Akurasi Diagnostik Fibrosis Hati Berdasarkan Rasio Red Cell Distribution Width (RDW) dan Jumlah Trombosit dibandingkan Fibroscan pada Penderita Hepatitis B Kronik

Frenky Jones, Juwita Sembiring, Lukman Hakim Zain

Abstract

Hepatitis B kronik merupakan masalah global dan Indonesia termasuk negara yang memiliki prevalensi hepatitis B yang tinggi. Keterbatasan tindakan biopsi hati untuk mendiagnosis fibrosis hati karena invasif, membangkitkan penelitian metode non-invasif. Dilakukan penelitian uji diagnostik potong lintang untuk mengetahui akurasi rasio RDW terhadap jumlah trombosit untuk memprediksi derajat fibrosis hati penderita hepatitis B kronik. Terhadap subjek penelitian dilakukan pemeriksaan HBsAg, darah rutin, dan fibroscan di RSUP H. Adam Malik, Medan, sejak Januari 2015 sampai Maret 2015. Nilai rasio RDW terhadap trombosit dihitung dari hasil pemeriksaan darah rutin. Derajat fibrosis hati dinilai berdasarkan hasil fibroscan dari skala F0-F4. Prosedur analisis adalah ROC dan AUC. Dari 34 kasus, 20 orang (58,8%) termasuk kelompok fibrosis hati ringan-sedang (F≤2) dan 14 orang (41,2%) kelompok fibrosis berat (F>2). Nilai akurasi sebesar 72,3 % (95% CI: 84,1% s/d 97%). Dengan nilai cut off 0,0591, didapatkan sensitivitas 71,4%, spesifisitas 60%, NPP 55,6%, NPN 75%, RKP 1,79, dan RKN 0,48. Simpulan: Rasio RDW terhadap jumlah trombosit mampu memprediksi derajat fibrosis hati penderita hepatitis B kronik dengan tingkat akurasi sedang (72,3%).


Chronic hepatitis B is a global problem and Indonesia has a high prevalence of hepatitis B. Limitation of liver biopsy as an invasive method, initiates many studies on non invasive diagnosing method for liver fibrosis. The cross sectional study was conducted to determine the accuracy of RDW to Platelet Ratio (RPR) in predicting liver fibrosis degree in chronic hepatitis B. HBsAg, complete blood count, and fibroscan was examined in H. Adam Malik Hospital, Medan, from January - March, 2015. RPR was calculated. The degree of liver fibrosis assessed by fibroscan on a scale of F0-F4. The accuracy was evaluated by constructing ROC and the AUC. From 34 cases, 20 subjects (58,8%) in mild-moderate liver fibrosis (F≤2) and 14 subjects (41,2%) in severe liver fibrosis (F>2). The accuracy is 72,3 % (95% CI : 84,1% - 97 %) with a cut off value 0,0591. Sensitivity 71,4%, specificity 60%, PPV 55,6%, NPV 75%, PPR is 1,79, and NPR is 0,48. Conclusion: RDW to platelet ratio can predict liver fibrosis grade in chronic hepatitis B with a moderate degree of accuracy (72,3%).

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References

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