PERBANDINGAN ALAT SKRINING GIZI SCREENING TOOL FOR RISK DAN ON NUTRITIONAL STATUS AND GROWTH (STRONGKIDS) DAN PAEDIATRIC YORKHILL MALNUTRITION SCORE (PYMS) DALAM MENDETEKSI RISIKO MALNUTRISI PADA PASIEN KANKER ANAK DI RUMAH SAKIT DR. SARDJITO

Abstract

Intensive therapy in children with cancer in developing countries often leads to digestive disturbances, malnutrition, and other adverse effects such as decreased tolerance to chemotherapy, treatment delays, increased infection risk, and reduced quality of life. This diagnostic study involved 54 male and female patients aged 1-16 years with cancer treated at Dr. Sardjito General Hospital. Each subject was evaluated using the STRONGkids, PYMS, and SCAN screening tools. Statistical analysis was conducted to calculate the sensitivity, specificity, and AUC of each screening tool in detecting malnutrition risk compared to SCAN as the gold standard. Overall, 61.1 percent of patients had a diagnosis of Acute Lymphoblastic Leukemia. Screening with STRONGkids revealed that 44.4 percent of subjects were at moderate risk of malnutrition, and 55.6 percent were at high risk. Meanwhile, PYMS indicated that 35.2 percent were at low risk and 64.8 percent were at high risk. Both screening tools showed moderate and substantial agreement levels with SCAN. PYMS exhibited higher sensitivity, specificity, and AUC compared to STRONGkids (89.1%, 88.2%, 0.925 (0.885-0.996) respectively). In this study, 31.5 percent of patients were not at risk of malnutrition, and 68.5 percent were at risk based on SCAN as the gold standard. In conclusion, the results from PYMS had higher sensitivity, specificity, and AUC in detecting malnutrition risk in pediatric cancer patients. However, both STRONGkids and PYMS demonstrated good specificity and AUC compared to SCAN.

Keywords: malnutrition, pediatric, cancer, STRONGkids, PYMS, SCAN

ABSTRAK
Terapi intensif pada anak dengan kanker di negara berkembang seringkali menyebabkan gangguan pencernaan, malnutrisi, dan dampak buruk lainnya seperti penurunan toleransi terhadap kemoterapi, keterlambatan pengobatan, dan peningkatan risiko infeksi, serta menurunkan kualitas hidup. Studi diagnostik ini melibatkan 54 pasien laki-laki dan Perempuan dengan kanker berusia 1-16 tahun yang dirawat di Rumah Sakit Umum Pusat Dr. Sardjito. Setiap subjek dilakukan evaluasi menggunakan alat skrining STRONGkids, PYMS dan SCAN. Analisis statistik dilakukan untuk menghitung sensitivitas, spesifisitas dan AUC dari masing-masing alat skrining dalam mendeteksi risiko malnutrisi terhadap SCAN sebagai baku emas. Secara keseluruhan, 61,1 persen pasien memiliki diagnosis Acute Lymphoblastic Leukemia. Hasil skrining dengan STRONGkids menunjukkan 44,4 persen subjek berisiko sedang malnutrisi, dan 55,6 persen berisiko tinggi. Sementara PYMS menunjukkan 35,2 persen berisiko rendah, dan 64,8 persen berisiko tinggi. Kedua alat skrining menunjukkan tingkat kesepakatan yang moderat dan substansial dengan SCAN. PYMS memiliki sensitivitas, spesifisitas, dan AUC yang lebih tinggi daripada STRONGkids (89,1%, 88,2%, 0,925 (0,885-0,996) secara berurutan). Dalam penelitian ini, 31,5 persen pasien tidak berisiko malnutrisi, dan 68,5% berisiko berdasarkan SCAN sebagai baku emas. Kesimpulannya hasil dari PYMS memiliki nilai sensitivitas, spesifisitas dan AUC yang lebih tinggi dalam mendeteksi risiko malnutrisi pada pasien anak dengan kanker. Namun baik keduanya STRONGkids dan PYMS memiliki spesifisitas dan AUC yang baik terhadap SCAN.

Kata kunci: malnutrisi, pediatri, kanker, STRONGkids, PYMS, SCAN