Korelasi Interferon Gamma (IFN-γ), Platelet-To-Lymphocyte Ratio (PLR), Dan Mortalitas Pasien Covid-19.

Wijanto, Giovanni Antonio and dr. Agustin Iskandar, Sp.PK (K) and dr. Catur Suci Sutrisnani, M.Biomed, Sp.PK (K) (2023) Korelasi Interferon Gamma (IFN-γ), Platelet-To-Lymphocyte Ratio (PLR), Dan Mortalitas Pasien Covid-19. Magister thesis, Universitas Brawijaya.

Abstract

Pada akhir tahun 2019 ditemukan kasus infeksi virus SARS CoV-2 yang menyebabkan penyakit COVID-19 dan menjadi sebuah pandemi sampai awal tahun 2023. Kasus COVID-19 yang berat dan kritis dapat terjadi karena keadaan badai sitokin yang melibatkan banyak sekali mediator inflamasi termasuk diantaranya adalah trombosit, limfosit, sitokin dan kemokin. Trombosit menjadi salah satu faktor yang mempengaruhi inflamasi secara tidak langsung, sedangkan limfosit akan sangat dipengaruhi dalam keadaan COVID-19 dimana keduanya dapat mengalami penurunan karena berbagai sebab. Salah satu sitokin yang terlibat dalam COVID-19 adalah IFN-γ yang dapat memicu sitokin lain dalam kondisi badai sitokin pada COVID-19 dan berbagai kondisi lain yang berkaitan dengan COVID-19. Pada COVID-19 juga terjadi peningkatan Platelet-To-Lymphocyte Ratio (PLR) dan IFN-γ. Adanya peningkatan PLR dan IFN-γ diharapkan dapat menjadi salah satu sarana prediktor luaran pasien. Untuk melihat korelasi antara PLR, IFN-γ, dan mortalitas kami melakukan uji regresi logistik, analisis jalur, serta analisis kesintasan. Penelitian ini menggunakan metode deskriptif analitik dengan desain kohort retrospektif. Diagnosis COVID-19 ditegakkan dengan RT-PCR SARS-CoV2 dengan menggunakan sampel usap nasofaring atau orofaring. Pada hari pertama perawatan, sisa serum pasien COVID-19 dikumpulkan, kemudian dilakukan pemilahan berdasarkan kriteria inklusi dan ekslusi terhadap serum pasien berdasarkan rekam medis. Lama rawat, tingkat keparahan, faktor komorbid dan luaran pasien dicatat. Kemudian dilakukan pemeriksaan serologis IFN-γ menggunakan ELISA kit (BT-Lab) dan dibaca dengan menggunakan Microplate reader Zenix-320. Data mengenai PLR pada hari pertama perawatan pasien kami dapatkan melalui rekam medik. PLR sendiri merupakan rasio antara trombosit dan limfosit. Trombosit dan limfosit didapatkan dari pemeriksaan darah rutin menggunakan tabung Ethylene Diamine Tetraacetic Acid (EDTA) dan dianalisis menggunakan alat Sysmex XN-1000. Data yang terkumpul dianalisis dengan uji normalitas distribusi, uji beda, regresi logistik, analisis jalur, analisis kurva ROC, analisis kesintasan menggunakan Kurva Kaplan Meier, dan Hazard Ratio. Penelitian ini melibatkan 84 pasien COVID-19 yang memenuhi kriteria inklusi. Sebanyak 39,3% berjenis kelamin perempuan dan 60,7% berjenis kelamin laki-laki. Rerata usia subyek adalah 57,30 tahun. Survivor berjumlah 47 orang (56,0%). Berdasarkan tingkat keparahan, 32,1% subyek merupakan pasien ringan sedang, 26,2% adalah pasien berat, dan sisanya sebanyak 41,7% merupakan pasien sangat berat atau kritis. Kami juga mendapati bahwa 53,6% subyek merupakan penderita diabetes melitus, 19,0% merupaan penderita gagal jantung, 51,2% merupakan penderita obesitas, 27,4% merupakan penderita gangguan ginjal, dan 61,9% merupakan penderita hipertensi. Tidak terdapat perbedaan yang bermakna pada kadar IFN-γ, PLR, dan lama perawatan antara pasien survivor dan non-survivor. Selain itu, tidak ada perbedaan yang bermakna pada semua karakteristik subyek dengan tingkat keparahan ringan-sedang, berat, dan sangat berat.

English Abstract

At the end of 2019, a case of SARS CoV-2 virus infection was found which caused COVID-19 disease and became a pandemic until early 2023. Severe and critical cases of COVID-19 can occur due to a cytokine storm involving many inflammatory mediators including platelets, lymphocytes, cytokines and chemokines. Platelets are one of the factors that affect inflammation indirectly, while lymphocytes will be greatly affected in the state of COVID-19 where both can decrease due to various reasons. One of the cytokines involved in COVID-19 is IFN-γ which can trigger other cytokines in cytokine storm conditions in COVID-19 and various other conditions related to COVID-19. In COVID-19 there is also an increase in Platelet-To-Lymphocyte Ratio (PLR) and IFN-γ. The increase in PLR and IFN-γ is expected to be a tool to predicting patient outcomes. To see the correlation between PLR, IFN-γ, and mortality, we conducted logistic regression test, path analysis, and survival analysis. This study used an analytic descriptive method with a retrospective cohort design. The diagnosis of COVID-19 was confirmed by RT-PCR of SARS-CoV2 using nasopharyngeal or oropharyngeal swab samples. On the first day of treatment, the remaining serum of COVID-19 patients was collected, then sorted based on the inclusion and exclusion criteria for patient serum based on medical records. Length of stay, severity, comorbid factors and patient outcomes were recorded. IFN-γ serologic examination was performed using ELISA kit (BT-Lab) and was read using Microplate reader Zenix-320. We obtained data on PLR on the first day of treatment through medical records. PLR itself is the ratio between platelets and lymphocytes. Platelets and lymphocytes were obtained from routine blood tests using Ethylene Diamine Tetraacetic Acid (EDTA) tubes and analyzed using a Sysmex XN-1000 device. The collected data were analyzed by distribution normality test, t-test, logistic regression, path analysis, ROC curve analysis, survival analysis using Kaplan Meier Curve, and Hazard Ratio. This study involved 84 COVID-19 patients who met the inclusion criteria. A total of 39.3% were female and 60.7% were male. The mean age of the subjects was 57.30 years. Survivors totaled 47 people (56.0%). Based on severity, 32.1% of the subjects were mild-moderate patients, 26.2% were severe patients, and the remaining 41.7% were very severe or critical patients. We also found that 53.6% of the subjects had diabetes mellitus, 19.0% had heart failure, 51.2% had obesity, 27.4% had renal impairment, and 61.9% had hypertension. There were No. significant differences in IFN-γ levels, PLR, and length of treatment between survivor and non-survivor patients. There were also no significant differences in all characteristics of subjects with mild-moderate, severe, and very severe severity. From the results of the analysis of differences in PLR and IFN-γ between COVID-19 survivor and non-survivor patients, both were found to have a non-significant relationship. To determine whether there is a correlation between PLR and IFN-γ as a predictor of mortality, a Spearman correlation analysis was performed. The Spearman correlation between PLR and IFN-γ as a predictor of mortality resulted in

Item Type:	Thesis (Magister)
Identification Number:	'0423060010
Subjects:	600 Technology (Applied sciences) > 616 Diseases > 616.07 Pathology
Divisions:	Profesi Kedokteran > Spesialis Patologi Klinik, Fakultas Kedokteran
Depositing User:	Endang Susworini
Date Deposited:	31 Oct 2023 03:16
Last Modified:	31 Oct 2023 03:16
URI:	http://repository.ub.ac.id/id/eprint/204146

Text (DALAM MASA EMBARGO) Giovanni Antonio Wijanto.pdf Restricted to Registered users only until 30 December 2025. Download (5MB)

Actions (login required)

View Item