LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

Nama : RAHMA NUR ISLAMI

NIM : 04011181520177

1. Dalam file excel tersedia DATA Abnormalitas terdiri dari variabel SGOT/SGPT laki-laki,
hemoglobin, trigliserid, total kolesterol, HDL dan LDL. Hitunglah Nilai Abnormalitas dari
data yang tersedia:
1.1. Hitung Harga Rerata
1.2. Hitung Standard Deviasi
1.3. Nilai Abnormalitas adalah
>rerata + 2x Standard Deviasi
Parameter Rerata SD Rerata ±2SD Nilai Abnormalitas
SGOT/SGPT 26,29 13,923 26,29 + 2 (13,923) 54,13 + 0,05 = 54,18
= 54,136 abnormal bila >54,186
Hemoglobin 12,472 0,3238 12,472 - 2 (0,3238) 11,83 – 0,05 = 11,78
= 11,8244 abnormal bila<11,78
Trigliserid 115,31 20,047 115,31 + 2 (20,027) 155,39 + 0,05 = 155,44
= 155,404 abnormal bila>155,454
Total 137,24 32,405 137,24 + 2 (32,405) 202,04 + 0,05 = 202,09
Kolesterol = 202,05 abnormal bila>202,1
HDL 89,44 17,119 89,44 – 2 (17,119) 55,22 – 0,05 = 55,17
= 55,202 abnormal bila<55,152
LDL 74,64 13,634 74,64 + 2 (13,634) 101,91 + 0,05 = 101,96
= 101,91 abnormal bila>101,96
2. Tersedia Clinical Scenario sebagai berikut:
You are a general practitioner working in a primary health care team who frequently sees
older patients reporting memory loss and concerned about the onset of dementia. You
routinely use the Mini-Mental State Examination (MMSE) screening tool with these
patients to evaluate their cognitive function as you know this tool to be sensitive, valid and
reliable. Recently you have heard of a tool called the Mini-Cog which is considered
quicker to administer and better for patients who or older, less educated or from culturally
and linguistically diverse (CALD) communities. You wish to find out if the Mini-Cog test
is as accurate as the MMSE in detecting Alzheimer’s disease or dementia.
2.1. Tabel P.I.C.O
P Elderly adult with early sign/symptoms of cognitive impairment
I Mini-Cog Screening Test
C Mini-Mental State Examination (MMSE)
O Accurate diagnosis of Dementia or Alzheimer’s disease

2.2. Buatlah Clinical Question

In Older adults with cognitive impairment, is the Mini-Cog Test or minicog as
accurate as MMSE or SMMSE in diagnosis of Alzheimer’s disease or Dementia?

2.3. Buatlah Search Term/Search/Keyword

(Mini-Cog OR minicog) AND (Mini Mental State Examination OR MMSE OR
SMMSE) AND (Alzheimer’s disease OR Dementia)

2.4. Lakukan Searching

Sumber: www.tripdatabase.com

2.5. Pastekan Abstract Artikel yang didapat pada lembar Jawaban

Cognitive tests for dementia: MMSE, Mini-Cog and ACE-R
The way we diagnose and detect dementia, therefore, is by systematically assessing
the function of various brain regions by using cognitive tests.‘Cognitive’ here means
the ‘higher brain functions’ I alluded to earlier; things
like memory, numeracy, visual perception, personality change and planning, to
name a few.
The commonest cognitive test used is called the Mini-Mental State Examination
(MMSE). In this test you can score up to 30 points by answering a range of questions
that test your orientation to time and place, your memory, attention and so on. The test
itself takes about 10 minutes to complete. As the authors of this paper state, the
performance of the MMSE in detecting dementia as compared to other tests has not
been systematically assessed and so, that is what they set out to do. One of the reasons
to assess the relative merits of the MMSE is that it is a proprietary instrument, owned
by ‘Psychological Assessment Resources’ meaning that it is not actually free for
organisations to use.
Methods
The reviewers included studies that:
 Looked for patients with either Alzheimer’s, vascular dementia or Parkinson’s
disease in any clinical setting
 Assessed patients or carers face-to-face
 Used a standardised diagnostic criteria to diagnose dementia
 Published the outcome measures they were interested in.
Results
The initial search yielded 26,380 papers! After applying the inclusion/exclusion
criteria they were left with 149 studies, which covered 11 different diagnostic tests
and over 40,000 people from around the world.
MMSE
 The vast majority of the studies looked at MMSE (108 of 149)
 Sample size was 36,080 of whom 10,263 had dementia
 From these studies the:
o Mean sensitivity was 81% (CI was 78% to 84%)
o Mean specificity was 89% (CI was 87% to 91%)
o All other markers also showed good diagnostic accuracy (LR+ = 7.45, LR- =
0.21, diagnostic OR was 35.4 and AUC was 92%)
Mini-Cog and ACE-R (the best of the rest)
 Of the 11 remaining tests, two stood out as being ‘better’ than the MMSE
o Mini-Cog (brief test <5 min): sensitivity of 91% and specificity of 86%
o ACE-R (20 min test): sensitivity of 92% and specificity of 89%
 However where the MMSE data was drawn from hundreds of studies:
o Mini-Cog data was drawn from just 9 studies
o ACE-R was drawn from just 13 studies
For all three of the above tests, there was found to be a high degree of heterogeneity.
In essence this is a statistical test telling us that between studies included in the
analyses, the results were quite different from one study to another. Heterogeneity is
not a good thing in systematic reviews.
Further analyses
The reviewers showed that the accuracy of the MMSE was not affected by
geographical location or clinical site (i.e. it was as effective for hospital patients as
community patients).
Finally they looked at the accuracy of diagnosing mild cognitive impairment (MCI);
a risk state that precedes dementia. They didn’t really go into much detail in the
methods of how they found the studies or how they defined MCI.
 Only 21 studies using MMSE were used to assess diagnostic accuracy for MCI
giving:
o a sensitivity of only 62%
o and a specificity of 87%.
 An alternative test, the MoCA, was found to perform better (in 9 studies) with:
o a sensitivity of 89%
o and a specificity of 75%
 No data was provided on the other tests presumably because there weren’t enough
studies.
Conclusions
In short, the MMSE is not a bad screening tool for dementia but it is not miles better
than the rest; it’s just really commonly used, probably for historical reasons. The
ACE-R and the Mini-Cog are both free to use and may be viable alternatives.
The MMSE is less good in mild cognitive impairment.
Final thoughts
It’s important to add that whilst this paper focussed on cognitive screening tests,
which play an important part in diagnosis, a full clinical assessment of someone with
suspected dementia requires a much more detailed approach. Combining information
from the history, examination, investigations and cognitive tests greatly improve the
diagnostic accuracy. Also where the screening tests are not clear, patients can be
referred for much more detailed assessments of cognition performed by
neuropsychologists.
Also it is important to remember that the diagnosis of dementia requires evidence of a
progressive illness. This means that repeating cognitive tests and looking for change is
often more helpful than just a snapshot. This aspect was not covered in this systematic
review.
2.6. Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet
Are the results of this diagnostic study valid?
Was there an independent, blind Ya, ada perbandingan MMSE
comparison with a reference (“gold”) sebagai gold standard
standard of diagnosis?
Was the diagnostic test evaluated in an Ya, tes dilakukan pada pasien
appropriate spectrum of patients (like dengan Demensia Alzheimer’s,
those in whom it would be used in demensia vaskular atau Parkinson.
practice)?
Was the reference standard applied Ya, dilakukan juga tes MMSE,
regardless of the diagnostic test result? MoCA, dan ACE
Was the test (or cluster of tests) Ya
validated in a second, independent
group of patients?
Kesimpulan: Hasil penelitian valid

Are the valid results of this diagnostic study important?

Mini-Cog (brief test <5 min): sensitivity of 91% and specificity of 86%
Sensitivity = a/(a+c) = 731/809 = 90%
Specificity = d/(b+d) = 1500/1770 = 85%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 90/15 = 6
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 10%/85% =
0.12

Only 21 studies using MMSE were used to assess diagnostic accuracy for MCI
giving:
o a sensitivity of only 62%
o and a specificity of 87%.
Hasilujidiagnostikinimenunjukkanhasilbahwasensitivitas Mini-Cog lebihtinggi
daripada MMSE. Sedangkan, spesifisitas Mini-Cog lebihrendahdibandingkan MMSE.
 Can you apply this valid, important evidence about a diagnostic test in caring for
your patient?
Is the diagnostic test available, Untuk presisi dan akurasinya belum
affordable, accurate, and precise in your tahu karena belum pernah diterapkan di
setting? klinik saya.
Can you generate a clinically sensible  Tidak, saya tidak bisa
estimate of your patient’s pre-test memperkirakan Pretest probabilities
probability (from personal experience, dari pasien saya
prevalence statistics, practice databases,  Ya, pasien di penelitian mirip
or primary studies)? dengan pasien yang datang kepada
 Are the study patients similar to saya.
your own?  Tidak, kemungkinan penyakit
 Is it unlikely that the disease tersebut tidak akan berubah
possibilities or probabilities have
changed since the evidence was
gathered?
Will the resulting post-test probabilities  Tidak, karena posttest
affect your management and help your probabilitiesnya tidak tersedia dan
patient? tidak bisa dihitung.
 Could it move you across a test-  Pasien saya mungkin akan mau
treatment threshold? diterapkan tes ini.
 Would your patient be a willing
partner in carrying it out?
Would the consequences of the test help Ya, sensitivitas Mini-Cog jauh lebih
your patient? tinggi dari MMSE (91% vs 62%),
sedangkan spesifisitas Mini-Cog hanya
sedikit lebih rendah dibanding MMSE
(86% vs 87%)
Kesimpulan: Hasilujidiagnostikkini valid dan Mini-Cog
dapatdiaplikasikankepasiensebagaialternatif dalammendiagnosis dementia.

3. Dalam file excel tersedia DATA Diagnostik. Data terdiri dari variabel LDL dan kreatinin
kinase.
3.1. Buatlah Grafik Titik Potong Diagnostik pastekan pada lembar jawaban.
Kreatinin Kinase

Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
Kreatinin Kinase

LDL

Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
80 100 120 140 160 180 200
LDL
 3.2. Perkirakan secara visual nilai titik potong diagnostik dan interpretasikan.
Kreatinin Kinase

Kreatinin Kinase
100
Sensitivity: 100,0
Specificity: 92,0
Criterion: >69,1098
80
Sensitivity

60

40

20
AUC = 0,973
P < 0,001
0
0 20 40 60 80 100
100-Specificity

Interpretasi: dari grafik di atas secara visual nilai titik potong kreatinin kinase lebih
dari 60 dan kurang dari 70.

LDL

LDL
100

80 Sensitivity: 84,6
Specificity: 47,1
Criterion: ≤143,002
Sensitivity

60

40

20
AUC = 0,598
P = 0,253
0
0 20 40 60 80 100
100-Specificity

Interpretasi: dari grafik di atas secara visual nilai titik potong LDLkurang dari 143.

3.3. Hitunglah Seluruh Nilai Diagnostik memakai MedCalc dan Epicalc buatlah
kesimpulan.
Kreatinin Kinase
ROC curve
Variable Kreatinin_kinase
Kreatinin Kinase
 Classification variable MCI
MCI
Sample size 100
Positive group a 13(13,00%)
Negative group b 87(87,00%)
aMCI = 1
bMCI = 0

Disease prevalence (%) unknown

Area under the ROC curve (AUC)
Area under the ROC curve (AUC) 0,973
Standard Errora 0,0140
95% Confidence intervalb 0,919 to 0,995
z statistic 33,901
Significance level P (Area=0.5) <0,0001
a DeLong et al., 1988
b
Binomial exact
Youden index
Youden index J 0,9195
Associated criterion >69,1098
Sensitivity 100,00
Specificity 91,95
Criterion values and coordinates of the ROC curve [Hide]
Criterion Sensitivity 95% CI Specificity 95% CI +LR 95% CI -LR 95% CI
≥40,0886 100,00 75,3 - 0,00 0,0 - 4,2 1,00 1,0 - 1,0
100,0
>40,0886 100,00 75,3 - 2,30 0,3 - 8,1 1,02 1,0 - 1,1 0,00
100,0
>42,2335 100,00 75,3 - 4,60 1,3 - 11,4 1,05 1,0 - 1,1 0,00
100,0
>43,9342 100,00 75,3 - 6,90 2,6 - 14,4 1,07 1,0 - 1,1 0,00
100,0
>44,5265 100,00 75,3 - 9,20 4,1 - 17,3 1,10 1,0 - 1,2 0,00
100,0
>45,3403 100,00 75,3 - 11,49 5,7 - 20,1 1,13 1,0 - 1,2 0,00
100,0
>45,993 100,00 75,3 - 13,79 7,3 - 22,9 1,16 1,1 - 1,3 0,00
100,0
>46,5438 100,00 75,3 - 16,09 9,1 - 25,5 1,19 1,1 - 1,3 0,00
100,0
>46,7113 100,00 75,3 - 18,39 10,9 - 1,23 1,1 - 1,4 0,00
100,0 28,1
>46,8232 100,00 75,3 - 20,69 12,7 - 1,26 1,1 - 1,4 0,00
100,0 30,7
>49,5672 100,00 75,3 - 22,99 14,6 - 1,30 1,2 - 1,5 0,00
100,0 33,2
>51,2017 100,00 75,3 - 25,29 16,6 - 1,34 1,2 - 1,5 0,00
100,0 35,7
>51,4334 100,00 75,3 - 27,59 18,5 - 1,38 1,2 - 1,6 0,00
100,0 38,2
>51,5042 100,00 75,3 - 29,89 20,5 - 1,43 1,2 - 1,6 0,00
100,0 40,6
>51,5992 100,00 75,3 - 32,18 22,6 - 1,47 1,3 - 1,7 0,00
100,0 43,1
>53,2779 100,00 75,3 - 34,48 24,6 - 1,53 1,3 - 1,8 0,00
100,0 45,4
>53,4525 100,00 75,3 - 36,78 26,7 - 1,58 1,3 - 1,9 0,00
 100,0 47,8
>53,565 100,00 75,3 - 39,08 28,8 - 1,64 1,4 - 1,9 0,00
100,0 50,1
>53,6501 100,00 75,3 - 41,38 30,9 - 1,71 1,4 - 2,0 0,00
100,0 52,4
>53,9037 100,00 75,3 - 43,68 33,1 - 1,78 1,5 - 2,1 0,00
100,0 54,7
>54,7923 100,00 75,3 - 45,98 35,2 - 1,85 1,5 - 2,2 0,00
100,0 57,0
>55,6222 100,00 75,3 - 48,28 37,4 - 1,93 1,6 - 2,4 0,00
100,0 59,2
>56,4282 100,00 75,3 - 50,57 39,6 - 2,02 1,6 - 2,5 0,00
100,0 61,5
>56,6846 100,00 75,3 - 52,87 41,9 - 2,12 1,7 - 2,7 0,00
100,0 63,7
>56,7849 100,00 75,3 - 55,17 44,1 - 2,23 1,8 - 2,8 0,00
100,0 65,9
>56,8989 100,00 75,3 - 57,47 46,4 - 2,35 1,8 - 3,0 0,00
100,0 68,0
>57,4361 100,00 75,3 - 59,77 48,7 - 2,49 1,9 - 3,2 0,00
100,0 70,1
>61,5142 100,00 75,3 - 62,07 51,0 - 2,64 2,0 - 3,4 0,00
100,0 72,3
>61,687 100,00 75,3 - 64,37 53,4 - 2,81 2,1 - 3,7 0,00
100,0 74,4
>62,1392 100,00 75,3 - 66,67 55,7 - 3,00 2,2 - 4,0 0,00
100,0 76,4
>63,3665 100,00 75,3 - 68,97 58,1 - 3,22 2,4 - 4,4 0,00
100,0 78,5
>64,2472 100,00 75,3 - 71,26 60,6 - 3,48 2,5 - 4,8 0,00
100,0 80,5
>65,3717 100,00 75,3 - 73,56 63,0 - 3,78 2,7 - 5,4 0,00
100,0 82,4
>65,405 100,00 75,3 - 75,86 65,5 - 4,14 2,9 - 6,0 0,00
100,0 84,4
>65,6424 100,00 75,3 - 78,16 68,0 - 4,58 3,1 - 6,8 0,00
100,0 86,3
>65,879 100,00 75,3 - 80,46 70,6 - 5,12 3,3 - 7,8 0,00
100,0 88,2
>67,1141 100,00 75,3 - 82,76 73,2 - 5,80 3,7 - 9,2 0,00
100,0 90,0
>67,9009 100,00 75,3 - 85,06 75,8 - 6,69 4,1 - 11,0 0,00
100,0 91,8
>68,4219 100,00 75,3 - 87,36 78,5 - 7,91 4,6 - 13,7 0,00
100,0 93,5
>69,0546 100,00 75,3 - 89,66 81,3 - 9,67 5,2 - 17,9 0,00
100,0 95,2
>69,1098 100,00 75,3 - 91,95 84,1 - 12,43 6,1 - 25,3 0,00
100,0 96,7
>70,1641 92,31 64,0 - 93,10 85,6 - 13,38 6,1 - 29,4 0,083 0,01 -
99,8 97,4 0,5
>72,9038 76,92 46,2 - 93,10 85,6 - 11,15 4,9 - 25,5 0,25 0,09 -
95,0 97,4 0,7
>73,2495 69,23 38,6 - 94,25 87,1 - 12,05 4,8 - 30,4 0,33 0,1 - 0,7
90,9 98,1
>75,2407 69,23 38,6 - 96,55 90,3 - 20,08 6,2 - 64,7 0,32 0,1 - 0,7
90,9 99,3
>76,5148 61,54 31,6 - 97,70 91,9 - 26,77 6,4 - 0,39 0,2 - 0,8
86,1 99,7 112,5
>76,8872 53,85 25,1 - 98,85 93,8 - 46,85 6,3 - 0,47 0,3 - 0,8
80,8 100,0 350,6
>77,4574 38,46 13,9 - 98,85 93,8 - 33,46 4,2 - 0,62 0,4 - 1,0
68,4 100,0 264,2
>77,995 30,77 9,1 - 61,4 100,00 95,8 - 0,69 0,5 - 1,0
100,0
>78,3619 15,38 1,9 - 45,4 100,00 95,8 - 0,85 0,7 - 1,1
100,0
>78,6751 0,00 0,0 - 24,7 100,00 95,8 - 1,00 1,0 - 1,0
100,0

Screening [95% CI]

Prevalence : 0,13 [0,07; 0,22]
Sensitivity : 1,00 [0,72; 0,99]
Specificity : 0,92 [0,84; 0,96]
Accuracy : 0,93 [0,86; 0,97]
Predictive value of +ve result : 0,65 [0,41; 0,84]
Predictive value of -ve result : 1,00 [0,94; 1,00]

Interpretasi:
1. Sensitivity: 100%
Kemampuan Kreatinin kinase untuk mendeteksi penyakit MCI, memiliki
kemungkinan benar 100%.
2. Specificity: 92%
Kemampuan Kreatinin kinase dalam mendeteksi seseorang bebas dari penyakit
MCI, memiliki kemungkinan benar 91.95%.
3. Accuracy: 93%
4. Nilai prediksi Positif: 65%
Kemungkinan seseorang yang hasil tesnya positif, akan benar-benar menderita
MCI sebesar 65%.
5. Nilai prediksi Negatif: 100%
Kemungkinan seseorang yang hasil tesnya negatif benar-benar tidak sakit adalah
100%.
6. Likelihood Ratio (+): 12,43%
Tes memberikan hasil positif 12.43% pada orang sakit
 7. Likelihood Ratio (-): 0
Tes memberikan hasil negatif 0% pada orang sakit
8. Likelihood Ratio test: 0
9. Area Under Curve(AUC): 97,3% (excellent)
Kreatinin kinase mampu mendiagnosis MCI dengan memberikan hasil tepat
sebesar 97,3%.

Kesimpulan: Kreatinin kinase dapat mendeteksi MCI pada sensitivitas 100% dan
spesifisitas 92% pada titik potong >69,1098 (MCI Positif bila kreatinin kinase
>69,1098, MCI Negatif bila ≤69,1098)

LDL
ROC curve
Variable LDL
LDL
Classification variable MCI
MCI
Sample size 100
Positive group a 13(13,00%)
Negative group b 87(87,00%)
aMCI = 1
bMCI = 0

Disease prevalence (%) unknown

Area under the ROC curve (AUC)
Area under the ROC curve (AUC) 0,598
Standard Errora 0,0855
95% Confidence intervalb 0,495 to 0,695
z statistic 1,143
Significance level P (Area=0.5) 0,2531
a DeLong et al., 1988
b Binomial exact
Youden index
Youden index J 0,3174
Associated criterion ≤143,002
Sensitivity 84,62
Specificity 47,13
Criterion values and coordinates of the ROC curve [Hide]
Criterion Sensitivity 95% CI Specificity 95% CI +LR 95% CI -LR 95% CI
<96,3896 0,00 0,0 - 24,7 100,00 95,8 - 1,00 1,0 - 1,0
100,0
≤96,3896 0,00 0,0 - 24,7 98,85 93,8 - 0,00 1,01 1,0 - 1,0
100,0
≤105,596 0,00 0,0 - 24,7 97,70 91,9 - 99,7 0,00 1,02 1,0 - 1,1
≤110,394 7,69 0,2 - 36,0 97,70 91,9 - 99,7 3,35 0,3 - 0,94 0,8 - 1,1
34,3
≤112,761 7,69 0,2 - 36,0 96,55 90,3 - 99,3 2,23 0,3 - 0,96 0,8 - 1,1
19,9
≤113,405 7,69 0,2 - 36,0 95,40 88,6 - 98,7 1,67 0,2 - 0,97 0,8 - 1,1
 13,8
≤114,336 15,38 1,9 - 45,4 95,40 88,6 - 98,7 3,35 0,7 - 0,89 0,7 - 1,1
16,5
≤115,006 15,38 1,9 - 45,4 94,25 87,1 - 98,1 2,68 0,6 - 0,90 0,7 - 1,1
12,4
≤116,879 15,38 1,9 - 45,4 93,10 85,6 - 97,4 2,23 0,5 - 9,9 0,91 0,7 - 1,2
≤118,208 15,38 1,9 - 45,4 91,95 84,1 - 96,7 1,91 0,4 - 8,2 0,92 0,7 - 1,2
≤118,827 15,38 1,9 - 45,4 90,80 82,7 - 95,9 1,67 0,4 - 7,0 0,93 0,7 - 1,2
≤118,88 15,38 1,9 - 45,4 89,66 81,3 - 95,2 1,49 0,4 - 6,1 0,94 0,7 - 1,2
≤121,168 23,08 5,0 - 53,8 89,66 81,3 - 95,2 2,23 0,7 - 7,2 0,86 0,6 - 1,2
≤122,323 23,08 5,0 - 53,8 88,51 79,9 - 94,3 2,01 0,6 - 6,3 0,87 0,6 - 1,2
≤122,637 23,08 5,0 - 53,8 87,36 78,5 - 93,5 1,83 0,6 - 5,7 0,88 0,6 - 1,2
≤123,418 23,08 5,0 - 53,8 86,21 77,1 - 92,7 1,67 0,5 - 5,1 0,89 0,7 - 1,2
≤124,331 23,08 5,0 - 53,8 85,06 75,8 - 91,8 1,54 0,5 - 4,7 0,90 0,7 - 1,2
≤124,449 23,08 5,0 - 53,8 83,91 74,5 - 90,9 1,43 0,5 - 4,3 0,92 0,7 - 1,3
≤124,98 30,77 9,1 - 61,4 83,91 74,5 - 90,9 1,91 0,7 - 4,9 0,83 0,6 - 1,2
≤125,275 30,77 9,1 - 61,4 82,76 73,2 - 90,0 1,78 0,7 - 4,6 0,84 0,6 - 1,2
≤125,307 30,77 9,1 - 61,4 81,61 71,9 - 89,1 1,67 0,7 - 4,2 0,85 0,6 - 1,2
≤128,024 30,77 9,1 - 61,4 80,46 70,6 - 88,2 1,57 0,6 - 4,0 0,86 0,6 - 1,3
≤128,427 30,77 9,1 - 61,4 79,31 69,3 - 87,3 1,49 0,6 - 3,7 0,87 0,6 - 1,3
≤128,55 30,77 9,1 - 61,4 78,16 68,0 - 86,3 1,41 0,6 - 3,5 0,89 0,6 - 1,3
≤129,615 30,77 9,1 - 61,4 77,01 66,8 - 85,4 1,34 0,5 - 3,3 0,90 0,6 - 1,3
≤130,024 30,77 9,1 - 61,4 75,86 65,5 - 84,4 1,27 0,5 - 3,1 0,91 0,6 - 1,3
≤130,075 30,77 9,1 - 61,4 74,71 64,3 - 83,4 1,22 0,5 - 3,0 0,93 0,6 - 1,4
≤130,544 30,77 9,1 - 61,4 73,56 63,0 - 82,4 1,16 0,5 - 2,8 0,94 0,6 - 1,4
≤130,768 30,77 9,1 - 61,4 72,41 61,8 - 81,5 1,12 0,5 - 2,7 0,96 0,7 - 1,4
≤132,209 30,77 9,1 - 61,4 71,26 60,6 - 80,5 1,07 0,4 - 2,6 0,97 0,7 - 1,4
≤132,883 30,77 9,1 - 61,4 70,11 59,4 - 79,5 1,03 0,4 - 2,5 0,99 0,7 - 1,5
≤133,028 30,77 9,1 - 61,4 68,97 58,1 - 78,5 0,99 0,4 - 2,4 1,00 0,7 - 1,5
≤133,264 30,77 9,1 - 61,4 67,82 56,9 - 77,4 0,96 0,4 - 2,3 1,02 0,7 - 1,5
≤133,479 30,77 9,1 - 61,4 66,67 55,7 - 76,4 0,92 0,4 - 2,2 1,04 0,7 - 1,5
≤134,41 30,77 9,1 - 61,4 65,52 54,6 - 75,4 0,89 0,4 - 2,1 1,06 0,7 - 1,6
≤135,19 30,77 9,1 - 61,4 64,37 53,4 - 74,4 0,86 0,4 - 2,0 1,08 0,7 - 1,6
≤135,316 30,77 9,1 - 61,4 63,22 52,2 - 73,3 0,84 0,4 - 2,0 1,10 0,7 - 1,6
≤135,632 30,77 9,1 - 61,4 62,07 51,0 - 72,3 0,81 0,3 - 1,9 1,12 0,7 - 1,7
≤135,713 38,46 13,9 - 68,4 62,07 51,0 - 72,3 1,01 0,5 - 2,1 0,99 0,6 - 1,6
≤135,776 38,46 13,9 - 68,4 60,92 49,9 - 71,2 0,98 0,5 - 2,1 1,01 0,6 - 1,6
≤135,939 38,46 13,9 - 68,4 59,77 48,7 - 70,1 0,96 0,5 - 2,0 1,03 0,6 - 1,6
≤136,431 38,46 13,9 - 68,4 58,62 47,6 - 69,1 0,93 0,4 - 1,9 1,05 0,7 - 1,7
≤136,531 46,15 19,2 - 74,9 58,62 47,6 - 69,1 1,12 0,6 - 2,1 0,92 0,5 - 1,6
≤136,969 53,85 25,1 - 80,8 58,62 47,6 - 69,1 1,30 0,7 - 2,3 0,79 0,4 - 1,5
≤139,397 61,54 31,6 - 86,1 58,62 47,6 - 69,1 1,49 0,9 - 2,4 0,66 0,3 - 1,3
≤140,212 69,23 38,6 - 90,9 58,62 47,6 - 69,1 1,67 1,1 - 2,6 0,52 0,2 - 1,2
≤140,341 69,23 38,6 - 90,9 57,47 46,4 - 68,0 1,63 1,1 - 2,5 0,54 0,2 - 1,2
≤140,675 69,23 38,6 - 90,9 56,32 45,3 - 66,9 1,59 1,0 - 2,4 0,55 0,2 - 1,3
≤140,727 69,23 38,6 - 90,9 55,17 44,1 - 65,9 1,54 1,0 - 2,4 0,56 0,2 - 1,3
≤141,05 69,23 38,6 - 90,9 54,02 43,0 - 64,8 1,51 1,0 - 2,3 0,57 0,2 - 1,3
≤141,576 69,23 38,6 - 90,9 52,87 41,9 - 63,7 1,47 1,0 - 2,2 0,58 0,3 - 1,3
≤141,657 69,23 38,6 - 90,9 51,72 40,8 - 62,6 1,43 0,9 - 2,2 0,59 0,3 - 1,4
≤141,684 69,23 38,6 - 90,9 50,57 39,6 - 61,5 1,40 0,9 - 2,1 0,61 0,3 - 1,4
≤141,889 69,23 38,6 - 90,9 49,43 38,5 - 60,4 1,37 0,9 - 2,1 0,62 0,3 - 1,4
≤142,734 69,23 38,6 - 90,9 48,28 37,4 - 59,2 1,34 0,9 - 2,0 0,64 0,3 - 1,5
≤142,787 76,92 46,2 - 95,0 48,28 37,4 - 59,2 1,49 1,0 - 2,1 0,48 0,2 - 1,3
≤142,907 76,92 46,2 - 95,0 47,13 36,3 - 58,1 1,45 1,0 - 2,1 0,49 0,2 - 1,4
≤143,002 84,62 54,6 - 98,1 47,13 36,3 - 58,1 1,60 1,2 - 2,2 0,33 0,09 - 1,2
≤143,657 84,62 54,6 - 98,1 45,98 35,2 - 57,0 1,57 1,2 - 2,1 0,33 0,09 - 1,2
≤143,791 84,62 54,6 - 98,1 44,83 34,1 - 55,9 1,53 1,1 - 2,1 0,34 0,09 - 1,3
≤144,591 84,62 54,6 - 98,1 43,68 33,1 - 54,7 1,50 1,1 - 2,0 0,35 0,10 - 1,3
≤144,883 84,62 54,6 - 98,1 42,53 32,0 - 53,6 1,47 1,1 - 2,0 0,36 0,10 - 1,3
≤145,289 84,62 54,6 - 98,1 41,38 30,9 - 52,4 1,44 1,1 - 1,9 0,37 0,1 - 1,4
≤145,675 84,62 54,6 - 98,1 40,23 29,9 - 51,3 1,42 1,1 - 1,9 0,38 0,1 - 1,4
≤145,792 84,62 54,6 - 98,1 39,08 28,8 - 50,1 1,39 1,0 - 1,8 0,39 0,1 - 1,4
≤146,063 84,62 54,6 - 98,1 37,93 27,7 - 49,0 1,36 1,0 - 1,8 0,41 0,1 - 1,5
≤146,304 84,62 54,6 - 98,1 36,78 26,7 - 47,8 1,34 1,0 - 1,8 0,42 0,1 - 1,5
≤146,809 84,62 54,6 - 98,1 35,63 25,6 - 46,6 1,31 1,0 - 1,7 0,43 0,1 - 1,6
≤149,252 84,62 54,6 - 98,1 34,48 24,6 - 45,4 1,29 1,0 - 1,7 0,45 0,1 - 1,6
≤149,717 84,62 54,6 - 98,1 33,33 23,6 - 44,3 1,27 1,0 - 1,7 0,46 0,1 - 1,7
≤150,43 84,62 54,6 - 98,1 32,18 22,6 - 43,1 1,25 0,9 - 1,6 0,48 0,1 - 1,8
≤150,491 84,62 54,6 - 98,1 31,03 21,5 - 41,9 1,23 0,9 - 1,6 0,50 0,1 - 1,8
≤151,153 84,62 54,6 - 98,1 29,89 20,5 - 40,6 1,21 0,9 - 1,6 0,51 0,1 - 1,9
≤152,231 84,62 54,6 - 98,1 28,74 19,5 - 39,4 1,19 0,9 - 1,6 0,54 0,1 - 2,0
≤152,397 84,62 54,6 - 98,1 27,59 18,5 - 38,2 1,17 0,9 - 1,5 0,56 0,1 - 2,1
≤154,57 84,62 54,6 - 98,1 26,44 17,6 - 37,0 1,15 0,9 - 1,5 0,58 0,2 - 2,2
≤154,605 84,62 54,6 - 98,1 25,29 16,6 - 35,7 1,13 0,9 - 1,5 0,61 0,2 - 2,3
≤154,959 84,62 54,6 - 98,1 24,14 15,6 - 34,5 1,12 0,9 - 1,4 0,64 0,2 - 2,4
≤155,153 84,62 54,6 - 98,1 22,99 14,6 - 33,2 1,10 0,8 - 1,4 0,67 0,2 - 2,5
≤156,496 84,62 54,6 - 98,1 21,84 13,7 - 32,0 1,08 0,8 - 1,4 0,70 0,2 - 2,7
≤156,771 84,62 54,6 - 98,1 20,69 12,7 - 30,7 1,07 0,8 - 1,4 0,74 0,2 - 2,8
≤157,444 84,62 54,6 - 98,1 19,54 11,8 - 29,4 1,05 0,8 - 1,4 0,79 0,2 - 3,0
≤157,661 84,62 54,6 - 98,1 18,39 10,9 - 28,1 1,04 0,8 - 1,3 0,84 0,2 - 3,2
≤158,411 84,62 54,6 - 98,1 17,24 10,0 - 26,8 1,02 0,8 - 1,3 0,89 0,2 - 3,5
≤158,868 92,31 64,0 - 99,8 17,24 10,0 - 26,8 1,12 0,9 - 1,3 0,45 0,06 - 3,1
≤159,01 92,31 64,0 - 99,8 16,09 9,1 - 25,5 1,10 0,9 - 1,3 0,48 0,07 - 3,3
≤159,842 92,31 64,0 - 99,8 14,94 8,2 - 24,2 1,09 0,9 - 1,3 0,51 0,07 - 3,6
≤160,633 92,31 64,0 - 99,8 13,79 7,3 - 22,9 1,07 0,9 - 1,3 0,56 0,08 - 3,9
≤160,874 92,31 64,0 - 99,8 12,64 6,5 - 21,5 1,06 0,9 - 1,3 0,61 0,09 - 4,3
≤161,081 92,31 64,0 - 99,8 11,49 5,7 - 20,1 1,04 0,9 - 1,2 0,67 0,09 - 4,8
≤161,43 92,31 64,0 - 99,8 10,34 4,8 - 18,7 1,03 0,9 - 1,2 0,74 0,1 - 5,4
≤161,922 92,31 64,0 - 99,8 9,20 4,1 - 17,3 1,02 0,9 - 1,2 0,84 0,1 - 6,2
≤162,959 92,31 64,0 - 99,8 8,05 3,3 - 15,9 1,00 0,8 - 1,2 0,96 0,1 - 7,2
≤167,967 92,31 64,0 - 99,8 6,90 2,6 - 14,4 0,99 0,8 - 1,2 1,12 0,1 - 8,5
≤168,92 92,31 64,0 - 99,8 5,75 1,9 - 12,9 0,98 0,8 - 1,2 1,34 0,2 - 10,6
≤170,381 92,31 64,0 - 99,8 4,60 1,3 - 11,4 0,97 0,8 - 1,1 1,67 0,2 - 13,8
≤178,869 92,31 64,0 - 99,8 3,45 0,7 - 9,7 0,96 0,8 - 1,1 2,23 0,3 - 19,9
≤184,759 92,31 64,0 - 99,8 2,30 0,3 - 8,1 0,94 0,8 - 1,1 3,35 0,3 - 34,3
≤185,206 92,31 64,0 - 99,8 1,15 0,03 - 6,2 0,93 0,8 - 1,1 6,69 0,4 -
100,6
≤187,68 100,00 75,3 - 1,15 0,03 - 6,2 1,01 1,0 - 1,0 0,00
100,0
≤192,217 100,00 75,3 - 0,00 0,0 - 4,2 1,00 1,0 - 1,0
100,0
Screening [95% CI]
Prevalence :0,13 [0,07; 0,22]
Sensitivity :0,85 [0,54; 0,97]
Specificity :0,47 [0,36; 0,58]
Accuracy :0,52 [0,42; 0,62]
Predictive value of +ve result :0,19 [0,10; 0,32]
Predictive value of -ve result :0,95 [0,83; 0,99]

Interpretasi:
1. Sensitivity: 84,62%
Kemampuan LDL untuk mendeteksi penyakit MCI, memiliki kemungkinan benar
84,62%.
2. Specificity: 47%
Kemampuan LDL dalam mendeteksi seseorang bebas dari penyakit MCI, memiliki
kemungkinan benar 47%.
3. Accuracy: 52%
4. Nilai prediksi Positif: 19%
Kemungkinan seseorang yang hasil tesnya positif, akan benar-benar menderita
MCIsebesar 19%.
5. Nilai prediksi Negatif: 95%
Kemungkinan seseorang yang hasil tesnya negatif benar-benar tidak sakit adalah
95%.
6. Likelihood Ratio (+): 1,60
Tes memberikan hasil positif 1,60% pada orang sakit.
7. Likelihood Ratio (-): 0,33
Tes memberikan hasil negatif 0,33% pada orang sakit.
8. Likelihood Ratio test: 4,85
9. Area Under Curve(AUC): 59,8%
AUC 59,8% dinyatakangagal

Kesimpulan:
LDL dapat mendeteksi MCI pada sensitivitas 84,62% dan spesifisitas 47% pada titik
potong ≤143,002 (MCI Positif bila LDL ≤143,002, MCI Negatif bila >143,002).
4. Dalam File Excel tersedia DATA Therapy Bad Outcome.
4.1. Hitunglah Nilai Nilai Importance

1. ERR: 12%
Terjadi bad outcome sebesar 12% pada kelompok eksperimental.
2. CER: 26%
Terjadi bad outcome sebesar 26% pada kelompok kontrol.
3. RR: 0,46
RR <1 berarti pengobatan menurunkan risiko kematian (sangat bermakna).
4. ARR:14%
Penggunaan ACE Inhibitor dapat menurunkan kematian sebesar 14% dibandingkan
dengan plasebo.
 5. RRR: 54% (Pasti bermakna)
Penggunaan ACE Inhibitor menurunkan kematian 54% relatif dibandingkan
dengan kelompok plasebo.
6. NNT: 7,14
diperlukanterapi ACE Inhibitor pada 7,14 pasien (dalam waktu yang ditentukan)
untuk mencegah 1 kematian MCI.

Berdasarkan Chi-Square didapatkan hasil 0.126 (tidak signifikan), menunjukkan tidak

ada perbedaan bermakna secara statistik antara kelompok ACE Inhibitor dan
kelompok plasebo.

4.2. Buatlah Kesimpulan

Penggunaan ACE Inhibitor sebagai terapi MCI menunjukkan efek yang bermakna
(secara klinis).

5. Dalam File Excel tersedia DATA Therapy Effectiveness.

5.1. Hitunglah Nilai Importance
1. ERR: 52%
Terjadi good outcome sebesar 12% pada kelompok eksperimental.
2. CER: 18%
Terjadi good outcome sebesar 26% pada kelompok kontrol.
3. RR: 2,88
Kemungkinan pasien yang diterapi dengan Enalapril+ASA mengalami
kesembuhan adalah 2,88 kali dibandingkan kelompok Isosorbid + Diuretik.
4. ABI: 34%
Penggunaan Enalapril+ASA dapat meningkatkan kesembuhan sebesar 34%
dibandingkan dengan Isosorbid+Diuretik.
5. RBI: 188,9% (sangat bermakna)
Penggunaan Enalapril+ASA meningkatkan kesembuhan sebesar 188,9% relatif
dibandingkan tingkat kesembuhan sebelumnya.
6. NNT: 2,94
diperlukan terapi Enalapril+ASA pada 2,94 pasien yang harus diobati (dalam
waktu yang ditentukan) untuk meningkatkan 1 kesembuhan.
 Berdasarkan Chi-Square didapatkan hasil 0.001 (signifikan), menunjukkan terdapat
perbedaan bermakna secara statistik antara kelompok Enalapril + ASA dan kelompok
Isosorbid + Diuretik.

5.2. Buatlah Kesimpulan

Penggunaan Enalapril + ASA sebagai terapi MCI memenuhi aspek importance secara
klinis dan statistik.