HUBUNGAN NILAI ESTIMASI PLASMA VOLUME, BALANCE CAIRAN KUMULATIF, DAN NT-proBNP TERHADAP SEQUENTIAL ORGAN FAILURE ASSESSMENT (SOFA) SCORE PASIEN SYOK SEPSIS DI ICU

Objective: To determine the association of estimated plasma volume status, cumulative fluid balance, and NT-proBNP levels with SOFA score in ICU patients with septic shock before and after fluid resuscitation. Design: Prospective observational cohort study with repeated pre-post measurements. Setting: Intensive care unit of Dr. Wahidin Sudirohusodo General Hospital and HUMRC Laboratory of Hasanuddin University Hospital, Makassar, Indonesia. Patients and participants: Thirty-eight adult patients aged 18-65 years with septic shock admitted to the ICU were enrolled using consecutive sampling. Interventions: No experimental intervention was performed. All patients received standard septic shock management, including intravenous crystalloid resuscitation at 30 mL/kg within the first three hours for hypoperfusion, with vasopressors, mechanical ventilation, and supportive therapy adjusted according to hemodynamic status. Measurements and results: ePVS, cumulative fluid balance, NT-proBNP, and SOFA score were assessed at baseline, 24 hours, and 72 hours. ePVS increased significantly from baseline to 24 hours, 5.94±1.30 to 7.12±1.67, p-value<0.001, and decreased by 72 hours to 5.39±1.25, p-value<0.001. Cumulative fluid balance increased significantly at 24 hours and 72 hours, both p-value≤0.010. NT-proBNP increased at 24 hours, 1724.90 (1390.95) to 2013.28 (1164.55), p-value<0.001, and decreased at 72 hours to 1033.44 (980.57), p-value<0.001. SOFA score decreased from 8 (5) at baseline to 6 (5) at 24 hours and 3 (4) at 72 hours, both p-value<0.001. In multivariable analysis, only ΔNT-proBNP was independently associated with ΔSOFA, standardized beta=-0.381, p-value=0.037. Conclusions: In ICU patients with septic shock, ePVS, cumulative fluid balance, NT-proBNP, and SOFA score changed significantly during the first 72 hours after fluid resuscitation. Serial NT-proBNP change was the only parameter independently associated with SOFA score change, suggesting its potential value as a dynamic marker of cardiovascular stress and organ dysfunction.