HUBUNGAN KADAR INTERLEUKIN-6 TERHADAP LUARAN MORTALITAS DAN HARI RAWAT SERTA HARI PENGGUNAAN OKSIGENASI TEKANAN POSITIF PASIEN COVID-19 DI RSUP DR SARDJITO

KUSUMA EDHI KUNCORO, Dr.dr.Sudadi, Sp.An, KNA, KAR; Dr.dr. Djayanti Sari, Sp.An, KAP, M.Kes; dr. Calcarina Fitriani R.W, Sp.An, KIC

2021 | Tesis-Spesialis | ANESTESIOLOGI DAN TERAPI INTENSIF

Latar belakang COVID-19 adalah penyakit yang disebabkan oleh virus SARS-CoV-2 dengan manifestasi klinis utama gangguan pernapasa. Manifestasi klinis pasien COVID19 memiliki spektrum yang luas, mulai dari tanpa gejala, gejala ringan, sedang, berat dan kritis. Pasien dengan gejala berat dan kritis membutuhkan terapi oksigenasi selama perawatan. Tingkat mortalitas COVID-19 di Indonesia sebesar 8,9%, merupakan yang tertinggi di Asia Tenggara. Interleukin-6 berperan dalam perjalanan penyakit dan berhubungan dengan keparahan klinis COVID-19. IL-6 berpotensi sebagai salah satu parameter pemeriksaan untuk memperkirakan luaran pasien COVID-19. Tujuan Mengetahui hubungan antara kadar IL-6 terhadap mortalitas, hari rawat dan hari penggunaan oksigenasi tekanan positif pasien COVID-19 di RSUP Dr. Sardjito. Metode Desain penelitian adalah observasional kohort retrospektif dengan mengambil data sekunder dari rekam medis pasien terkonfirmasi COVID-19 yang diperiksa IL-6 serum selama perawatan periode April 2020-Maret 2021 di RSUP dr.Sardjito. Pengambilan data dilakukan di Instalasi Catatan Medik RSUP dr. Sardjito. Hubungan variabel IL-6 terhadap luaran diuji dengan metode regresi logistik dan dilanjutkan dengan analisis survival Kaplan-Meier dan Cox regression. Hasil Didapatkan 302 subjek penelitian dengan rerata usia 55.45 (+ 14.79) tahun, pria 183 (60,6%) dan wanita 119 (39,4%). Subjek dengan IL-6 >80 pg/mL mempunyai risiko kematian lebih tinggi dibandingkan dengan IL-6 <80 (p=0.000, HR=4.68). Sebanyak 87,4% diantaranya membutuhkan bantuan oksigenasi selama dirawat. Terapi oksigenasi tekanan positif menggunakan HFNC, NIV dan ETT secara signifikan lebih banyak dibutuhkan pada kelompok subjek dengan nilai IL-6 >80 (p=0.000) dengan perbedaan lama penggunaan oksigenasi tekanan positif pada subjek IL-6 >80 adalah 9,36(+5,9) hari secara statistik berbeda bermakna (p=0.005) dibandingkan kelompok subjek IL-6 <80 6(+2,98) hari. Lama hari rawat berbeda bermakna antar kelompok subjek, dengan median hari rawat subjek IL-6 >80 adalah 25 hari sedangkan pada subjek IL-6 <80 adalah 13 hari (p=0.000). 2 Kesimpulan Terdapat hubungan bermakna antara kadar IL-6 >80 pg/mL terhadap peningkatan resiko mortalitas, hari rawat dan penggunaan oksigenasi tekanan positif pasien COVID-19.

Background: COVID-19 is a disease caused by the SARS-CoV-2 virus with the main clinical manifestations of respiratory disorders. The clinical manifestations of COVID-19 patients have a broad spectrum, ranging from asymptomatic, mild, moderate, severe and critical symptoms. Patients with severe and critical symptoms require oxygenation therapy during treatment. The COVID-19 mortality rate in Indonesia is 8.9%, which is the highest in Southeast Asia. Interleukin-6 plays a role in the course of the disease and is associated with the clinical severity of COVID-19. IL-6 has the potential as one of the test parameters to estimate the outcome of COVID-19 patients. Aim To know the relationship between IL-6 levels and the outcome of mortality, length of stay (LOS) and positive pressure oxygenation days of COVID-19 patients during hospitalization at Dr. Sardjito hospital. Methods The study design was a retrospective observational cohort by taking secondary data from the medical records of hospitalized COVID-19 confirmed patients who were examined for serum IL-6 during April 2020-March 2021 at dr.Sardjito Hospital. Data collection was carried out at the Medical Records Instalation of Dr. Sardjito Hospital. The relationship of the IL-6 variable to the outcome was tested by logistic regression method and further analyzed with Kaplan-Meier and Cox regression analysis of survival. Results There were 302 research subjects with a mean age of 55.45 (+14.79) years, 183 male (60.6%) and 119 female (39.4%). Subjects with IL-6 >80 pg/mL had a higher risk of death than those with IL-6 <80 (p = 0.000,HR=4.68). As many as 87.4% of the subject required oxygenation therapies during hospitalization. Positive pressure oxygenation therapy using HFNC, NIV and ETT was significantly more required in the group of subjects with an IL-6 value >80 (p=0.000), with the difference in the duration of using positive pressure oxygenation in subjects with IL-6 >80 was 9.36(+5,9) days, significantly different compared to the group of subjects with IL-6 <80 6(+2,98) days(p=0.005). The difference in LOS was significantly different between groups of subjects, with the median LOS for subjects with IL-6 >80 was 25 days, while for subjects with IL-6 <80 was 13 days (p= 0.000). 2 Conclusion There was a significant relationship of IL-6 levels >80 pg/mL with increased risk of mortality, LOS and the requirement of positive pressure oxygenation therapies in COVID-19 patients.

Kata Kunci : COVID-19, IL-6, mortalitas, lama rawat, oksigenasi tekanan positif