Nilai High-Sensitivity C-Reactive Protein Terhadap Mortalitas 90 Hari Pada Pasien Gagal Jantung

39

LAMPIRAN 1
LEMBAR PENJELASAN KEPADA CALON SUBYEK PENELITIAN

Saya, dr. Nursyamsiah adalah peserta pendidikan dokter spesialis di
Fakultas Kedokteran Sumatera Utara. Saya sedang mengadakan penelitian dengan
judul “Hubungan antara hsCRP dengan tingkat mortalitas 90 hari pada pasien
gagal jantung”.
Penelitian ini digunakan untuk memprediksi kematian 90 hari pada pasien
– pasien gagal jantung. Prediksi kematian dilakukan dengan pemeriksaan hsCRP.
Penelitian ini dilakukan dengan pengambilan darah, EKG, Foto toraks,
ekokardiografi.
Saya sangat mengharapkan kesediaan Bapak/Ibu untuk berpartisipasi
dalam penelitian ini. Penelitian ini bersifat sukarela dan tidak akan memberikan
dampak yang membahayakan. Semua informasi yang Bapak/Ibu berikan akan
dirahasiakan dan hanya digunakan dalam penelitian ini. Bila data Bapak/Ibu
dipublikasikan, kerahasiaannya tetap akan dijaga. Bila keterangan yang saya
berikan masih belum jelas, Bapak/ibu dapat langsung bertanya kepada saya:
Nama


: dr. Nursyamsiah

Alamat

: Jl. Canna Raya Komplek Tasbih Blok M No.3 Medan

No Telp

: 081269886231

Atas perhatian Bapak/ Ibu saya ucapkan terima kasih
Demikian informasi ini saya sampaikan. Atas bantuan, partisipasi dan
kesediaan waktu Bapak/Ibu sekalian, saya ucapkan terimakasih.

Peneliti,

(dr. Nursyamsiah)

Universitas Sumatera Utara


40

LAMPIRAN 2
SURAT PERSETUJUAN SETELAH PENJELASAN
(INFORMED CONCERN)

Saya yang bertanda tangan dibawah ini :
Nama

:

Alamat

:

Umur

:

Jenis kelamin


: Laki-laki/Perempuan*

No. telp/HP

:

tahun

Setelah mendapat penjelasan dari peneliti tentang kebaikan dan keburukan
prosedur penelitian ini, menyatakan bersedia ikut serta dalam penelitian tentang ”
Hubungan antara hsCRP dengan tingkat mortalitas 90 hari pada pasien
gagal jantung ”. Apabila sewaktu-waktu saya mengundurkan diri dari penelitian
ini, kepada saya tidak dituntut apapun.
Demikianlah surat persetujuan bersedia ikut dalam penelitian ini saya buat, untuk
dapat digunakan seperlunya.
Medan,

Saksi,


(.......................................)

2016

Yang memberi pernyataan,

(.......................................)

Penelti

(.......................................)

Universitas Sumatera Utara

41

LAMPIRAN 3

LEMBAR KERJA PROFIL PESERTA PENELITIAN


Tanggal

:

MR :

I. IDENTITAS PRIBADI

:

1. Nama

:

2. Alamat

:

3. No telepon


:

4. Usia

:

5. Jenis Kelamin

: laki-laki / perempuan

6. Pendidikan terakhir

:

7. Pekerjaan
8. Riwayat Penyakit yang anda derita:
Diabetes Mellitus/sakit gula
Hipertensi/tekanan darah tinggi
Kelainan darah
Lain-lain:


II. PEMERIKSAAN LABORATORIUM
Parameter

Hari pertama

hsCRP

III.

Ekokardiografi
Fraksi Ejeksi:

IV.
V.

VI.

Diagnosis
Obat – Obat Yang Digunakan

Kondisi 90 hari

Universitas Sumatera Utara

42

LAMPIRAN 4

Universitas Sumatera Utara

43

LAMPIRAN 5

Universitas Sumatera Utara

44

Descriptives


Usia Mean
95% Confidence Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
IMT Mean
95% Confidence Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum

Range
Interquartile Range
Skewness
Kurtosis
TDS Mean
95% Confidence Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis

Lower Bound
Upper Bound


Lower Bound
Upper Bound

Lower Bound
Upper Bound

Statistic Std. Error
54.4615 2.21358
49.9804
58.9427
54.9031
57.0000
191.097
13.82379
20.00
80.00
60.00
16.00
-.538
.378
.576
.741
24.6962
.34158
24.0047
25.3876
24.7620
25.0000
4.550
2.13316
20.20
28.11
7.91
4.20
-.183
.378
-.992
.741
130.0000 2.46432
125.0112
134.9888
129.4444
130.0000
236.842
15.38968
110.00
160.00
50.00
20.00
.365
.378
-1.044
.741

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TDD

Mean
74.6154
95% Confidence Interval for Mean Lower Bound 71.5630
Upper Bound 77.6677
5% Trimmed Mean
74.5726
Median
70.0000
Variance
88.664
Std. Deviation
9.41615
Minimum
60.00
Maximum
90.00
Range
30.00
Interquartile Range
10.00
Skewness
.316
Kurtosis
-.759
EF
Mean
49.1795
95% Confidence Interval for Mean Lower Bound 44.8133
Upper Bound 53.5456
5% Trimmed Mean
49.9815
Median
55.0000
Variance
181.414
Std. Deviation
13.46901
Minimum
14.00
Maximum
67.00
Range
53.00
Interquartile Range
22.00
Skewness
-.649
Kurtosis
-.322
hsCRP Mean
2.7718
95% Confidence Interval for Mean Lower Bound
2.1228
Upper Bound
3.4208
5% Trimmed Mean
2.6840
Median
2.8000
Variance
4.008
Std. Deviation
2.00197
Minimum
.10
Maximum
7.90
Range
7.80
Interquartile Range
3.10
Skewness
.498
Kurtosis
-.523
Tests of Normality
Kolmogorov-Smirnova
Shapiro-Wilk
Statistic
df
Sig.
Statistic
df
Usia
.091
39
.200*
.960
39
IMT
.162
39
.012
.940
39
TDS
.204
39
.000
.904
39
TDD
.278
39
.000
.859
39
EF
.206
39
.000
.921
39
hsCRP
.131
39
.089
.946
39
*. This is a lower bound of the true significance.
a. Lilliefors Significance Correction

1.50779

.378
.741
2.15677

.378
.741
.32057

.378
.741

Sig.
.181
.038
.003
.000
.009
.059

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46

Usia
IMT
TDS
TDD
EF
hsCRP

Kematian90hari
ya
tidak
ya
tidak
ya
tidak
ya
tidak
ya
tidak
ya
tidak

Case Processing Summary
Cases
Valid
Missing
N
Percent
N
Percent
9
100.0%
0
0.0%
30
100.0%
0
0.0%
9
100.0%
0
0.0%
30
100.0%
0
0.0%
9
100.0%
0
0.0%
30
100.0%
0
0.0%
9
100.0%
0
0.0%
30
100.0%
0
0.0%
9
100.0%
0
0.0%
30
100.0%
0
0.0%
9
100.0%
0
0.0%
30
100.0%
0
0.0%

N

Total
Percent
9
100.0%
30
100.0%
9
100.0%
30
100.0%
9
100.0%
30
100.0%
9
100.0%
30
100.0%
9
100.0%
30
100.0%
9
100.0%
30
100.0%

Descriptives
Usia

Kematian90hari
ya
Mean
95% Confidence Lower Bound
Interval for Mean Upper Bound
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
tidak Mean
95% Confidence Lower Bound
Interval for Mean Upper Bound
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis

Statistic Std. Error
64.1111
3.19046
56.7539
71.4683
64.1235
65.0000
91.611
9.57137
48.00
80.00
32.00
13.00
-.045
.717
.257
1.400
51.5667
2.50043
46.4527
56.6806
51.7963
50.5000
187.564
13.69541
20.00
78.00
58.00
15.00
-.465
.427
.589
.833

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IMT

ya

tidak

TDS

ya

tidak

Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis

Lower Bound
Upper Bound

Lower Bound
Upper Bound

Lower Bound
Upper Bound

Lower Bound
Upper Bound

24.4678
22.7608
26.1748
24.5142
25.0000
4.932
2.22072
20.80
27.30
6.50
3.75
-.216
-.981
24.7647
23.9654
25.5639
24.8178
25.0000
4.581
2.14035
20.20
28.11
7.91
3.95
-.186
-.960
135.5556
124.6097
146.5014
136.1728
140.0000
202.778
14.24001
110.00
150.00
40.00
25.00
-.645
-.543
128.3333
122.5250
134.1416
127.5926
120.0000
241.954
15.55487
110.00
160.00
50.00
20.00
.650
-.675

.74024

.717
1.400
.39077

.427
.833
4.74667

.717
1.400
2.83992

.427
.833

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48

TDD

ya

tidak

EF

ya

tidak

Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Interval for Mean
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis

Lower Bound
Upper Bound

Lower Bound
Upper Bound

Lower Bound
Upper Bound

Lower Bound
Upper Bound

77.7778
69.3770
86.1786
78.0864
80.0000
119.444
10.92906
60.00
90.00
30.00
20.00
-.188
-1.232
73.6667
70.3437
76.9897
73.5185
70.0000
79.195
8.89918
60.00
90.00
30.00
10.00
.433
-.374
37.8889
34.5506
41.2272
37.5988
38.0000
18.861
4.34294
33.00
48.00
15.00
4.00
1.710
3.858
52.5667
47.5419
57.5915
53.7963
57.0000
181.082
13.45666
14.00
67.00
53.00
16.75
-1.433
1.592

3.64302

.717
1.400
1.62476

.427
.833
1.44765

.717
1.400
2.45684

.427
.833

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hsCRP ya

tidak

Mean
95% Confidence
Interval for Mean

Lower Bound
Upper Bound

5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis
Mean
95% Confidence
Lower Bound
Interval for Mean
Upper Bound
5% Trimmed Mean
Median
Variance
Std. Deviation
Minimum
Maximum
Range
Interquartile Range
Skewness
Kurtosis

4.9000
3.6058
6.1942
4.8889
5.2000
2.835
1.68375
2.10
7.90
5.80
2.10
-.004
.687
2.1333
1.5264
2.7403
2.0537
1.5500
2.642
1.62551
.10
5.70
5.60
2.70
.579
-.640

.56125

.717
1.400
.29678

.427
.833

Tests of Normality
Kolmogorov-Smirnova
Shapiro-Wilk
Kematian90hari Statistic
df
Sig.
Statistic
df
*
Usia
ya
.159
9
.200
.973
9
*
tidak
.121
30
.200
.954
30
IMT
ya
.174
9
.200*
.943
9
tidak
.172
30
.023
.937
30
TDS
ya
.178
9
.200*
.899
9
tidak
.237
30
.000
.885
30
TDD
ya
.206
9
.200*
.884
9
tidak
.293
30
.000
.856
30
EF
ya
.268
9
.062
.837
9
tidak
.272
30
.000
.840
30
hsCRP ya
.167
9
.200*
.960
9
tidak
.162
30
.043
.929
30
*. This is a lower bound of the true significance.
a. Lilliefors Significance Correction

Universitas Sumatera Utara

Sig.
.918
.216
.619
.075
.246
.004
.172
.001
.053
.000
.798
.047

50

NYHA

Total

NYHA * Kematian 90 Hr Crosstabulation
Kematian90hari
ya
tidak
NYHA III
Count
5
26
Expected Count
7.2
23.8
% within NYHA
16.1%
83.9%
% within
55.6%
86.7%
Kematian90hari
% of Total
12.8%
66.7%
NYHA IV
Count
4
4
Expected Count
1.8
6.2
% within NYHA
50.0%
50.0%
% within
44.4%
13.3%
Kematian90hari
% of Total
10.3%
10.3%
Count
9
30
Expected Count
9.0
30.0
% within NYHA
23.1%
76.9%
% within
100.0%
100.0%
Kematian90hari
% of Total
23.1%
76.9%

Value

Chi-Square Tests
Asymp. Sig.
df
(2-sided)

Total
31
31.0
100.0%
79.5%
79.5%
8
8.0
100.0%
20.5%
20.5%
39
39.0
100.0%
100.0%
100.0%

Exact Sig. (2- Exact Sig. (1sided)
sided)

Pearson Chi4.110a
1
.043
Square
Continuity
2.423
1
.120
Correctionb
Likelihood Ratio
3.654
1
.056
Fisher's Exact
.065
.065
Test
Linear-by-Linear
4.004
1
.045
Association
N of Valid Cases
39
a. 1 cells (25.0%) have expected count less than 5. The minimum expected count is
1.85.
b. Computed only for a 2x2 table
Area Under the Curve
Test Result Variable(s): hsCRP
Asymptotic 95% Confidence
Interval
Asymptotic
a
b
Area
Std. Error
Sig.
Lower Bound Upper Bound
.880
.060
.001
.762
.997
The test result variable(s): hsCRP has at least one tie between the
positive actual state group and the negative actual state group.
Statistics may be biased.
a. Under the nonparametric assumption
b. Null hypothesis: true area = 0.5

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Coordinates of the Curve
Test Result Variable(s): hsCRP
Positive if Greater Than or
Equal To a
-.9000
.1500
.3000
.4500
.6500
.9000
1.1000
1.3500
1.5500
1.8000
2.0500
2.3000
2.6500
2.8500
2.9500
3.1000
3.3500
3.5500
3.8000
4.1000
4.2500
4.4000
4.7000
5.0500
5.3000
5.5500
5.9000
7.0000
8.9000

Sensitivity
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
1.000
.889
.889
.889
.889
.778
.778
.778
.778
.778
.778
.667
.667
.556
.333
.222
.222
.111
.000

1 - Specificity
1.000
.900
.867
.833
.800
.733
.700
.567
.500
.467
.433
.433
.400
.333
.300
.300
.267
.200
.167
.133
.100
.100
.067
.067
.067
.033
.000
.000
.000

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kat.hscrp

Total

kat.hscrp * Kematian90hari Crosstabulation
Kematian90hari
ya
tidak
>4.25
Count
7
3
% within kat.hscrp
70.0%
30.0%
% within
77.8%
10.0%
Kematian90hari
% of Total
17.9%
7.7%