Tesis

Hubungan skor Charlson Comorbidity Index dengan mortalitas 28 hari pada pasien COVID-19 yang dirawat di ICU = The Correlation between Charlson Comorbidity Index Score and 28-days Mortality in COVID-19 patients in ICU.

Latar Belakang: Saat ini, dunia sedang menghadapi krisis kesehatan yang belum pernah terjadi sebelumnya yang disebabkan oleh pandemi Severe Acute Respiratory Syndrome Coronavirus 2, dimana diketahui pertama kali di Indonesia pada 2 Maret 2020. Pada infeksi COVID-19 yang berat, diperlukan perawatan di Intensive Care Unit (ICU), dan didapatkan bahwa pasien dengan komorbid seperti hipertensi, diabetes, dan penyakit respirasi memiliki faktor risiko untuk COVID-19 yang lebih berat. Skor CCI adalah sistem skoring komorbid yang mengurangi ragam komorbiditas menjadi skor numerik tunggal. Studi ini menguji hubungan antara skor CCI dengan mortalitas pasien dengan COVID-19, dan menganalisis hubungan antar variabel skor CCI dengan mortalitas pasien COVID-19 yang dirawat di ICU. Tujuan: Studi ini menguji hubungan antara skor CCI dengan mortalitas pasien dengan COVID-19, dan menganalisis hubungan antar variabel skor CCI dengan mortalitas pasien COVID-19 yang dirawat di ICU. Metode: Studi ini merupakan studi kohort retrospektif di RSUPN Cipto Mangunkusumo dan RS Universitas Indonesia selama Maret-Agustus 2020. Sebanyak 208 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Mortalitas pasien COVID-19 di ICU dan skor CCI subjek dicatat sesuai dengan data rekam medis. Variabel skor CCI dianalisis dengan menggunakan analisis bivariat dan regresi logistik multivariat. Kesahihan dinilai menggunakan uji diskriminasi dengan melihat Area Under Curve (AUC) dan uji kalibrasi Hosmer Lemeshow. Titik potong optimal ditentukan secara statistik. Hasil: Analisis statistik menunjukkan bahwa skor CCI memiliki hubungan dengan mortalitas pasien dengan COVID-19 yang dirawat di ICU (OR 4,19; 95%IK: 2,078,46; p=0,00003). Variabel skor CCI pada kasus konfirmasi yang secara statistik berpengaruh signifikan (p ≤ 0,05) adalah gagal ginjal kronis, gagal jantung kongestif, penyakit vaskular perifer, ulkus peptikum, dan diabetes mellitus. Skor CCI menunjukkan nilai diskriminasi sedang (AUC 76,1% IK 95% 0,661-0,881) dan kalibrasi yang baik (Hosmer-Lemeshow p=0,743). Titik potong optimal skor CCI adalah 2,5 dengan sensitivitas 72,5% dan spesifisitas 67,3%. Kesimpulan: Skor CCI memiliki hubungan dengan mortalitas pasien COVID-19 yang dirawat di ICU.
Kata Kunci: COVID-19, mortalitas, ICU, Charlson Comorbidity Index


Background: Currently, the world is facing an unprecedented health crisis caused by the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic, which was first known in Indonesia on March 2, 2020. For severe COVID-19 infections, treatment at the Intensive Care Unit (ICU) is required, and it was found that patients with comorbidities such as hypertension, diabetes, and respiratory disease have more severe risk factors for COVID-19. The CCI scoring is a comorbid scoring system that reduces the ranges of comorbidities to a single numerical score. This study examines the correlation of CCI score and the mortality of patients with COVID-19, and analyzes the correlation of variables in CCI score and the mortality of COVID-19 patients in ICU. Goals: This study examines the correlation of CCI score and the mortality of patients with COVID-19, and analyzes the correlation of variables in CCI score and the mortality of COVID-19 patients in ICU. Methods: This study is a retrospective cohort study at Cipto Mangunkusumo Hospital and Universitas Indonesia Hospital during March to August 2020. A total of 208 subjects who met the inclusion criteria were analyzed from medical record. The mortality of COVID-19 patients in the ICU and the subject's CCI score were recorded according to medical record. CCI score variables were analyzed using bivariate and multivariate logistic regression analysis. The validity of CCI score was assessed by measurement of the Area Under Curve (AUC) and HosmerLemeshow calibration test. The optimal cut-off point was determined statistically. Results: The results of the statistical analysis showed that the CCI score had a correlation with mortality of patients with COVID-19 in ICU (OR 4,19; 95%CI: 2,07 – 8,46; p=0,00003). The CCI score variable which was statistically significant (p ≤ 0,05) in confirmed group are chronic kidney disease, congestive heart failure, peripheral vascular disease, peptic ulcer, and diabetes mellitus. CCI showed a moderate discrimination ability ((AUC 76,1% CI 95% 0,661-0,881) and good calibration ability (Hosmer-Lemeshow p=0,743). The optimal cut off point of CCI score was 2,5 with sensitivity 72,5% and specificity 67,3%. Conclusion: The CCI score has a correlation with the mortality of COVID-19 patients in ICU.
Keywords: COVID-19, mortality, ICU, Charlson Comorbidity Index