Nastiti, Theresia Maharani Sari and Prof. Dr. dr. Kusworini, M.Kes, Sp.PK, Subsp.I.K.(K) and dr. Agustin Iskandar, M.Kes, Sp.PK, Subsp.P.I (K) (2023) Interleukin-1 Beta (IL-1β) dan C-Reactive Protein (CRP) Sebagai Prediktor Mortalitas Pasien COVID-19. Magister thesis, Universitas Brawijaya.
Abstract
COVID-19 merupakan kasus infeksi virus SARS-CoV-2 yang muncul sejak Desember 2019 dan menjadi pandemi hingga pertengahan tahun 2023. Penyakit COVID-19 sangat menular dan menyebabkan kematian. Kasus COVID-19 yang berat terjadi sebagai dampak dari badai sitokin yang melibatkan sitokin-sitokin serta mediator pro-inflamasi. Salah satu sitokin yang terlibat adalah IL-1β, yang merupakan sitokin pro-inflamasi yang berperan memicu munculnya sitokin-sitokin lain dalam patogenesis badai sitokin. Pada kondisi infeksi SARS-CoV-2 juga terdapat kondisi inflamasi yang memicu munculnya acute phase reactant seperti CRP. Kadar IL-1β juga mengalami peningkatan pada patogenesis penyakit lain seperti sepsis, TB dan infeksi lain. Adanya peningkatan kadar IL-1β diharapkan dapat menjadi salah satu prediktor luaran pasien. Untuk menilai kadar IL-1β, CRP dan mortalitas kami melakukan analisis kesintasan. Penelitian ini menggunakan metode deskriptif dengan desain kohort retrospektif. Penegakan diagnosis COVID-19 dengan menggunakan RT-PCR SARS-CoV-2 dengan menggunakan sampel usap nasofaring dan orofaring. Pada hari pertama perawatan, sisa sampel serum pasien dikumpulkan dan disimpan, untuk selanjutnya dilakukan pemilahan berdasarkan kriteria inklusi dan ekslusi mengacu pada data rekam medis. Tingkat keparahan, lama rawat, jenis kelamin, faktor komorbid dan luaran pasien didokumentasikan. Selanjutnya dilakukan pemeriksaan serologis IL-1β menggunakan ELISA kit (BT Lab) dan dibaca menggunakan Microplate reader. Data kadar IL-1β pada hari pertama rawat inap didapatkan melalui rekam medis pasien. Pemeriksaan CRP dilakukan menggunakan alat Cobas C6000 (Roche Diagnostic) dengan metode dan prinsip pemeriksaan immunoturbidimetry spectrophotometry. Data yang terkumpul dianalisis dengan uji normalitas distribusi, uji beda, analisis kurva ROC, analisis kesintasan menggunakan Kurva Kaplan Meier, dan Hazard Ratio. Penelitian ini melibatkan 69 pasien terkonfirmasi COVID-19 yang memenuhi kriteria inklusi. Sebanyak 39,1% berjenis kelamin laki-laki dan 60,9% berjenis kelamin perempuan. Median usia pasien pada penelitian ini adalah 61 tahun. Subyek penelitian ini memiliki median lama rawat inap adalah 11 hari, dengan luaran survivor (hidup) sebanyak 49,3% dan non-survivor (meninggal) 50,3%. Subyek penelitian dirawat dengan kondisi keparahan yang berbeda, yaitu ringan-sedang, berat dan sangat berat. Pada penelitian ini juga didokumentasikan berkaitan dengan riwayat komorbid pada pasien, meliputi diabetes mellitus, hipertensi,
English Abstract
COVID-19 is a case of infection with the SARS-CoV-2 virus that emerged since December 2019 and escalated into a pandemic until mid-2023. The disease is highly contagious and leads to fatalities. Severe cases of COVID-19 occur as a result of a cytokine storm involving various cytokines and pro-inflammatory mediators. One such involved cytokine is IL-1β, which plays a role in triggering the emergence of other cytokines in the pathogenesis of the cytokine storm. In the condition of SARS-CoV-2 infection, there is also an inflammatory state that triggers the appearance of acute phase reactants such as CRP. IL-1β levels also increase in the pathogenesis of other diseases such as sepsis, TB, and other infections. The elevation of IL-1β levels is expected to serve as one of the predictors of patient outcomes. To assess IL-1β, CRP, and mortality, we conducted survival analysis. This study employed a descriptive method with a retrospective cohort design. The diagnosis of COVID-19 was established using RT-PCR for SARS-CoV-2, utilizing nasopharyngeal and oropharyngeal swab samples. On the first day of treatment, residual serum samples from patients were collected and stored for subsequent sorting based on inclusion and exclusion criteria, referencing medical record data. Severity level, duration of treatment, gender, comorbid factors, and patient outcomes were documented. Subsequently, serological examination of IL-1β was conducted using an ELISA kit (BT Lab) and read using a Microplate reader. IL-1β levels on the first day of hospitalization were obtained from patients' medical records. CRP examination was performed using the Cobas C6000 instrument (Roche Diagnostic) with the method and principle of immunoturbidimetry spectrophotometry. The collected data were analyzed using tests for the normality of distribution, difference tests, ROC curve analysis, survival analysis using the Kaplan-Meier Curve, and Hazard Ratio analysis. This study involved 69 confirmed COVID-19 patients who met the inclusion criteria. Of these, 39.1% were male, and 60.9% were female. The median age of the patients in this study was 61 years. The research subjects had a median length of hospital stay of 11 days, with 49.3% surviving and 50.3% not surviving. The subjects were treated with varying degrees of severity, namely mild-moderate, severe, and very severe. The study also documented comorbidity history in patients, including diabetes mellitus, hypertension, heart failure, obesity, and renal insufficiency. Of the subjects, 49.3% had comorbid diabetes mellitus, 27.5% had heart failure, 14.5% had obesity, 18.8% had renal insufficiency, and 13% had comorbid hypertension.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 042306 |
| Divisions: | Profesi Kedokteran > Spesialis Patologi Klinik, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 27 Feb 2024 08:11 |
| Last Modified: | 27 Feb 2024 08:11 |
| URI: | http://repository.ub.ac.id/id/eprint/216309 |
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