Fadlilah, Ilham and dr. Arie Zainul Fatoni, Sp.An, KIC and dr. Taufiq Agus Siswagama, Sp.An., KMN (2021) Hubungan Kadar Procalcitonin Dengan Luaran Pada Pasien Covid-19 Di Intensive Care Unit (ICU) Rumah Sakit Dr. Saiful Anwar. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang: Respon inflamasi sistemik berlebihan pada pasien Covid-19 dapat menyebabkan produksi sitokin pro-inflamasi dan kemokin, dimana hal tersebut dapat memicu badai sitokin. kadar procalcitonin meningkat secara signifikan karena pelepasan jaringan parenkimal di bawah pengaruh endotoksin dan sitokin proinflamasi. Pemeriksaan procalcitonin dapat menjadi parameter prognostik luaran pasien COVID-19. Tujuan: Tujuan dalam penelitian ini adalah untuk mengetahui hubungan antara kadar prokalsitonin dengan luaran pasien pneumonia COVID-19, yaitu mortalitas pasien COVID -19 dan penggunaan ventilator invasif. Metode: Penelitian merupakan studi satu senter, kohort retrospektif observasional. Diambil sampel pasien COVID-19 yang dirawat di ICU RSSA mulai dari bulan Maret 2020 sampai dengan Maret 2021 dengan sumber data dari rekam medis. Data yang dikumpulkan antara lain karakteristik demografis, komorbid pasien, hasil laboratorium, modalitas terapi, serta luaran pasien. Data laboratorium yang diambil dua sample yaitu procalcitonin hari pertama dan pengambilan sample ke dua antara hari kedua dan ketujuh di ICU. Hasil: Didapatkan 139 subyek setelah melalui proses inklusi dan eksklusi dengan angka mortalitas sebesar 51.7%. Rerata kadar Procalcitonin pada pasien yang meninggal (1.61 (CI0.03 -99.75)), lebih tinggi daripada pasien hidup ( 0.1 (0.00-18.84)). Ditemukan bahwa peningkatan kadar PCT > 1.105 μg/ml ( AUC 0,724, sensitivitas 89.7%, spesifisitas 56.5%, PPV 39.4%, dan NPV 22.2% ) berbeda dengan pasien hidup ( 0.1 (0.00-18.84)). Ditemukan nilai Procalcitonin pada pasien yang menggunakan ventilasi mekanik (0,37 (0,02 -100)), tidak jauh berbeda pasien yang tidak menggunakan ventilasi mekanik ( 0,24 (0,02 -23.77)). Hasil analisis menggunakan uji Chi-square didapatkan hubungan antara perubahan nilai PCT dengan mortalitas memiliki nilai signifikansi sebesar 0.003 (p<0.05), dan penggunaan ventilasi mekanik dengan nilai signifikansi sebesar 0.104 (p>0.05). Penelitian ini menunjukkan bahwa terdapat hubungan yang sangat bermakna antara kadar procalcitonin dengan angka mortalitas pasien COVID-19 ( p=0,003). Kesimpulan: Terdapat hubungan yang signifikan antara kadar procalcitonin dengan mortalitas pasien COVID-19 yang dirawat di ruang ICU COVID.
English Abstract
Background: Excessive systemic inflammatory response in Covid-19 patients can lead to the production of pro-inflammatory cytokines and chemokines, which can trigger a cytokine storm. procalcitonin levels were significantly increased due to the release of parenchymal tissue under the influence of endotoxins and proinflammatory cytokines. Procalcitonin examination can be a prognostic parameter of the outcome of COVID-19 patients. Objective: The purpose of this study was to determine the relationship between procalcitonin levels and the outcome of patients with COVID-19 pneumonia, namely mortality of COVID-19 patients and the use of invasive ventilators. Methods: The study was a one-centre, retrospective observational cohort study. Samples were taken of COVID-19 patients who were treated in the ICU RSSA from March 2020 to March 2021 with data sources from medical records. The data collected included demographic characteristics, patient comorbidities, laboratory results, treatment modalities, and patient outcomes. Two samples were taken from the laboratory, namely the first day of procalcitonin and the second day of sampling between the second and seventh days in the ICU. Results: There were 139 subjects after going through the inclusion and exclusion process with a mortality rate of 51.7%. The mean level of procalcitonin in patients who died (1.61 (CI0.03 -99.75)), was higher than that of living patients (0.1 (0.00- 18.84)). It was found that the increase in PCT levels > 1,105 g/ml (AUC 0.724, sensitivity 89.7%, specificity 56.5%, PPV 39.4%, and NPV 22.2%) was different in living patients (0.1 (0.00-18.84)). Procalcitonin values were found in patients using mechanical ventilation (0.37 (0.02 -100)), not much different from patients not using mechanical ventilation (0.24 (0.02 -23.77)). The results of the analysis using the Chi-square test showed that the relationship between changes in PCT values and mortality had a significance value of 0.003 (p<0.05), and the use of mechanical ventilation with a significance value of 0.104 (p>0.05). This study showed that there was a very significant relationship between procalcitonin levels and the mortality rate of COVID-19 patients (p=0.003).
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0421060033 |
| Uncontrolled Keywords: | COVID-19, procalcitonin, makanikal, ventilator, Mortalitas |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.9 Operative surgery and special fields of surgery > 617.95 Cosmetic and restorative plastic surgery, transplantation of tissue and organs, implantation of artificial organs |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | Budi Wahyono Wahyono |
| Date Deposited: | 10 Jun 2022 09:24 |
| Last Modified: | 27 Sep 2024 01:28 |
| URI: | http://repository.ub.ac.id/id/eprint/190964 |
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