Association Between Glucose Plasma Levels and Neutrophil Leukocyte Ratio (NLR) in Severe-Critical COVID-19 Patients at dr.Sardjito Hospital, Yogyakarta.

VIENN ELVIRA LEE, dr. Hemi Sinorita, sp.PD-KEMD; dr. Heni Retnowulan, M.Kes, sp.PD-KP; dr. Rizka Humardewayanti Asdie, sp.PD-KPTI

2024 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang: Sepanjang pandemi COVID-19, penelitian telah melaporkan bahwa prognosis infeksi lebih buruk pada mereka dengan kadar glukosa plasma tinggi karena infeksi SARS-CoV-2 dan hiperglikemia menyebabkan peradangan sistemik. Rasio Neutrofil-ke-Leukosit (NLR), penanda peradangan, digunakan untuk melihat hubungan antara kadar glukosa dan respons peradangan yang berkontribusi pada pemburukan nya hasil infeksi COVID-19.

Metode: Populasi penelitian pasien COVID-19 dewasa yang parah dan kritis di RSUP dr. Sardjito pada tahun 2021 akan disertakan dalam studi potong lintang retrospektif ini berdasarkan kadar glukosa plasma dan NLR mereka, dengan kadar glukosa plasma sebagai variabel independen dan NLR sebagai variabel dependen. Variabel potensi pengacau adalah usia, IMT, dan tekanan darah. Ada tiga jenis statistik analisis yang mencakup univariat (distribusi dan frekuensi), bivariat (uji Chi Square atau uji ekstrak Fisher), dan multivariat (regresi linear berganda).

Tujuan: Untuk mengevaluasi hubungan antara kadar glukosa plasma dan NLR pada pasien COVID-19 yang parah dan kritis.

Hasil: Studi ini melibatkan 128 pasien (72 pria, 56 wanita) dengan rata-rata usia 55.570±14.389 tahun. Nilai ambang NLR sebesar 14.77 untuk sensitivitas 57.45% terungkap dan melalui uji Kolmogorov-Smirnov, ditemukan bahwa kadar glukosa plasma tidak terdistribusi secara normal. Selanjutnya, kurva ROC juga dibuat untuk menemukan skor ambang kadar glukosa plasma (275) terhadap rata-rata NLR. Untuk analisis bivariat, analisis Mann-Whitney menunjukkan tidak ada perbedaan signifikan pada rata-rata NLR antara kelompok glukosa plasma yang berbeda dan uji Fisher's Exact mengungkapkan bahwa mereka dengan kadar glukosa plasma >200 dan kadar glukosa plasma >275 dua kali lebih mungkin memiliki tingkat NLR lebih dari atau sama dengan 14.775.

Kesimpulan: Tidak ada perbedaan rata-rata yang signifikan. Namun, ada hubungan signifikan antara skor ambang kadar glukosa plasma masuk (275) dan NLR (14.775) pada pasien COVID-19 yang parah dan kritis.

Kata Kunci: hiper glikemia, NLR, coronavirus, COVID-19

Background: Throughout this COVID-19 pandemic, studies have reported that the prognosis of the infection are worse in those with high glucose plasma levels as both SARS-CoV-2 infection and hyperglycemia induce systemic inflammation. Neutrophil-to-Leukocyte ratio (NLR), a known marker of inflammation, is used to see the association between glucose levels and inflammatory response which contributes to the declining outcome of COVID-19 infection.

Methods: A research population of severe and critical adult COVID-19 patients in RSUP dr. Sardjito in 2021 will be included in this retrospective cross sectional study according to their glucose plasma level and NLR, with glucose plasma level as the independent variable and NLR as the dependent variable. The confounding variables potential are age, BMI, and blood pressure. There are three types of analysis statistics which includes univariate (distribution and frequency), bivariate (Chi Square test or fisher's extract test) and multivariate (multiple linear regression).

Aim: To evaluate the relationship between glucose plasma level and NLR in severe and critical COVID-19 patients.

Result: This study involved 128 patients (72 men, 56 women) with a mean age of 55.570±14.389 years. An NLR cut-off value of 14.77 for 57.45% sensitivity were revealed and through Kolmogorov-Smirnov test, it was found that plasma glucose levels are not normally distributed. Furthermore, an ROC curve was also made to find the cut-off score of plasma glucose level (275) against mean NLR. For bivariate analysis, Mann-whitney analysis showed no significant difference on mean NLR between different plasma glucose groups and Fischer’s Exact test revealed that those with plasma glucose level>200 and plasma glucose level>275 is twice more likely to have NLR levels of more than or equal to 14.775.

Conclusion: There is no significant mean difference. However, there is asignificant association between the cut-off scores of admission plasma glucose levels(275) and NLR(14.775) in severe-critical COVID-19 patients.

Keyword: hyperglycemia, NLR, coronavirus, COVID-19

Kata Kunci : hyperglycemia, NLR, coronavirus, COVID-19