Hubungan Penyakit Komorbid dan Faktor Prognostik dengan Mortalitas pada Pasien COVID-19 Critical ill Bulan Juni - Desember 2021 di Ruang Intensive Care RSUP Prof. DR. I.G.N.G Ngoerah Denpasar

Ni Wayan Eka Satyawati1, Putu Andrika2
1Program Studi Spesialis Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia
2Staf Divisi Pulmonologi dan Penyakit Kritis, Departemen/KSM Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Udayana/ RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar, Bali, Indonesia

Background : Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2). The spread of COVID-19 occurs globally and designated as a pandemic with clinical manifestations of COVID-19 mainly affect the respiratory system. COVID-19 there is often an increase in inflammatory response, thrombosis, coagulopathy, and the presence of comorbid chronic diseases which is associated with increased degree of disease severity, morbidity and mortality. In this study, aimed that there will be a relationship between the presence of comorbid diseases (Diabetes Mellitus, hypertension, and chronic kidney disease) as well as prognostic factors (platelet levels, neutrophil lymphocyte ratio (NLR), procalcitonin and D-dimer) with mortality in critically ill COVID-19 patients in the Intensive Care Unit (ICU) Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar.
Methods : This research is an analytical study with a retrospective approach using secondary data from medical records with a purposive sampling method. The population was all medical record data for critically ill COVID-19 patients in the ICU Prof. Dr. I.G.N.G. Ngoerah Hospital Denpasar period June - December 2021 as many as 397 patients. The analysis performed was univariate and bivariate analysis with the Chi-Square statistical test using the SPSS 26.0 application for windows.
Results : In this study, based on data from patients critical ill period June - December 2021 were treated in the ICU Prof. Dr. I.G.N.G Ngoerah Hospital Denpasar obtained that the predominant age was 45-59 years for 214 patients (53.9%), with a mortality rate of 133 patients (50.6%). The gender factor was more in males, 229 patients (57.7%) with a mortality rate of 154 patients (58.6%) The bivariate test results found no significant relationship between age and mortality and between gender and mortality in critically ill COVID-19 patients, with a p-value of 0.148 and 0.62. In the comorbid factor data, more patients with hypertension were found, namely 154 patients (38.8%), while type II DM was 141 patients (35.5%) and chronic kidney disease 84 patients (21.2%). Based on the results of the bivariate test, there was no significant association with mortality in critically ill COVID-19 patients with comorbid factors, with p-values of 0.31 and 0.67, respectively. Whereas in the comorbid factors of chronic kidney disease, the results of bivariate tests found a significant relationship with mortality in critically ill COVID-19 patients, p-value 0.03. In terms of platelet levels, there were more platelets with normal platelet levels, namely 308 patients (77.6%) with bivariate test results, there was no significant relationship with mortality in critically ill COVID-19 patients, p-value 0.23. The factor of NLR levels was higher with an increase in NLR in 365 patients (91.9%), procalcitonin levels was higher with increased procalcitonin in 283 patients (71.3%), D-dimer levels with increased D-dimer levels in 370 patients (93.2%), with the results of bivariate tests there is a significant relationship with mortality in critically ill COVID-19 patients, p-value 0.001 for NLR, p-value 0.000 for procalsitonin and p-value 0.013 for D-dimer.
Conclusion : In this study it was found that the age and gender factors did not have a significant relationship with mortality in critically ill COVID-19 patients who were treated in the June-December 2021 period at Prof. Dr. IGNG Ngoerah Denpasar. While the comorbid factors studied were mostly hypertension, followed by type II DM and chronic kidney disease. However, comorbid chronic kidney disease has a significant relationship with mortality in critically ill COVID-19 patients. As for the levels of routine investigations carried out in patients with COVID-19, they are a complete blood count (in this study including NLR and platelet values) as well as procalcitonin and D-dimer levels. In this study it was found that elevated NLR, procalcitonin and D-dimer levels had a significant relationship with mortality in critically ill COVID-19 patients.
Keyword : COVID-19 critical ill, comorbid, D-Dimer, procalcitonin