Hartanti, Khoirunisah Dwi and Dr. dr. Agustin Iskandar,, M.Kes, Sp.PK, Subsp.P.I.(K) and dr. Siti Fatonah,, Sp.PK, Subsp.B.D.K.T.(K) (2023) Biomarker MCP-1 dan D-Dimer Sebagai Prediktor Mortalitas Pasien COVID-19. Magister thesis, Universitas Brawijaya.
Abstract
COVID-19 adalah penyakit infeksi yang disebabkan oleh virus SARS-CoV�2 dengan tingkat mortalitas yang tinggi. Pasien COVID-19 berisiko mengalami disfungsi koagulasi yang merupakan salah satu penyebab utama kematian. Ekspresi berlebihan dari kemokin yang terutama diproduksi oleh monosit dan makrofag, seperti Monocyte Chemoattractant Protein-1 (MCP-1), berhubungan langsung dengan tingkat keparahan COVID-19 dan merupakan kunci infiltrasi sel imun ke dalam paru-paru pasien COVID-19. MCP-1 sebagai marker trombosis mungkin berkorelasi dengan D-dimer sebagai parameter koagulopati. MCP-1 dan D-dimer dapat dikaitkan dengan risiko kematian pada pasien COVID-19. Penelitian ini bertujuan untuk mengetahui apakah MCP-1 dan D-dimer dapat menjadi prediktor mortalitas pada pasien COVID-19. Penelitian ini adalah penelitian observasional analitik dengan desain kohort. Kadar MCP-1 dan D-dimer dievaluasi pada hari pertama rawat inap. Subjek penelitian diikuti luaran mortalitas pada hari ke-28. Data yang terkumpul dianalisis dengan uji normalitas distribusi, uji beda, analisis kurva ROC, analisis survival menggunakan Kurva Kaplan Meier, dan Hazard Ratio (HR). Didapatkan subjek sebanyak 70 pasien COVID-19 dengan 36 (51,4%) pasien COVID-19 yang hidup dan 34 (48,6%) pasien COVID-19 yang meninggal. Subjek penelitian ini didominasi oleh perempuan sebanyak 43 subjek (61,4%) dengan usia rata rata keseluruhan subjek adalah 57,3 tahun. Kadar MCP-1 lebih tinggi pada pasien COVID-19 non survivor dengan median 65,07 ng/L (16,38 – 163,31) dibandingkan survivor dengan median 39,32 ng/L (11,79 – 64,33) secara signifikan (p=0,046). Kadar D-dimer lebih tinggi pada pasien COVID-19 non survivor dengan median 2,26 mg/L FEU (1,02 – 26,25) dibandingkan survivor dengan median 1,36 mg/L FEU (0,81 – 2,96) secara signifikan (p=0,037). Dari hasil analisis ROC, didapatkan cut-off MCP-1 sebesar 48,59 ng/L dan D-dimer sebesar 1,465 mg/L FEU. Kadar MCP-1 ≥48,59 ng/L memiliki median survival 17 hari serta HR 1,309. Kadar D-dimer ≥1,465 mg/L FEU memiliki median survival 15 hari serta HR 2,548. Kombinasi tingginya kadar MCP-1 dan D-dimer memiliki median survival 9 hari serta HR 2,139. Hasil penelitian ini menunjukkan adanya potensi MCP-1 dan D-dimer dalam memprediksi mortalitas meskipun MCP-1 mempunyai performa yang lebih rendah dibandingkan D-dimer. Keduanya dapat dipakai sebagai biomarker stratifikasi pasien COVID-19 di rumah sakit
English Abstract
COVID-19 is an infection disease caused by the SARS-CoV-2 virus with a high mortality rate. COVID-19 patients are at risk of coagulation dysfunction, which is a major cause of death. Excessive expression of chemokines, primarily produced by monocytes and macrophages, such as Monocyte Chemoattractant Protein-1 (MCP-1), is directly associated with the severity of COVID-19 and is a key factor in the infiltration of immune cells into the lungs of COVID-19 patients. MCP-1, as a thrombosis marker, may correlate with D-dimer as a coagulopathy parameter. MCP-1 and D-dimer may be associated with the risk of death in COVID�19 patients. This research aims to determine whether MCP-1 and D-dimer can be predictors of mortality in COVID-19 patients. It is an analytical observational research study with cohort design. MCP-1 and D-dimer levels were evaluated on the first day of hospitalization. The research subjects were followed for mortality outcomes on the 28th day. The collected data were analyzed using tests for normal distribution, comparative tests, ROC analysis, survival analysis using the Kaplan-Meier curve, and Hazard Ratio (HR). In this study, a total of 70 COVID-19 patients were included, with 36 (51.4%) survivor and 34 (48.6%) non-survivors. The study subjects were predominantly with 43 female subjects (61.4%), and the overall average age of the subjects was 57.3 years. MCP-1 levels were higher in non-survivor COVID-19 patients with a median of 65.07 ng/L (16.38 – 163.31) compared to survivors with a median of 39.32 ng/L (11.79 – 64.33), significantly (p=0.046). D-dimer levels were higher in non-survivor COVID-19 patients with a median of 2.26 mg/L FEU (1.02 – 26.25) compared to survivors with a median of 1.36 mg/L FEU (0.81 – 2.96), significantly (p=0.037). ROC analysis yielded MCP-1 and D-dimer cutoff values of 48.59 ng/L and 1.465 mg/L FEU, respectively. MCP-1 levels ≥48.59 ng/L had a median survival of 17 days and HR of 1.309. D-dimer levels ≥1.465 mg/L FEU had a median survival of 15 days and HR of 2.548. The combination of high MCP-1 and D-dimer levels has a median survival of 9 days with an HR of 2.139.This research indicates the potential of MCP-1 and D-dimer in predicting mortality, although MCP-1 has lower performance compared to D-dimer. Both can be used as biomarkers for stratifying COVID-19 patients in hospitals.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 042306 |
| Divisions: | Profesi Kedokteran > Spesialis Patologi Klinik, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 14 Mar 2024 06:16 |
| Last Modified: | 14 Mar 2024 06:16 |
| URI: | http://repository.ub.ac.id/id/eprint/216778 |
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