Electronic Theses and Dissertation

Latar Belakang: Stroke iskemik merupakan penyebab mortalitas kedua tertinggi di Indonesia. Berbagai biomarker telah ditemukan berhubungan dengan stroke iskemik. D-dimer merupakan biomarker yang sering digunakan dalam diagnosis, prediktor perkembangan, stratifikasi risiko, prognosis dan pemantauan terapi penderita stroke iskemik dengan obat antikoagulan dan trombolisis.
Tujuan: Untuk mengetahui peran D-Dimer sebagai predictor volume infark dan
clinical outcome
Metode: Studi korelatif numerik dengan pendekatan potong lintang. Sampel penelitian diambil berdasarkan teknik consecutive sampling pada pasien stroke iskemik akut yang dirawat di RSUD dr. Zainoel Abidin Banda Aceh pada Februari 2024 hingga April 2024. Penilaian clinical outcome menggunakan NIHSS, Barthel Index (BI) dan modified rankin scale (mRS)
Hasil: Diperoleh total 101 subjek penelitian yang memenuhi kriteria penelitian. Pada penelitian ini diperoleh kadar D-Dimer berhubungan terhadap volume infark (r=0,271; p=0,006), skor NIHSS pada hari pertama rawatan (r=0,312; p=0,001) dan ketujuh rawatan(r=0,243; p=0,014), skor BI (r=-0,340; p=0,0001) dan mRS (r=0,370; p=0,0001). Kadar D-Dimer merupakan prediktor yang baik dalam memprediksikan luaran buruk berdasarkan BI (nilai ambang 535 ng/mL; sensitivitas 57,6%; Spesifisitas 71,4%; area under curve (AUC) 0,685) dan mRS (nilai ambang 505 ng/mL; sensitivitas 62,5%; Spesifisitas 64,4%; AUC 0,677) serta NIHSS derajat sedang-berat pada hari pertama (nilai ambang 435 ng/mL; sensitivitas 65,8%; Spesifisitas 67,9%; AUC 0,727) dan ketujuh rawatan (nilai ambang 520 ng/mL; sensitivitas 56,4%; Spesifisitas 56,5%; AUC 0,628).
Diskusi: Pada penelitian ini didapatkan bahwa kadar D-Dimer merupakan prediktor yang baik dalam memprediksikan volume infark dan clinical outcome. Mekanisme yang mendasari hubungan antara kadar D-Dimer terhadap clinial outcome diduga berhubungan dengan aktivasi sistem koagulasi dan fibrinolitik yang berlebihan, gangguan rekanalisasi dan peningkatan risiko cedera reperfusi, hiperkoagulabilitas sistemik dan reaksi inflamasi yang mempengaruhi volume infark dan luaran klinis penderita stroke iskemik akut.
Kata Kunci: Stroke iskemik akut, volume infark, clinical outcome, NIHSS, Barthel Index, mRS.

Background: Ischemic stroke is the second highest cause of mortality in Indonesia. Various biomarkers have been found to be associated with ischemic stroke. D-dimer is a biomarker that is often used in diagnosis, predictor of progression, risk stratification, prognosis and monitoring therapy for ischemic stroke patients with anticoagulant drugs and thrombolysis. Objective: To determine the role of D-Dimer as a predictor of infarct volume and clinical outcome Method: Numerical correlative study with a cross-sectional approach. The research sample was taken based on a consecutive sampling technique from acute ischemic stroke patients treated at RSUD dr. Zainoel Abidin Banda Aceh from February 2024 to April 2024. Clinical outcome assesses using NIHSS, Barthel Index (BI) and modified Rankin scale (mRS) Results: A total of 101 subjects were obtained. In this study, D-Dimer levels were related to infarct volume (r=0.271; p=0.006), NIHSS score on the first day of treatment (r=0.312; p=0.001) and seventh day of treatment (r=0.243; p=0.014), BI score (r=-0.340; p=0.0001) and mRS (r=0.370; p=0.0001). D-Dimer levels are a good predictor in predicting poor outcomes based on BI (threshold value 535 ng/mL; sensitivity 57.6%; Specificity 71.4%; area under curve (AUC) 0.685) and mRS (threshold value 505 ng/ mL; sensitivity 62.5%; Specificity 64.4%; AUC 0.677) as well as moderate-severe NIHSS on the first day (threshold value 435 ng/mL; sensitivity 65.8%; Specificity 67.9%; AUC 0.727) and seventh day of treatments (threshold value 520 ng/mL; sensitivity 56.4%; Specificity 56.5%; AUC 0.628). Discussion: In this study it was found that D-Dimer levels were a good predictor in predicting infarct volume and clinical outcome. The mechanism underlying the relationship between D-Dimer levels and clinical outcome is thought to be related to excessive activation of the coagulation and fibrinolytic systems, impaired recanalization and increased risk of reperfusion injury, systemic hypercoagulability and inflammatory reactions that affect infarct volume and clinical outcomes of patients with acute ischemic stroke. Keywords: