ,905b ,905b
a. Grouping Variable: Outcome
b. Not corrected for ties.
Descriptives
Kematian90Hr Statistic Std. Error
Predicescore hidup Mean 12.8333 .84887
95% Confidence Interval for Mean
Lower Bound 11.0424
Upper Bound 14.6243
5% Trimmed Mean 13.2037
Median 13.5000
Variance 12.971
Std. Deviation 3.60147
Minimum 2.00
Maximum 17.00
Range 15.00
Interquartile Range 3.50
Skewness -1.641 .536
Kurtosis 3.897 1.038
meninggal Mean 17.0625 .69203
95% Confidence Interval for Mean
Lower Bound 15.5875
Upper Bound 18.5375
5% Trimmed Mean 17.1806
Median 18.0000
Variance 7.663
Std. Deviation 2.76812
Minimum 12.00
Maximum 20.00
Range 8.00
Interquartile Range 4.75
Skewness -.699 .564
Kurtosis -1.012 1.091
Tests of Normality
Kematian90Hr
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Predicescore hidup .186 18 .099 .864 18 .014
meninggal .196 16 .103 .867 16 .024
63
Test Statisticsa
Predicescore
Mann-Whitney U 47.000
Wilcoxon W 218.000
Z -3.363
Asymp. Sig. (2-tailed) .001
a. Grouping Variable: Kematian90Hr
b. Not corrected for ties.
Area Under the Curve
Test Result Variable(s): Predicescore
Area Std. Errora Asymptotic Sig.b
Asymptotic 95% Confidence Interval
Lower Bound Upper Bound
.837 .070 .001 .699 .974
The test result variable(s): Predicescore has at least one tie between the positive actual
state group and the negative actual state group. Statistics may be biased.
a. Under the nonparametric assumption
64
Nilai PREDICE * Kematian90Hr Crosstabulation
Count
Kematian90Hr
Total meninggal hidup
Nilai
PREDICE
>15 12 6 18
<15 4 12 16
Total 16 18 34
Coordinates of the Curve
Test Result Variable(s): Predicescore
Positive if Greater
Than or Equal Toa Sensitivity 1 - Specificity
1.0000 1.000 1.000
The test result variable(s): Predicescore has at least one tie between the positive
actual state group and the negative actual state group.
a. The smallest cutoff value is the minimum observed test value minus
1, and the largest cutoff value is the maximum observed test value plus
1. All the other cutoff values are the averages of two consecutive
