Tesis

Karakteristik dasar, gambaran klinis, dan luaran pasien COVID19 dengan dan tanpa ventilasi mekanis berdasarkan sebaran usia = Baseline characteristics, clinical profile, and outcomes of COVID-19 patients with and without mechanical ventilation according to age distribution.

Latar Belakang: Penyakit akibat coronavirus jenis baru (SARS-CoV-2) yang muncul sejak Desember 2019 sudah menjadi pandemi global, termasuk di Indonesia. Hingga saat ini, beberapa negara sudah mempublikasikan laporan terkait penyakit ini. Namun di Indonesia, informasi karakteristik dan luaran pasien dengan COVID-19, terutama pasien yang menjalani perawatan di ruang intensif dengan dan tanpa ventilator berdasarkan sebaran usia masih terbatas. Metode: Studi dilakukan pada pasien dewasa yang dirawat di ruang intensif (HCU dan ICU) RSCM dan RSUI selama Maret – Desember 2020. Data yang dikumpulkan melalui rekam medis meliputi karakteristik dasar pasien, pemeriksaan penunjang laboratorium dan radiologi, terapi, komplikasi, dan luaran. Hasil: Terdapat 682 pasien yang menjalani perawatan di ruang intensif RSCM dan RSUI. Pada semua kelompok usia, sebagian besar pasien adalah pria. Pada kelompok usia muda (18–29, 30–39, 40–49 tahun), mayoritas bergejala awal sesak dan menggunakan suplementasi oksigen dengan nasal kanul (37%, 33%, dan 29,6%). Pada kelompok usia 50–64 tahun suplementasi oksigen terbanyak dengan ventilator invasif (33,5%). Rasio PF terendah sebesar 120 terdapat pada kelompok usia ≥65 tahun, dengan penggunaan ventilator pada 49,7% pasien. Prevalensi komorbid tertinggi terdapat pada kelompok usia ≥65 tahun (95,6%) di antaranya hipertensi, penyakit jantung koroner, diabetes melitus, dan CKD. Koinfeksi bakteri paling banyak terjadi pada kelompok usia 50–64 tahun. Kelompok usia ≥65 tahun memiliki median neutrofil dan D-dimer paling tinggi (4.210 µg/L) serta limfosit paling rendah. Angka komplikasi tertinggi terjadi pada 75,6% pasien kelompok usia ≥65 tahun, dengan komplikasi tersering adalah ARDS (50,9%), syok sepsis (50,3%), dan AKI (38,4%). Angka kematian tertinggi terdapat pada kelompok usia 50–64 dan ≥65 tahun yaitu sebesar 46,9% dan 46,5%. Angka kematian pada kelompok pasien yang menggunakan ventilator lebih tinggi pada semua kelompok usia, dengan persentase mortalitas tertinggi terdapat pada kelompok usia 50–64 tahun yang menggunakan ventilator (74,63%). Kesimpulan: Seiring dengan bertambahnya usia, terdapat peningkatan jumlah pasien dengan komorbiditas (hipertensi, penyakit jantung koroner, diabetes melitus, dan CKD); penurunan parameter fungsi oksigenasi paru; penurunan limfosit; peningkatan jumlah neutrofil, D-dimer, ureum dan kreatinin; dan peningkatan angka kematian. Pada pasien yang dirawat di ruang intensif, mortalitas tertinggi terjadi pada kelompok usia 50–64 tahun dan terutama pada penggunaan ventilator.
Kata Kunci: COVID-19, karakteristik, terapi, komplikasi, luaran, sebaran usia


Background: The disease due to the novel coronavirus (SARS-CoV-2) emerging in December 2019 has since become a global pandemic, including in Indonesia. To date, several countries have reported about this disease. However, in Indonesia, limited information was available about the characteristics and outcomes of COVID-19 patients according to age, notably those in intensive care units with and without ventilation. Methods: The study was conducted on adult patients in the intensive care units (HCU and ICU) of RSCM and RSUI between March – December 2020. Data was collected from medical records, including basic patient characteristics, laboratory and radiology results, treatments, complications, and outcomes. Results: A total of 682 patients were treated in the intensive care units of RSCM and RSUI. In all age groups, most patients were male. In younger age groups (18– 29, 30–39, 40–49 years), the majority of patients presented initially with shortness of breath and were supplemented with oxygen through nasal cannula (37.0%, 33.0%, and 29.6%). In the age group of 50–64 years, oxygen was supplemented mostly using invasive ventilators (33.5%). The lowest PF ratio of 120 was observed in the age group of 65 years and above, with ventilators being used in 49.7% of the patients. The highest prevalence of comorbidities was found in the age group of 65 years and above (95.6%), among which were hypertension, coronary artery diseases, diabetes mellitus, and CKD. Bacterial co-infection was found primarily in the age group of 50–64 years. The age group of 65 years and above had the highest median neutrophil and D-dimer levels (4.210 µg/L) and the lowest lymphocyte count. The highest complication rate at 75.6% was observed in the age group of 65 years and above, with the most common complications being ARDS (50.9%), septic shock (50.3%), and AKI (38.4%). The highest mortality rates were found in the age groups of 50–64 and 65 years and above, at 46.9% and 46.5% respectively. Mortality was higher in ventilated patients across all age groups, with the highest rate found in the age group of 50–64 years (74.63%). Conclusion: With increasing age, the following were observed: increased comorbidities (hypertension, coronary artery diseases, diabetes mellitus, CKD); a decline in functional parameters for lung oxygenation; decreased lymphocyte count; increased neutrophil count, D-dimer, urea and creatinine levels; and increased mortality rate. In intensive care unit patients, the highest mortality rate was observed in ventilated patients aged 50–64 years.
Keywords: COVID-19, characteristics, treatment, complication, outcome, age distribution