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Hubungan penyakit komorbiditas terhadap derajat klinis COVID-19



Abstract

Pendahuluan: Coronavirus Disease 2019 (COVID-19) adalah penyakit infeksi virus yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Komorbiditas merupakan faktor risiko keparahan dan mortalitas pada pasien COVID-19. Tingginya prevalensi COVID-19 disertai dengan variasi klinis yang luas mengindikasikan bahwa telaah prediktor derajat klinis COVID-19 sangat diperlukan

Metode: Penelitian analitik potong lintang dilakukan di Rumah Sakit Bhayangkara Denpasar. Data demografi dan klinis pasien rawat inap usia usia ?18 tahun dengan COVID-19 dikumpulkan pada periode Agustus 2020-Januari 2021 dengan metode Total Sampling. Kriteria inklusi meliputi pasien usia ?18 tahun yang menjalani rawat inap dengan diagnosis COVID-19 yang terkonfirmasi dengan pemeriksaan RT-PCR SARS-CoV-2. Sampel dikategorikan menjadi derajat berat-kritis dan sedang. Analisis data dilakukan secara deskriptif dan analitik

Hasil: Terdapat 153 pasien COVID-19 dengan rerata usia 47±15 tahun dan mayoritas laki-laki (60%). Sebagian besar pasien mengalami gejala sedang (77,1%). Gejala utama meliputi demam (71,9%), sesak (16,3%) dan batuk (7,2%). Sebagian pasien memiliki komorbiditas (42,8%). Komorbiditas yang ada paling banyak ditemukan adalah hipertensi (21,6%) dan diabetes melitus (17,6%), diikuti dengan gagal ginjal kronis (5,9%) dan penyakit jantung (4,6%). Sebagian besar pasien (71,9%) menunjukkan hasil bacaan x-ray thorax normal. Mayoritas pasien tidak dirujuk (86,3%) dengan median lama rawat inap 12,5 hari. Hanya 2% pasien yang meninggal. Hasil analisis bivariat menunjukkan pasien dengan usia >50 tahun, adanya komorbid dan gambaran x-ray thorax abnormal berhubungan dengan derajat berat-kritis. Komorbiditas hipertensi, diabetes melitus dan gagal ginjal kronik yang masing-masing berhubungan dengan derajat klinis COVID-19 berat-kritis. Pada analisis multivariat hanya gambaran x-ray thorax abnormal dan adanya penyakit komorbiditas yang berhubungan dengan derajat klinis COVID-19 berat-kritis.

Simpulan: Adanya penyakit komorbid hipertensi, diabetes melitus, penyakit ginjal kronis disertai gambaran x-ray thoraks abnormal merupakan faktor prediktor infeksi COVID-19 derajat berat-kritis.

 

 

Introduction: Coronavirus Disease 2019 (COVID-19) is a viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Comorbidity is a risk factor for severity and mortality in COVID-19. The high prevalence of COVID-19 accompanied by a wide clinical variation makes determining the predictors of COVID-19 clinical severity an important endeavor.

Methods: A cross-sectional study was conducted at Bhayangkara Hospital Denpasar. Demographic and clinical data of inpatients aged 18 years with COVID-19 were collected from August 2020-January 2021 with the total sampling method. Inclusion criteria included 18 years of age hospitalized with a confirmed COVID-19 diagnosis by SARS-CoV-2 RT-PCR examination. The samples were categorized into severe-critical and moderate infection. Data was analyzed in both descriptive and analytics manner.

Results: There were 153 COVID-19 patients with an average age of 47±15 years, and the majority were male (60%). Most experienced moderate symptoms (77.1%). The main symptoms included fever (71.9%), shortness of breath (16.3%) and cough (7.2%). Almost half had comorbidities (42.8%). The most common were hypertension (21.6%) and diabetes mellitus (17.6%), followed by chronic kidney disease (5.9%) and heart disease (4.6%). Most of the patients (71.9%) had a normal chest x-ray. Most patients did not need a referral (86.3%) and were treated with a median length of stay of 12.5 days. The mortality rate was 2%. The results of bivariate analysis showed that patients aged >50 years, comorbidities and abnormal chest x-rays were associated with severe infection. Comorbidities of hypertension, diabetes mellitus and chronic kidney disease were associated with severe-critical infection. In the multivariate analysis, only abnormal chest x-ray images and the presence of comorbid diseases were associated with the clinical degree of severe-critical COVID-19.

Conclusion: The presence of comorbid hypertension, diabetes mellitus, chronic disease accompanied by an abnormal chest x-ray was a predictor of severe-critical COVID-19 infection.

Keywords: COVID-19 SARS-COV-2 Comorbidity Hypertension Diabetes Mellitus Chronic Kidney Disease

References

  1. Burhan E, Susanto A, Isbaniah F, Nasution S, Ginanjar E, Pitoyo C, et al. Pedoman tatalaksana COVID-19. Edisi 3. Jakarta: Perhimpunan Dokter Paru Indonesia (PDPI), Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI), Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI), Perhimpunan Dokter Anestesiologi dan Terapi Intensif Indonesia (PERDATIN), Ikatan Dokte; 1–7, 57–87 p.
  2. World Health Organization. WHO Coronavirus Disease (COVID-19) dashboard. 2021. Diakses pada: covid19.who.int
  3. Sugihantono A, Burhan E, Susanto A, Damayanti T, Wiyono W, Prasenohadi. Pedoman pencegahan dan pengendalian Coronavirus Disease 2019 (COVID-19). Revisi ke-. Aziza L, Aqmarina A, Ihsan M, editors. Jakarta: Kementrian Kesehatan Republik Indonesia; 17–24, 40–43, 80–109 p.
  4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. Diakses pada: http://www.thelancet.com/article/S0140673620301835/fulltext
  5. Wang D, Yin Y, Hu C, Liu X, Zhang X, Zhou S, et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care. 2020;24(1):188. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/32354360
  6. Zhang J, Yu M, Tong S, Liu L-Y, Tang L-V. Predictive factors for disease progression in hospitalized patients with coronavirus disease 2019 in Wuhan, China. J Clin Virol. 2020/04/28. 2020;127:104392. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/32361327
  7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England). 2020/03/11. 2020;395(10229):1054–62. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/32171076
  8. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020/03/12. 2020;94:91–5. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/32173574
  9. Ejaz H, Alsrhani A, Zafar A, Javed H, Junaid K, Abdalla AE, et al. COVID-19 and comorbidities: Deleterious impact on infected patients. J Infect Public Health. 2020/08/04. 2020;13(12):1833–9. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/32788073
  10. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2021. Diakses pada: https://www.r-project.org/.
  11. RStudio Team. RStudio: Integrated Development Environment for R. Boston: Rstudio PBC; 2021.
  12. Ndera merlin L, Supriyatni N, Rahayu A. Faktor Komorbid terhadap Covid-19 di Puskesmas Kota Tahun 2020.pd. J BIOSAINTEK. 2020;3:1–9.
  13. Al Mutair A, Alhumaid S, Alhuqbani WN, Zaidi ARZ, Alkoraisi S, Al-Subaie MF, et al. Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: an observational cohort study. Eur J Med Res. 2020;25(1).
  14. Radwan NM, Mahmoud NE, Alfaifi AH, Alabdulkareem KI. Comorbidities and severity of coronavirus disease 2019 patients. Saudi Med J. 2020;41(11):1165–74.
  15. Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS One. 2020;15(8 August):1–16.
  16. Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17(9):543–58.
  17. Jin J-M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender differences in patients with COVID-19: Focus on severity and mortality. Cold Spring Harbor Laboratory; 2020.
  18. Chang W-H. Understanding the COVID-19 pandemic from a gender perspective. Taiwan J Obstet Gynecol. 2020;59(6):801–7.
  19. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. 2020;
  20. Yang J-K, Jin J-M, Liu S, Bai P, He W, Wu F, et al. New onset COVID-19–related diabetes: an indicator of mortality. Cold Spring Harbor Laboratory; 2020.
  21. Weinstock MB, Echenique ANA, Russell JW, Leib ARI, Miller JA, Cohen DJ, et al. Chest X-Ray Findings in 636 Ambulatory Patients with COVID-19 Presenting to an Urgent Care Center: A Normal Chest X-Ray Is no Guarantee. J Urgent Care Med. 2020;13–8.
  22. Wang Z, Ji JS, Liu Y, Liu R, Zha Y, Chang X, et al. Survival analysis of hospital length of stay of novel coronavirus (COVID-19) pneumonia patients in Sichuan, China. Cold Spring Harbor Laboratory; 2020.
  23. Kamps Bernd, Sebastian Hoffmann C. COVID Reference. COVID Reference. 2021. 271 p.
  24. Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID-19): A pooled analysis. Polish Arch Intern Med. 2020;130(4):304–9.
  25. Kuster GM, Pfister O, Burkard T, Zhou Q, Twerenbold R, Haaf P, et al. SARS-CoV2: should inhibitors of the renin–angiotensin system be withdrawn in patients with COVID-19? Eur Heart J. 2020;41(19):1801–3.
  26. Henry BM VJ. Clinical Characteristics of Covid-19 in China. N Engl J Med. 2020;382(19):1859–62.
  27. Chalmers JD, Singanayagam A, Hill AT. Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia. Thorax. 2008;63(8):698–702.
  28. Price LC, Wort SJ. Pulmonary hypertension in ARDS: inflammation matters! Thorax. 2017;72(5):396–7.
  29. Dai Q, Wang S, Liu R, Wang H, Zheng J, Yu K. Risk factors for outcomes of acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2019;11(3):673–85.
  30. Leoncini G, Viazzi F, Storace G, Deferrari G, Pontremoli R. Blood pressure variability and multiple organ damage in primary hypertension. J Hum Hypertens. 2013;27(11):663–70.
  31. Satria RMA, Tutupoho RV, Chalidyanto D. Analisis Faktor Risiko Kematian dengan Penyakit Komorbid Covid-19. J Keperawatan Silampari. 2020;4(1):48–55.
  32. Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr Clin Res Rev. 2020;14(4):535–45.
  33. Pal R, Bhadada SK. COVID-19 and diabetes mellitus: An unholy interaction of two pandemics. Diabetes Metab Syndr Clin Res Rev. 2020;14(4):513–7.
  34. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr Clin Res Rev. 2020;14(4):395–403.
  35. Shang L, Shao M, Guo Q, Shi J, Zhao Y, Xiaokereti J, et al. Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis. Arch Med Res. 2020;51(7):700–9.
  36. RAO S, LAU A, SO H-C. Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of SARS-CoV-2: A Mendelian Randomization analysis highlights tentative relevance of diabetes-related traits. American Diabetes Association; 2020.
  37. Fernandez C, Rysä J, Almgren P, Nilsson J, Engström G, Orho-Melander M, et al. Plasma levels of the proprotein convertase furin and incidence of diabetes and mortality. J Intern Med. 2018;284(4):377–87.
  38. Shang J, Wan Y, Luo C, Ye G, Geng Q, Auerbach A, et al. Cell entry mechanisms of SARS-CoV-2. Proc Natl Acad Sci. 2020;117(21):11727–34.
  39. Kulcsar KA, Coleman CM, Beck SE, Frieman MB. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 2019;4(20).
  40. Council E-E, Ortiz A, Cozzolino M, Fliser D, Fouque D, Goumenos D, et al. Chronic kidney disease is a key risk factor for severe COVID-19: a call to action by the ERA-EDTA. Nephrol Dial Transplant. 2021;36(1):87–94. Diakses pada: https://academic.oup.com/ndt/article/36/1/87/6041849
  41. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020/01/24. 2020;395(10223):497–506. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/31986264
  42. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2020;8(1):1–14. Diakses pada: /pmc/articles/PMC7096724/
  43. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020;52(6):1. Diakses pada: /pmc/articles/PMC7103107/
  44. Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HHX, Mercer SW, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Heal. 2020;8(8):e1003. Diakses pada: /pmc/articles/PMC7295519/
  45. Ishigami J, Grams M, Chang A, Carrero J, Coresh J, Matsushita K. CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2017;69(6):752–61. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/27884474/
  46. MG B. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol. 2013;9(5):255–65. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/23507826/
  47. Broseta J, Rodríguez-Espinosa D, Cuadrado E, Guillén-Olmos E, Hermida E, Montagud-Marrahi E, et al. SARS-CoV-2 Infection in a Spanish Cohort of CKD-5D Patients: Prevalence, Clinical Presentation, Outcomes, and De-Isolation Results. Blood Purif. 2021;50(4–5):531–8. Diakses pada: https://pubmed.ncbi.nlm.nih.gov/33352569/
  48. Menon T, Gandhi SAQ, Tariq W, Sharma R, Sardar S, Arshad AM, et al. Impact of Chronic Kidney Disease on Severity and Mortality in COVID-19 Patients: A Systematic Review and Meta-analysis. Cureus. 2021;13(4). Diakses pada: /pmc/articles/PMC8093366/

How to Cite

Karya, K. W. S., Suwidnya, I. M., & Wijaya, B. S. (2021). Hubungan penyakit komorbiditas terhadap derajat klinis COVID-19. Intisari Sains Medis, 12(2), 708–717. https://doi.org/10.15562/ism.v12i2.1143
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