Tesis

Kejadian cedera miokard akut pada pasien COVID-19 di Rumah Sakit Rujukan Respirasi Nasional di Jakarta, Indonesia, serta faktor-faktor yang memengaruhinya = Associated factors and prevalence of acute myocardial injury among COVID-19 patients treated at a national respiratory referral hospital in Jakarta, Indonesia.

Latar Belakang: Cedera miokard akut merupakan salah satu manifestasi klinis yang sering timbul pada pasien terkonfirmasi COVID-19 yang mengakibatkan meningkatnya risiko morbiditas dan mortalitas. Meskipun demikian, kejadian cedera miokard akut pada pasien COVID-19 belum banyak didokumentasikan. Penelitian ini bertujuan untuk mengetahui prevalensi cedera miokard akut pada pasien COVID-19 serta faktor-faktor yang memengaruhinya. Metode: Penelitian ini merupakan penelitian potong lintang dengan menggunakan data rekam medis pasien COVID-19 yang dirawat di Rumah Sakit Rujukan Respirasi Nasional di Jakarta, Indonesia, periode Juni-Desember 2020. Cedera miokard akut didefinisikan sebagai peningkatan kadar high sensitivity Troponin I (hsTrop-I) serum > 26 pg/mL. Penelitian ini juga menentukan hubungan antara faktor demografi (usia dan jenis kelamin), riwayat penyakit komorbid kardiovaskuler, derajat keparahan COVID-19, kadar penanda inflamasi serta faktor koagulasi dengan cedera miokard akut pada pasien terkonfirmasi COVID-19. Hasil: Dari total 340 sampel yang memenuhi kriteria inklusi dalam penelitian ini didapatkan sebanyak 62 (18,2%) sampel mengalami cedera miokard akut. Cedera miokard akut lebih banyak didapatkan pada kelompok laki-laki (51,6%) meskipun tidak ditemukan hubungan yang bermakna (p=0,778). Cedera miokard akut menunjukkan hubungan bermakna dengan variabel usia (p=0,004), riwayat komorbid kardiovaskuler (p < 0,001), riwayat hipertensi (p=0,002), derajat keparahan COVID-19 (p < 0,001) dan kadar d-dimer serum (p < 0,001). Hubungan yang bermakna dengan cedera miokard akut juga ditunjukkan oleh penanda inflamasi yaitu prokalsitonin (p < 0,001), C-Reactive Protein/CRP (p=0,001), leukosit (p=0,012) dan Neutrophil-to-Lymphocyte Ratio/NLR (p < 0,001). Kesimpulan: Prevalensi cedera miokard akut pada pasien COVID-19 pada penelitian ini sebesar 18,2%. Cedera miokard akut berhubungan dengan usia, komorbid kardiovaskuler, derajat keparahan COVID-19, kadar penanda inflamasi (prokalsitonin, CRP, leukosit, NLR) dan penanda faktor koagulasi (d-dimer).
Kata kunci: cedera miokard, COVID-19, komorbid, penanda hayati, prevalensi


Background: Acute myocardial injury (AMI) is one of the most common clinical manifestations in confirmed COVID-19 patients which results in an increased risk of morbidity and mortality. However, the incidence of AMI in COVID-19 patients has not been widely documented. This study aims to determine the prevalence of AMI among COVID-19 patients, as well as the factors that contribute to it. Methods: This was a cross-sectional medical records study of COVID-19 patients treated at a national respiratory referral hospital in Jakarta, Indonesia between June and December 2020. An increase in serum high sensitivity troponin I (hsTrop-I) levels > 26 pg/mL defined an AMI. This study also determined the association between demographic characteristics (age and sex), history of cardiovascular comorbidity, degree of COVID-19 severity, level of inflammatory markers, and coagulation factors with AMI in confirmed COVID-19 patients. Results: A total of 62 (18.2%) of the 340 samples that fulfilled the inclusion criteria in this study had AMI. Acute myocardial injury was more frequent in the male group (51.6%), although no correlation was observed (p=0.778). Age (p=0.004), history of cardiovascular comorbidities (p < 0.001), history of hypertension (p=0.002), degree of COVID-19 disease (p < 0.001), and serum ddimer level (p < 0.001) were associated with AMI. Inflammatory markers including procalcitonin (p < 0.001), c-reactive protein/CRP (p=0.001), leukocytes (p=0.012), and neutrophil-to-lymphocyte ratio/NLR (p < 0.001) were associated with AMI. Conclusion: Acute myocardial injury affected 18.2% of COVID-19 patients in our study. Age, cardiovascular comorbidities, COVID-19 severity, inflammatory markers (procalcitonin, CRP, leukocyte, NLR), and coagulation factor biomarkers (d-dimer) were all associated with AMI.
Keywords: biomarkers, comorbidity, COVID-19, myocardial injury, prevalence