IL-6, CRP, dan Ferritin Sebagai Prediktor Mortalitas 14 Hari di Rumah Sakit pada Pasien COVID-19 Derajat Berat Atau Kritis di RSUP Dr. Sardjito

Firda Widasari, dr. Doni Priambodo Wijisaksono, Sp.PD KPTI .; dr. Heni Retno Wulan, M.Kes., Sp.PD KP.,FINASIM

2023 | Tesis-Spesialis | S2 Ilmu Penyakit Dalam

Latar Belakang : Kasus Coronavirus disease 2019 (COVID-19) menjadi pusat perhatian di seluruh dunia akibat tingginya angka mortalitas. Reaksi inflamasi memainkan peran penting dalam patofisiologi COVID-19. Badai sitokin menyebabkan pasien jatuh pada kondisi Acute Respiratory Distress Syndrome (ARDS). Berbagai sitokin inflamasi dan protein fase akut meningkat pada pasien COVID-19 sehingga dijadikan marker prediktor mortalitas, diantaranya CRP, IL-6, dan ferritin. Belum ada penelitian di Indonesia yang membandingkan ketiga parameter tersebut pada pasien COVID-19 derajat berat atau kritis dalam memprediksi kematian 14 hari. Tujuan : Mengetahui apakah IL-6, CRP, dan ferritin dapat berperan sebagai prediktor mortalitas 14 hari pasien COVID-19 derajat berat dan kritis di RSUP dr. Sardjito. Metode : Penelitian kohort retrospektif dari rekam medik pasien COVID-19 derajat berat dan derajat kritis yang dirawat di RSUP dr. Sardjito pada Juli 2020 – Maret 2023. Analisis ROC untuk mendapatkan cut off IL-6, CRP, dan ferritin. Analisa statistik bivariat menggunakan uji Chi-Square dan menghitung OR (Odds Ratio), dilanjutkan uji analisis multivariat dengan regresi logistik. Hasil Penelitian : Diperoleh 305 pasien COVID-19 derajat berat dan kritis, dengan median usia 61 tahun, komorbid DM sebesar 48,9%, hipertensi 32,5%, stroke 6,9%, PJK 3,6%, dan CKD stadium 5 2,6%. Analisis bivariat didapatkan CRP, IL-6, dan ferritin dapat berperan sebagai prediktor mortalitas 14 hari (p<0 CRP=59,5 ferritin =1404,025 p=0,001 OR=2,889; p=0,001 OR=2,394; p=0,001 OR=2,426, p=0,026 OR=3,150 CRP=59,5 ferritin=1404,025 IL-6=67,81>

Background: Coronavirus Disease 2019 (COVID-19) cases have garnered global attention due to the high mortality rate. Inflammatory reactions play a crucial role in the pathophysiology of COVID-19, leading to patients experiencing Acute Respiratory Distress Syndrome (ARDS) during cytokine storms. Various inflammatory cytokines and acute-phase proteins increase in COVID-19 patients, making them potential markers for predicting mortality, including CRP, IL-6, and ferritin. No studies in Indonesia have compared these three parameters in severe or critical COVID-19 patients to predict 14-day mortality.Objective: To determine whether IL-6, CRP, and ferritin can serve as predictors of 14-day mortality in severe and critical COVID-19 patients at Dr. Sardjito General Hospital. Methods: A retrospective cohort study using medical records of severe and critical COVID-19 patients admitted to Dr. Sardjito General Hospital from July 2020 to March 2023. ROC analysis was conducted to obtain cut-offs for IL-6, CRP, and ferritin. Bivariate statistical analysis was performed using the Chi-Square test, calculating Odds Ratios (OR), followed by multivariate analysis with logistic regression.Result: A total of 305 severe and critical COVID-19 patients were included, with a median age of 61 years. Comorbidities included diabetes mellitus (48.9%), hypertension (32.5%), stroke (6.9%), coronary artery disease (3.6%), and stage 5 chronic kidney disease (2.6%). Bivariate analysis revealed that CRP, IL-6, and ferritin could act as predictors of 14-day mortality (p<0 CRP=59.5 ferritin=1404.025 IL-6=67.81 p=0.001, OR=2.889), p=0.001, OR=2.394), p=0.001, OR=2.426), p=0.026, OR=3.150) CRP=59.5 ferritin=1404.025 IL-6=67.81>

Kata Kunci : COVID-19, CRP, IL-6, ferritin, mortalitas , mortality