Analisis Rasio PaO2/FiO2, Komorbiditas,CRP Dan Prokalsitonin Terhadap Waktu Kematian Pasien Covid-19 Rawat Inap Di RSUD Dr. Saiful Anwar Malang

Febriawati, Juwita and dr. Ngakan Putu Parsama Putra,, Sp.P (K) and dr. Aditya Sri Listyoko,, Sp.P (K) and Dr.dr. Nanik Setijowati,, M.Kes (2023) Analisis Rasio PaO2/FiO2, Komorbiditas,CRP Dan Prokalsitonin Terhadap Waktu Kematian Pasien Covid-19 Rawat Inap Di RSUD Dr. Saiful Anwar Malang. Magister thesis, Universitas Brawijaya.

Abstract

Latar Belakang: COVID-19 adalah suatu sindroma pernapasan yang berat yang disebabkan oleh infeksi virus SARS-CoV-2. Spektrum klinis penyakit COVID-19 bervariasi mulai dari gejala ringan hingga hipoksia berat gagal napas, dan sepsis yang melibatkan kerusakan multiorgan, hingga kematian. ARDS sebagai komplikasi tersering COVID-19 terjadi akibat inflamasi sistemik yang ditandai dengan penurunan rasio PaO2/FiO2. Severitas penyakit COVID-19 dipengaruhi oleh banyak faktor meliputi usia, jenis kelamin, komorbiditas dan komplikasi penyakit. Berbagai parameter banyak diteliti sebelumnya untuk memprediksi derajat severitas dan luaran pasien COVID-19 termasuk CRP dan prokalsitonin. Penelitian ini dilakukan untuk menganalisis Rasio PaO2/FiO2, komorbiditas, CRP dan Prokalsitonin sebagai faktor risiko kematian yang mempengaruhi waktu kematian pasien dengan COVID-19. Metode: penelitian menggunakan desain cohort observational retrospektif dengan sampel 250 pasien yang meninggal dunia saat rawat inap menggunakan data rekam medis dan Sistem Informasi Rumah Sakit. Data dianalisis dengan Uji Mann Whitney, Uji Wilcoxon, Uji Chi Square, dan Uji Friedman. Uji multivariat regresi logistik biner dilakukan untuk mengetahui korelasi antar variabel. Hasil: Terdapat perbedaan yang signifikan antara CRP dan prokalsitonin saat awal pasien masuk rumah sakit dengan waktu kematian (p=0,000; p=0,007). Namun tidak ada perbedaan signifikan antara Rasio PaO2/FiO2 dengan waktu kematian (p=0,078). Analisis regresi logistik biner menunjukkan CRP berpengaruh signifikan dengan waktu kematian dengan Odds ratio 0,959 (95%CI: 0,933-0,985), kurva ROC menunjukkan nilai optimal threshold 11,75mg/L dengan sensitivitas 72,3% dan spesifisitas 59,6%. Rasio PaO2/FiO2, CRP, dan Prokalsitonin awal ditemukan secara signifikan mengalami perubahan dibandingkan sebelum pasien meninggal dengan nilai p berturut-turut 0,000; 0,017; 0,000. Sementara itu, penggunaan alat terapi oksigen dengan komorbiditas menunjukkan tidak ada perbedaan signifikan dengan waktu kematian (p=0,070; p=0,547) Simpulan: Rasio PaO2/FiO2, CRP dan Prokalsitonin pada saat awal masuk rumah sakit dibandingkan sebelum pasien meninggal menunjukkan perubahan yang signifikan namun hanya CRP dan prokalsitonin yang berhubungan signifikan dengan waktu kematian pasien COVID-19 yang meninggal di RSUD Dr. Saiful Anwar

English Abstract

Background: COVID-19 is a severe respiratory syndrome caused by infection SARS-CoV-2 virus. The clinical spectrum of COVID-19 disease varies from mild symptom to severe hypoxia, respiratory failure and sepsis involving multiorgan damaged to death. ARDS as the most common complication of COVID-19 disease occurs due to systemic inflamation which is characterized by a decrease PaO2/FiO2 ratio. The severity of COVID-19 is influenced by many factors including age, sex, comorbidities, and disease complication. Various parameters has been studied before to predict the severity and outcome COVID-19 patient CRP and procalcitonin. This study was conducted to analyze PaO2/FiO2 ratio, comorbidity, CRP and Procalcitonin as risk factor mortality that affect time of in-hospital mortality COVID-19 patients Methods:This study was cohort observational retrospective with 250 sample of COVID-19 patients who died while being hospitalized using medical record data and Hospital Information System. Data were analyzed using Mann Whitney test, Wilcoxon test, Chi square test, and Friedman test. A multivariate binary logistic regression model was adopted to analyze the association between variables. Result: There were significant differences between CRP, prokalcitonin at the time of hospital admission and time of in-hospital mortality (p= 0,000; p=0,007). Meanwhile, there was no significant differences between PaO2/FiO2 ratio and length of hospitalization (p=0,078). Binary logistic regression analysis showed that CRP was significantly associated with time of in-hospital mortality Odds ratio 0,959 (95%CI : 0,933-0,985). Defined by ROC curve, the optimal threshold value was 11,75mg/L with sensitivity 72,3% and specificity 59.6%. The initial PaO2/FiO2 ratio, CRP, and procalcitonin were found significantly changed compared to before the patient died with p=0,000; p=0,017; p=0,000 respectively. However, there were no significant differences between oxygen therapy devices, comorbidity and time of in-hospital mortality with p value 0,070 and 0,547 respectively. Conclusion: PaO2/FiO2 ratio, CRP, and procalcitonin at initial hospital admission showed significant changes compare to examination before the patient died. However, only CRP and Procalcitonin were significantly associated with time of in-hospital mortality of COVID-19 patients who died at Dr. Saiful Anwar General Hospital

Item Type:	Thesis (Magister)
Identification Number:	042306
Uncontrolled Keywords:	COVID-19, CRP, Komorbiditas, Prokalsitonin, Rasio PaO2/FiO2, Waktu Kematian, Comorbidity, PaO2/FiO2 ratio, Procalcitonin, time of in-hospital mortality
Divisions:	Profesi Kedokteran > Spesialis Pulmonologi dan Kedokteran Respirasi, Fakultas Kedokteran
Depositing User:	Unnamed user with username ihwan
Date Deposited:	12 Jan 2024 01:50
Last Modified:	12 Jan 2024 01:50
URI:	http://repository.ub.ac.id/id/eprint/208738

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