ABSTRAK
Latar belakang : Gagal jantung masih menjadi masalah kesehatan utama di dunia.
Penyebab tersering dari gagal jantung adalah gagal jantung iskemik. Penelitianpenelitian
observasional menemukan peranan high sensitive C-Reactive Protein
(hsCRP) dan hitung leukosit total pada kondisi penyakit kronik. Peningkatan neutrofil
berhubungan secara positif dengan derajat PJK dan gagal jantung, limfosit
menunjukkan hal sebaliknya. RNL mudah dihitung pada banyak rumah sakit.
Kemampuan latihan merupakan parameter penting yang dapat diterjemahkan dalam
aktivitas sehari-hari. Selain itu, kemampuan latihan ini merupakan prediktor morbiditas
dan mortalitas pada pasien gagal jantung.
Tujuan : Untuk mengetahui hubungan antara RNL dan kapasitas fungsional jantung
dan hs-CRP pada pasien gagal jantung iskemik AHA stage C.
Metode : Jenis penelitian ini adalah potong lintang analitik (Cross Sectional Analytic) ,
sebanyak 35 pasien gagal jantung iskemik AHA stage C pada poliklinik rawat jalan
KSM Jantung dan Pembuluh Darah di RSUD Dr. Moewardi Surakarta. Seluruh sampel
dilakukan pemeriksaan rasio neutrofil limfosit dan hs-CRP lalu dilakukan uji treadmill.
Data kapasitas fungsional jantung (METs) dan hs-CRP diuji beda dengan Mann-
Whitney test berdasarkan mean RNL penelitian terdahulu, sehingga terdapat 2 kelompok
RNL <2.3 dan kelompok RNL ??2.3. Uji korelasi untuk menilai adakah hubungan
antara 2 variabel menggunakan uji Spearman’s. Dianggap bermakna secara statistik bila
nilai p < 0.05.
Hasil : Nilai uji beda kapasitas fungsional jantung(METs) dan hs-CRP antara
kelompok 1 dank 2 masing-masing mendapatkan nilai p <0.001 dan p= 0.001. Analisis
korelasi RNL dengan METs menggunakan uji Spearman’s menunjukkan RNL
berkorelasi negatif bermakna dengan METs (r = -0.600 ; p<0.001) dan berkorelasi
positif bermakna dengan hsCRP (r = 0.509; p =0.002). Kurva ROC menunjukkan titik
potong RNL 2.28 mempunyai sensitivitas 73.3 % dan spesifisitas 80% ; Area Under the
Curve (AUC) 0.71 ; 95% CI 0.519-0.891 ; p =0.040.
Kesimpulan : Terdapat hubungan (korelasi negatif kuat) yang bermakna antara RNL
dan METs (r =-0.600; p< 0.001). Terdapat hubungan (korelasi positif sedang) yang
bermakna antara RNL dan hsCRP (r = 0.509; p = 0.002). RNL ??2.28 dapat
mendiagnosis adanya pasien gagal jantung iskemik AHA stage C dengan kapasitas
fungsional jantung yang rendah (< 5 METs).
Kata kunci : RNL, kapasitas fungsional jantung, hs-CRP.
ABSTRACT
Background : Heart failure is still being a main problem of the world. The main cause
of heart failure is due to ischemic problem (ischemic heart failure). Observational
researchs has found the role of high sensitive C-Reactive Protein (hs-CRP) and total
leucocyte count in many chronic disease. The neutrophyl has positive association with
the severity of coronary heart disease dan heart failure, lymphocyte has not. NLR is
easily measurable in many hospital. The ability to exercise is important parameter
which can measure as a daily activity. Meanwhile, the ability to exercise is a predictor
for morbidity and mortality in heart failure patient.
Objective : To analyze the association between Neutrophyl Lymphocyte Ratio (NLR)
and Functional Capacity and high sensitive C-Reactive Protein (hs-CRP) in Ischemic
Heart Failure AHA Stage C patients
Methods : This is an analytic cross sectional study. As many as 35 patient of ischemic
heart failure AHA stage C at outpatient clinics in Cardiovascular Department of
Dr.Moewardi’s Hospital, Surakarta were selected consecutively. Peripheral venous
blood samples to measure the NLR and hs-CRP were drawn before treadmill test in all
study population. METs and hsCRP compared using Mann-Whitney-test based on
preliminary study so that will be 2 groups, NLR <2.3 and NLR? 2.3. Correlation
analysis was performed using Spearman’s test. P<0.05 was considered as statistically
significant.
Result : There was significant different in functional capacity and hs-CRP between
group NLR <2.3 and NLR? 2.3 (p <0.001 dan p= 0.001, respectively). Correlation
analysis using Spearman’s test showed that NLR had significant negative correlation
with functional capacity (r = -0.600 ; p<0.001) and significant positive correlation with
hs-CRP (r = 0.509; p =0.002). The cut-off value of NLR for prediction of poor
functional capacity (<5 METs) was >2.28 with a sensitivity of 73.3% and a specificity
of 80% in the ROC curve analysis (Area Under the Curve (AUC) 0.71 ; 95% CI 0.519-
0.891 ; p =0.040)
Conclusion : NLR had significant negative correlation with functional capacity and
significant positive correlation with hs-CRP. The cut-off value of NLR for prediction of
poor functional capacity (<5 METs) was >2.28 with a sensitivity of 73.3% and a
specificity of 80%
Keywords : NLR, functional capacity, hs-CRP.