Tesis

Hubungan kadar interleukin-6 serum pasien COVID-19 terkonfirmasi dengan derajat gejala klinis, onset gejala dan luaran pada saat pertama admisi di Rumah Sakit Umum Pusat Persahabatan Jakarta = The correlation between COVID-19 patients serum interleukin-6 level with severity of clinical symptoms, onset of symptoms and clinical outcome when first admitted to Persahabatan Central General Hospital.

Latar belakang: Kondisi hiperinflamasi pasien COVID-19 terkonfirmasi dapat menyebabkan angka kematian meningkat. Hiperinflamasi ini ditandai oleh pelepasan sitokin berlebihan dan tidak terkontrol. Interleukin-6 adalah sitokin yang berperan dalam hiperinflamasi dan digunakan sebagai penanda hayati kejadian hiperinflamasi. Interleukin-6 berperan sebagai prediktor keadaan inflamasi yang tidak terkontrol, sehingga IL-6 digunakan sebagai prediktor prognosis pasien COVID-19 terkonfirmasi. Tujuan penelitian : Mengetahui hubungan kadar IL-6 serum terhadap derajat kondisi klinis, onset gejala dan luaran pasien COVID-19 terkonfirmasi. Metode penelitian: Analisis deskriptif korelatif potong lintang terhadap 60 pasien COVID-19 terkonfirmasi yang pertama kali admisi di ruang IGD RSUP Persahabatan dengan tehnik pengambilan sampel secara consecutive sampling serta menyetujui informed consent dari bulan februari hingga april 2021. Pasien dilakukan pengambilan sampel darah untuk menilai kadar IL-6 serum di laboratorium Patologi Klinik RSUP Persahabatan menggunakan CLIA. Hasil penelitian: Median usia pasien pada penelitian ini adalah 57 tahun dengan rentang usia 25-81 tahun, didominasi oleh laki-laki sebanyak 61%. Pasien yang disertai komorbid 70%. Onset gejala yang paling tinggi adalah 7-14 hari (41%) diikuti onset gejala < 7 hari (40%). Derajat gejala klinis sedang merupakan yang terbanyak (46%) dengan luaran kematian 22%. Hubungan IL-6 serum terhadap derajat gejala klinis bermakna (p= 0,014), hubungan IL-6 dengan luaran juga bermakna (p= 0,012). uji survival menunjukkan bahwa derajat gejala klinis ringan memiliki nilai IL-6 rendah dengan survival rate yang tinggi, namun terdapat perpotongan pada penurunan survival rate derajat gejala klinis sedang dan berat dengan nilai IL-6 sebesar 50 pg/ml. Uji diagnostik dengan ROC nilai IL-6 didapatkan nilai titik potong IL-6 sebesar 19,57 (Sensitifitas 92,3% dan Spesifisitas 51,1%) dan nilai AUC 0,728 (IK95:0,596-0,861) dengan nilai p= 0,012, yang menunjukkan bahwa akurasi IL-6 adalah cukup (sedang). Kesimpulan: Nilai IL-6 serum pasien COVID-19 terkonfirmasi yang pertama kali perawatan di IGD RSUP Persahabatan memiliki hubungan dengan derajat gejala klinis dan luaran pasien COVID-19 terkonfirmasi.
Kata Kunci: Kadar IL-6 serum, pasien COVID-19 terkonfirmasi, pemeriksaan CLIA


Introduction: Hyperinflammatory condition of COVID-19 patient can lead to increased mortality rate. This condition is marked by the over-released and uncontrolled cytokines. Interleukin-6 is a cytokine which plays a role in hyperinflammatory condition and used as biological marker for hyperinflammation. Interleukin-6 serves as a prognosis predictor in COVID-19 patients. Objective: To know the correlation between serum IL-6 level with severity of clinical symptoms, onset of symptoms, and clinical outcome of COVID-19 patients. Methods: This study is a cross-sectional correlative-descriptive analysis towards 60 COVID-19 patients who were admitted to Emergency Department of Persahabatan Central General Hospital for the first time, chosen using consecutive sampling as sampling technique and giving informed consent from February until April 2021. Patients’ blood samples were taken to asses their serum IL-6 level which was done in Clinical Pathology Clinic Laboratory of Persahabatan Central General Hospital by using CLIA test. Results: Patients median age in this study was 57 years old, with range between 25-81 years old, dominated by male (61%). Seventy percent of patients had comorbidity. Most common onset of symptoms was around 7-14 days (41%), followed by onset of symptoms < 7 days (40%). Moderate severity of symptoms was the most common (46%) with mortality output up to 22%. Serum IL-6 correlate significantly with severity of clinical symptoms (p=0.014), correlation between IL-6 and output was also significant (p=0.012). Survival test showed that mild clinical symptoms have low IL-6 value and high survival rate; however, there was a cut-off in the reduction of survival rate for moderate and severe symptoms with IL-6 values of 50 pg/mL. Diagnostic test using ROC for IL-6 value found that IL-6 cut off value was 19.57 (sensitivity 92.3% and specificity 51.1%) and AUC value was 0.728 (CI 95%: 0.596-0.861) with p value-0.012, which shows that the accuracy of IL-6 is moderate. Conclusion: COVID-19 patients who were first admitted to Emergency Department of Persahabatan Central General Hospital have serum IL-6 level correlates with their severity of clinical symptoms and clinical outcome.
Keyword: serum IL-6 level, COVID-19 patient, CLIA test