PERANAN RASIO MONOSIT TERHADAP LIMFOSIT (MLR) SEBAGAI PREDIKTOR KEJADIAN NSTEMI
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Infark miokard akut (IMA) merupakan salah satu penyakit jantung paling mematikan dan berkontribusi terhadap morbiditas dan mortalitas secara global. Berdasarkan laporan WHO tahun 2019, sekitar 17,9 juta orang meninggal dunia karena penyakit kardiovaskular, yang mencakup sekitar 32% dari total kematian di seluruh dunia. Peningkatan jumlah dan jenis monosit berhubungan erat dengan kejadian penyakit kardiovaskular. Rasio monosit terhadap limfosit (MLR) adalah hasil bagi antara jumlah monosit absolut dibagi dengan jumlah limfosit absolut, parameter tersebut telah terbukti menjadi parameter hematologis dan inflamasi. Penelitian ini bertujuan untuk menyelidiki akurasi diagnostik dari MLR pada kasus NSTEMI. Studi cross-sectional ini dilakukan di RSUD Depati Hamzah dari juni 2020 sampai juli 2020. Variabel penelitian meliputi usia, hemoglobin, trombosit, leukosit, limfosit, monosit, MLR, dan hasil EKG. Sebelum analisis statistik, dilakukan uji normalitas menggunakan tes Kolmogorov-Smirnov dan Shapiro Wilk serta tes Levene. Analisis statistik menggunakan Independent T-Test untuk data standar dan uji alternatif data yang tidak normal menggunakan tes Mann-Whitney. 30 rekam medis memenuhi kriteria inklusi. Setelah dilakukan analisis ROC, tiga variabel memiliki kemampuan prediktif yang cukup baik. Variabel tersebut antara lain usia (AUC: 0,738 / p-value: 0,029), leukosit (AUC: 0,775 / p-value: 0,012), dan MLR (AUC: 0,963 / p-value: 0,029). Kemampuan prediktif MLR sangat baik (AUC >0,8), tertinggi dari variabel lainnya. MLR dapat digunakan sebagai penilaian faktor risiko terhadap kejadian NSTEMI karena didapatkan perbedaan yang signifikan antara kelompok sehat dengan kelompok NSTEMI. Penggunaan marker ini bisa membantu dalam mendiagnosis pasien yang mengalami nyeri dada, terutama di pelayanan kesehatan yang terbatas.
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Alexander, K. P., Newby, L. K., Cannon, C. P., Armstrong, P. W., Gibler, W. B., Rich, M. W., Van de Werf, F., White, H. D., Weaver, W. D., Naylor, M. D., Gore, J. M., Krumholz, H. M., & Ohman, E. M. (2007). Acute Coronary Care in the Elderly, Part I. Circulation, 115(19), 2549–2569. https://doi.org/10.1161/CIRCULATIONAHA.107.182615
Alie, N., Eldib, M., Fayad, Z. A., & Mani, V. (2014). Inflammation, Atherosclerosis, and Coronary Artery Disease: PET/CT for the Evaluation of Atherosclerosis and Inflammation. Clinical Medicine Insights: Cardiology, 8s3, CMC.S17063. https://doi.org/10.4137/CMC.S17063
Anderson, J. L., & Morrow, D. A. (2017). Acute Myocardial Infarction. New England Journal of Medicine, 376(21), 2053–2064. https://doi.org/10.1056/NEJMra1606915
Chadwick Jayaraj, J., Davatyan, K., Subramanian, S. S., & Priya, J. (2019). Epidemiology of Myocardial Infarction. In Myocardial Infarction. IntechOpen. https://doi.org/10.5772/intechopen.74768
Chen, H., Li, M., Liu, L., Dang, X., Zhu, D., & Tian, G. (2019). Monocyte/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients with non-ST-elevation myocardial infarction. Medicine, 98(26), e16267. https://doi.org/10.1097/MD.0000000000016267
Cheng, H.-R., Song, J.-Y., Zhang, Y.-N., Chen, Y.-B., Lin, G.-Q., Huang, G.-Q., He, J.-C., & Wang, Z. (2020). High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.575809
Crea, F., & Libby, P. (2017). Acute Coronary Syndromes. Circulation, 136(12), 1155–1166. https://doi.org/10.1161/CIRCULATIONAHA.117.029870
Diskominfo. (2021). Rumah Sakit Umum Daerah Depati Hamzah. Diskominfo PGK.
Dziedzic, E. A., Gąsior, J. S., Tuzimek, A., & Kochman, W. (2023). Blood Count-Derived Inflammatory Markers and Acute Complications of Ischemic Heart Disease in Elderly Women. Journal of Clinical Medicine, 12(4), 1369. https://doi.org/10.3390/jcm12041369
Hua, Y., Sun, J.-Y., Lou, Y.-X., Sun, W., & Kong, X.-Q. (2023). Monocyte-to-lymphocyte ratio predicts mortality and cardiovascular mortality in the general population. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2023.03.016
Idzkowska, E., Eljaszewicz, A., Miklasz, P., Musial, W. J., Tycinska, A. M., & Moniuszko, M. (2015). The Role of Different Monocyte Subsets in the Pathogenesis of Atherosclerosis and Acute Coronary Syndromes. Scandinavian Journal of Immunology, 82(3), 163–173. https://doi.org/10.1111/sji.12314
Ji, H., Li, Y., Fan, Z., Zuo, B., Jian, X., Li, L., & Liu, T. (2017). Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment. BMC Cardiovascular Disorders, 17(1), 90. https://doi.org/10.1186/s12872-017-0507-4
Kementerian Kesehatan RI. (2019). Laporan Nasional RISKESDAS 2018. Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan.
Kounis, N. G., Soufras, G. D., Tsigkas, G., & Hahalis, G. (2015). White Blood Cell Counts, Leukocyte Ratios, and Eosinophils as Inflammatory Markers in Patients With Coronary Artery Disease. Clinical and Applied Thrombosis/Hemostasis, 21(2), 139–143. https://doi.org/10.1177/1076029614531449
Kytö, V., Sipilä, J., & Rautava, P. (2015). Association of age and gender with risk for non-ST-elevation myocardial infarction. European Journal of Preventive Cardiology, 22(8), 1003–1008. https://doi.org/10.1177/2047487314539434
Lscher, T. F. (2018). The ESC Textbook of Cardiovascular Medicine. In A. J. Camm, T. F. Lüscher, G. Maurer, & P. W. Serruys (Eds.), Cardiovascular Medicine (3rd ed.). Oxford University Press. https://doi.org/10.1093/med/9780198784906.001.0001
Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. (2018). Pedoman Tatalaksana Sindrom Koroner Akut (4th ed.). Jurnal Kardiologi Indonesia.
Quan, X. Q., Wang, R. C., Zhang, Q., Zhang, C. T., & Sun, L. (2020). The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: A systematic review and meta-analysis. BMC Cardiovascular Disorders, 20(1), 1–7. https://doi.org/10.1186/S12872-020-01614-X/TABLES/3
Ren, H., Liu, X., Wang, L., & Gao, Y. (2017). Lymphocyte-to-Monocyte Ratio: A Novel Predictor of the Prognosis of Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases, 26(11), 2595–2602. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.019
Robbins, C. S., Hilgendorf, I., Weber, G. F., Theurl, I., Iwamoto, Y., Figueiredo, J.-L., Gorbatov, R., Sukhova, G. K., Gerhardt, L. M. S., Smyth, D., Zavitz, C. C. J., Shikatani, E. A., Parsons, M., van Rooijen, N., Lin, H. Y., Husain, M., Libby, P., Nahrendorf, M., Weissleder, R., & Swirski, F. K. (2013). Local proliferation dominates lesional macrophage accumulation in atherosclerosis. Nature Medicine, 19(9), 1166–1172. https://doi.org/10.1038/nm.3258
Shang, C.-Y., Wu, J.-Z., Ren, Y.-M., Liang, J.-H., Yin, H., Xia, Y., Wang, L., Li, J.-Y., Li, Y., & Xu, W. (2023). Prognostic significance of absolute monocyte count and lymphocyte to monocyte ratio in mucosa-associated lymphoid tissue (MALT) lymphoma. Annals of Hematology, 102(2), 359–367. https://doi.org/10.1007/s00277-023-05098-5
Sharma, K., Patel, A. K., Shah, K. H., & Konat, A. (2017). Is Neutrophil-to-Lymphocyte Ratio a Predictor of Coronary Artery Disease in Western Indians? International Journal of Inflammation, 2017, 1–8. https://doi.org/10.1155/2017/4136126
Shumilah, A. M., Othman, A. M., & Al-Madhagi, A. K. (2021). Accuracy of neutrophil to lymphocyte and monocyte to lymphocyte ratios as new inflammatory markers in acute coronary syndrome. BMC Cardiovascular Disorders, 21(1), 422. https://doi.org/10.1186/s12872-021-02236-7
Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2018). Fourth Universal Definition of Myocardial Infarction (2018). Journal of the American College of Cardiology, 72(18), 2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038
World Health Organization. (2021). Cardiovascular diseases (CVDs). WHO. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Xiang, F., Chen, R., Cao, X., Shen, B., Liu, Z., Tan, X., Ding, X., & Zou, J. (2018). Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study. Hemodialysis International, 22(1), 82–92. https://doi.org/10.1111/hdi.12549
Yamamoto, E., Sugiyama, S., Hirata, Y., Tokitsu, T., Tabata, N., Fujisue, K., Sugamura, K., Sakamoto, K., Tsujita, K., Matsumura, T., Kaikita, K., & Hokimoto, S. (2016). Prognostic significance of circulating leukocyte subtype counts in patients with coronary artery disease. Atherosclerosis, 255, 210–216. https://doi.org/10.1016/j.atherosclerosis.2016.08.033
Zhang, T., Zhao, Q., Liu, Z., Zhang, C., Yang, J., & Meng, K. (2020). Relationship between monocyte/lymphocyte ratio and non-culprit plaque vulnerability in patients with acute coronary syndrome. Medicine, 99(41), e21562. https://doi.org/10.1097/MD.0000000000021562