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KARYA TULIS AKHIR
HUBUNGAN ANTARA JUMLAH TROMBOSIT, MEAN PLATELET VOLUME, DAN PLATELETCRIT DENGAN MORTALITAS PADA PASIEN
SEPSIS YANG DIRAWAT DI RSU UMM
Oleh :
Agam Siswanto Hardoyo NIM. 201810330311021
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG 2022
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HUBUNGAN ANTARA JUMLAH TROMBOSIT, MEAN PLATELET VOLUME, DAN PLATELETCRIT DENGAN MORTALITAS PADA
PASIEN SEPSIS YANG DIRAWAT DI RSU UMM
KARYA TULIS AKHIR Diajukan Kepada
Universitas Muhammadiyah Malang Salah satu persyaratan dalam menyelesaikan
Program Sarjana Fakultas Kedokteran
Oleh :
Agam Siswanto Hardoyo NIM. 201810330311021
PROGRAM STUDI PENDIDIKAN DOKTER FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG 2022
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KATA PENGANTAR
Puji syukur saya panjatkan kepada Allah Subhanahu wata’ala, karena atas kehendak-Nya penulisan tugas akhir ini dapat diselesaikan. Shalawat serta salam tak lupa selalu tercurahkan kepada Nabi Rasulullah Muhammad shalallahu alaihi wasallam, keluarganya dan para sahabatnya yang telah berjasa membawa syiar dakwah Islam ke seluruh dunia. Tugas akhir ini berjudul “Hubungan Antara Jumlah Trombosit, Mean Platelet Volume, dan Plateletcrit dengan Mortalitas Pada Pasien Sepsis Yang Dirawat di Rsu Umm”
Penulis menyadari bahwa penyusunan proposal ini masih jauh dari sempurna. Meskipun demikian penulis telah berusaha semaksimal mungkin serta mendapatkan banyak bantuan dan bimbingan dari dosen pembimbing dalam penyusunannya. Tanpa bantuan dan dorongan dari berbagai pihak penulis akan merasa kesulitan dalam penyusunan proposal ini,
Akhir kata, penulis sampaikan terimakasih kepada semua pihak yang telah membantu dalam penyusunan proposal penelitian ini. Semoga karya tulis ini dapat menambah wawasan keilmuan dan bermanfaat bagi semua pihak.
Malang, 21 Juli 2022
Penulis
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UCAPAN TERIMAKASIH
Puji syukur kehadirat Allah SWT atas rahmat dan karunia-Nya sehingga penulis dapat menyelesaikan tugas akhir ini. Tugas akhir ini dapat terselesaikan ata s bantuan dan bimbingan dari berbagai pihak. Oleh karena itu pada kesempatan kali ini penulis mengucapkan rasa hormat dan terimakasih kepada :
1. Dr. dr Meddy Setiawan, Sp.PD, FINASIM., selaku Dekan Fakultas Kedokteran Universitas Muhammadiyah Malang atas ilmu dan bimbingannya selama di Fakultas Keduokteran UMM.
2. dr. Ruby Riana Asparini, Sp.Bp, selaku Wakil Dekan I Fakultas Kedokteran UMM atas kesediaan waktu dan penyampaian ilmu yang bermanfaat bagi mahasiswa FK UMM.
3. dr. Sri Adila Nurainiwati, Sp.KK, selaku Wakil Dekan II Fakultas Kedokteran UMM atas kesabaran, kebaikan hati, serta kesediaan kesediaan dalam meluangkan waktu untuk mendidik mahasiswa.
4. dr. Indra Setiawan, Sp.THT-KL, selaku Wakil Dekan III Fakultas Kedokteran UMM yang dengan penuh semangat menyampaikan ilmu dan motivasi kepada mahasiswa selama menjalani pendidikan.
5. Prof. Dr. dr. Djoni Djuanedi, SpPD-KPTI, selaku pembimbing I atas kesabaran, kebaikan hati, dan juga kesediaan dalam meluangkan waktunya selama membimbing penulis hingga dapat menyelesaikan penelitian ini dengan baik.
6. dr. Diah Hermayanti, Sp.PK, selaku pembimbing II, atas kesabaran , kebaikan hari, serta kesediaannya dalam meluangkan waktu selama bimbingan hingga saya dapat menyelesaikan tugas akhir ini dengan baik.
7. dr.Thahri Iskandar, Sp.P, selaku penguji tugas akhir saya, atas segala masukan dan arahan yang sangat bermanfaat dalam pengerjaan tugas akhir ini hingga dapat terselesaikan dengan baik.
8. Seluruh Dosen Fakultas Kedokteran Universitas Muhammadiyah Malang atas ilmu dan pengetahuan yang diberikan kepada penulis selama menempuh Pendidikan di Fakultas Kedokteran ini.
9. Seluruh Staf Tata Usaha Fakultas Kedokteran Universitas Muhammadiyah Malang yang telah membantu penulis dalam menyelesaikan tugas akhir.
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10. Kedua orang tua saya, Gatut Suwandoyo, Maryana adik saya Afrina Billah Izzah yang selalu memberikan doa, dukungan, dan semangat sehingga penulis dapat menyelesaikan tugas akhir ini dengan baik.
11. Bude Pipit beserta keluarga yang menyokong segala keperluan perkuliahan dan kehidupan selama berada di Malang.
12. Aulia Rachma dan keluarga yang memberi dukungan untuk menyelesaikan Tugas Akhir ini.
13. Sahabat Uye Uye, Syahdan, Rajmil, Firli, Fani, Bond, Vio, Tita, Arif, Akhdan, Prima, Fajar, Ulya, dan Vini yang selalu memberikan bantuan, semangat, serta doa.
14. Sahabat yang paling banyak meluangkan waktu Bersama, Izan, Akhdan, Arif, dan Bond yang selalu memberikan bantuan, semangat, serta doa.
15. Sahabat Kura-Kura, Gibran, Syahdan, BO, Kiki, Kal, Geo, Chandra, Abid, Rasyid yang telah berbagi dan membantu pada waktu sulit dan pada waktu Bahagia.
16. Sejawat FK UMM Angkatan 2018 atas dukungan dan kerjasamanya. Semoga kelak dapat menjadi dokter-dokter professional dan barokah, sukses dunia akhirat dan senantiasa dalam ketaatan kepada Allah SWT.
17. Semua pihak yang terlibat secara langsung maupun tidak langsung yang tidak mampu penulis sebutkan satu per satu, terimakasih atas bantuan, dukungan, dan doanya.
Malang, 21 Juli 2022
Agam Siswanto Hardoyo
xi DAFTAR ISI
JUDUL DALAM i
LEMBAR PENGESAHAN iii
LEMBAR PERNYATAAN ORISINALITAS iv
LEMBAR PENGUJIAN v
KATA PENGANTAR vi
UCAPAN TERIMAKASIH vii
ABSTRAK ix
ABSTRACT x
DAFTAR ISI xi
DAFTAR TABEL xiv
DAFTAR GAMBAR xv
DAFTAR LAMPIRAN xvi
DAFTAR SINGKATAN xvii
BAB 1 PENDAHULUAN 1
1.1 Latar Belakang 1
1.2 Rumusan Masalah 4
1.3 Tujuan Penelitian 4
1.3.1 Tujuan Umum 4
1.3.2 Tujuan Khusus 5
1.4 Manfaat penelitian 5
1.4.1 Manfaat Akademis 5
1.4.2 Manfaat Praktis 5
BAB 2 TINJAUAN PUSTAKA 6
2.1 Sepsis 6
2.1.1 Definsi Sepsis 6
2.1.2 Diagnosis Sepsis 8
2.1.3 Komplikasi Sepsis 10
2.1.4 Epidemiologi 11
2.1.5 Patogenesis Sepsis 12
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2.2 Sistem Hemostasis dan Pembekuan Darah 15
2.2.1 Definisi Sistem Hemostasis 15
2.2.2 Mekanisme Pembekuan Darah 16
2.2.3 Hiperkoagulasi pada Sepsis 20
2.3 Trombosit 22
2.3.1 Definisi Trombosit 22
2.3.2 Trombosit pada sepsis 23
2.4 Mean Platelet Volume (MPV) 24
2.4.1 Definisi Mean Platelet Volume (MPV) 24
2.4.2 Mean Platelet Volume (MPV) pada sepsis 25
2.5 Plateletcrit (PCT) 27
2.5.1. Definisi Plateletcrit (PCT) 27
2.5.2. Plateletcrit (PCT) Pada Sepsis 27
BAB 3 KERANGKA KONSEP DAN HIPOTESIS 29
3.1 Kerangka Konsep 29
3.2 Hipotesis Penelitian 32
BAB 4 METODE PENELITIAN 33
4.1 Rancangan Penelitian 33
4.2 Lokasi Penelitian 33
4.2.1 Lokasi Penelitian 33
4.2.2 Waktu Penelitian 33
4.3 Populasi dan Subjek 33
4.3.1 Populasi 33
4.3.2 Estimasi Besar Subjek 33
4.4 Karakteristik Sampel Penelitian 34
4.4.1 Kriteria Inklusi 34
4.4.2Kriteria Eksklusi 34
4.5 Variabel Penelitian 34
4.5.1Variabel Bebas (Independen) 34
4.5.2 Variabel Tergantung 34
4.6 Instrumen Penelitian 35
4.7 Definisi Operasional 35
4.8 Prosedur Penelitian 37
4.9 Analisis Data 37
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BAB 5 HASIL PENELITIAN DAN ANALISIS DATA 39
5.1 Karakteristik Subjek Penelitian 39
5.2 Analisis Hasil 39
5.2.1 Uji Normalitas Data 40
5.2.2 Uji korelasi Pearson 41
5.2.3 Penentuan Cut-off dan Relative Risk 41
BAB 6 PEMBAHASAN 48
6.1 Karakteristik Subjek Penelitian 47
6.2 Hubungan Jumlah Trombosit dengan Mortalitas Pasien Sepsis 47 6.3 Hubungan Mean Platelet Volume dengan Mortalitas Pasien Sepsis 50 6.4 Hubungan Plateletcrit dengan Mortalitas Pasien Sepsis 52
6.5 Implikasi Penelitian 53
6.6 Keterbatasan penelitian 54
BAB 7 PENUTUP 55
7.1 Kesimpulan 55
7.2 Saran 56
DAFTAR PUSTAKA 57
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DAFTAR TABEL
Nomor Judul Tabel Halaman
Tabel 2.1 Kriteria klinis SIRS 8
Tabel 2.2 Skor SOFA 9
Tabel 2.3 Kriteria qSOFA 10
Tabel 4.1 Definisi Oprasional 35
Tabel 5.1 Data Deskriptif Subjek Penelitian 39
Tabel 5.2 Rata-Rata Jumlah Trombosit, Nilai MVP dan Nilai
Plateletcrit pada pasien yang hidup dan meninggal 39
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DAFTAR GAMBAR
Nomor Judul Gambar Halaman
Gambar 2.1 (a) SIRS, sepsis dan infeksi dan (b) sepsis-3 7
Gambar 2.2 Patogenesis sepsis 15
Gambar 2.3 Hemostatis Primer 17
Gambar 2.4 Skema kaskade koagulasi dan fibrinolitik 20 Gambar 2.5 Perubahan pada kaskade koagulasi pada kasus sepsis
parah 22
Gambar 2.6 Diagram kemungkinan perubahan dalam
trombopoiesis 26
Gambar 5.1 Kurva ROC Jumlah Trombosit 42
Gambar 5.2 Cut-off Point Jumlah Trombosit 42
Gambar 5.3 Kurva ROC MPV 43
Gambar 5.4 Cut-off Point MPV 44
Gambar 5.5 Kurva ROC Plateletcrit 44
Gambar 5.6 Cut-off point Plateletcrit 45
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DAFTAR LAMPIRAN
Nomor Judul Lampiran Halaman
Lampiran 1 Data Primer Penelitian 67
Lampiran 2 Pengolahan Data Analisis 68
Lampiran 3 Dokumentasi Kegiatan Penelitian 75
Lampiran 4 Surat keterangan layak etik 76
Lampiran 5 Surat Ijin Penelitian 77
Lampiran 6 Hasil Deteksi Plagiasi 78
Lampiran 7 Kartu Konsultasi 79
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78 L:ampiran 6. Hasil Deteksi Plagiasi
