Hubungan Terapi ACEI/ARB dan Non-ACEI/ARB Terhadap Luaran Klinis Pasien COVID-19 Disertai Komorbid Hipertensi di RSUP DR. Sardjito Yogyakarta

Siti Olega Adawiyah Murni, Prof. Dr. apt. Tri Murti Andayani, Sp.FRS

2024 | Tesis | S2 Mag.Farmasi Klinik

Disfungsi renin-angiotensin-system (RAS) telah diamati pada pasien COVID-19. Disfungsi ini dapat memunculkan bentuk COVID-19 yang parah. Efek pemberian terapi penghambat RAS, seperti Angiotensin Converting Enzyme Inhibitor (ACEI) dan Angiotensin 2 Receptor Blocker (ARB) pada ACE2 pada manusia masih menimbulkan kekhawatiran bahwa pengobatan ini dapat meningkatkan kematian pasien COVID-19. Penelitian bertujuan mengetahui hubungan monoterapi ACEI/ARB dan non-ACEI/ARB terhadap luaran klinis pasien COVID-19 disertai hipertensi di RSUP DR. Sardjito Yogyakarta.

Penelitian dilakukan secara observasional-analitik dengan desain kohort retrospektif. Pemilihan sampel secara consecutive sampling hingga mendapatkan 37 pasien pada setiap kelompok terapi antihipertensi. Sumber data menggunakan data rekam medis pasien rawat inap berusia ?18 tahun, terkonfirmasi COVID-19 disertai hipertensi, menerima protokol terapi COVID-19, mendapatkan perawatan di bangsal isolasi serta menerima terapi tunggal ACEI/ARB dan Non-ACEI/ARB periode tahun 2020 - 2023 di RSUP Dr. Sardjito. Luaran klinis yang diamati adalah: angka mortalitas, admisi ke ICU, penggunaan ventilator dan lama rawat inap. Analisis hubungan terapi dan luaran klinis menggunakan uji Chi-Square dan Fisher dengan nilai signifikansi p< 0>Multiple Logistic Regression untuk menilai variabel perancu yang paling signifikan dengan kemaknaan p <0>

Total 74 pasien yang memenuhi kriteria inklusi dan eksklusi dengan persentase terbanyak pasien laki-laki 45 (60,85%), usia 18-60 tahun 45 (60,8%) dan pasien dengan COVID-19 derajat berat 64 (86,5%). Penyakit penyerta terbanyak adalah DM 24 (32,4%) dan ARDS 17 (23%). Berdasarkan uji statistik Chi-Square dan Fisher didapatkan nilai signifikansi antara terapi ACEI/ARB dan Non-ACEI/ARB dengan luaran klinis tidak berbeda signifikan p> 0,05 yaitu admisi ICU p= 0,611 (OR:0,772; CI 95%:0,284-2,098), penggunaan ventilator p= 0,674 (OR: 2,121; CI 95%:0,364-12,363), mortalitas p= 0,480; (OR: 0,716; CI 95%:0,283-1,810) dan lama rawat inap p= 0,327 (OR:1,925; CI 95%:0,512-7,237). Hasil ini menunjukkan tidak terdapat hubungan antara monoterapi ACEI/ARB dan Non-ACEI/ARB terhadap luaran klinis pasien COVID-19 dengan hipertensi di RSUP Dr. Sardjito Yogyakarta.

Renin-angiotensin-system (RAS) dysfunction has been observed in COVID-19 patients. This dysfunction can give rise to severe forms of COVID-19. The effect of RAS inhibitor therapy, such as Angiotensin Converting Enzyme Inhibitor (ACEI) and Angiotensin 2 Receptor Blocker (ARB) on ACE2 in humans still raises concerns that this treatment may increase the mortality of COVID-19 patients. This study aims to determine the relationship between ACEI/ARB and non-ACEI/ARB monotherapy on the clinical outcomes of COVID-19 patients with hypertension at the General Hospital DR. Sardjito Yogyakarta. 

The study was conducted observational-analytically with a retrospective cohort design. Sample selection was consecutive sampling to get 37 patients in each antihypertensive therapy group. The data source used medical record data of inpatients aged ?18 years, confirmed COVID-19 with hypertension, receiving COVID-19 therapy protocols, getting treatment in isolation wards and received monotherapy ACEI/ARB and Non-ACEI/ARB therapy for the period 2020-2023 at Dr. Sardjito Hospital. The clinical outcomes observed were: mortality rate, admission to ICU, ventilator use and length of hospitalization. Analysis of the relationship between therapy and clinical outcomes used Chi-Square and Fisher's test with a significance value of p< 0>

A total of 74 patients met the inclusion and exclusion criteria the highest percentage of male patients 45 (60,85%), age 18-60 years 45 (60,8%) and patients with severe COVID-19 64 (86,5%). The most common comorbidities were DM 24 (32,4%) and ARDS 17 (23%). Based on Chi-Square and Fisher statistikal tests, the significance value between ACEI/ARB and Non-ACEI/ARB therapy with clinical outcomes are not significantly different p> 0,05, namely ICU admission p= 0,611 (OR:0,772; CI 95%:0,284-2,098), ventilator use p= 0,674 (OR: 2,121; CI 95%:0,364-12,363), mortality p= 0,480; (OR: 0,716; CI 95%:0,283-1,810) and length of hospitalization p= 0,327 (OR:1,925; CI 95%:0,512-7,237). These results indicate that there were no relationship between ACEI/ARB and Non-ACEI ARB monotherapy on the clinical outcomes of COVID-19 patients with hypertension at RSUP Dr. Sardjito Yogyakarta.

Kata Kunci : Hipertensi,COVID-19,ACEI/ARB, non-ACEI/ARB,luaran klinis