Tesis

Hubungan kadar 25-hydroxy (25-OH) vitamin D dengan luaran pasien terkonfirmasi COVID-19 = Association between 25-hydroxy (25-OH) vitamin D level and outcome in hospitalized patient with confirmed COVID-19.

Latar Belakang. Berbagai studi telah menunjukkan adanya hubungan antara rendahnya kadar serum vitamin D dan risiko infeksi COVID-19 serta terjadinya prognosis yang lebih buruk. Pasien COVID-19 dengan defisiensi vitamin D menunjukkan lama rawat yang lebih panjang, penggunaan ventilasi mekanik yang lebih tinggi dan angka ketahanan hidup yang lebih rendah. Tujuan. Mengetahui hubungan antara kadar 25-OH vitamin D dengan luaran pasien terkonfirmasi COVID-19. Metode. Penelitian ini menggunakan metode kohort prospektif pada total 191 pasien COVID- 19 di RSUPN Cipto Mangunkusumo dan RS Darurat COVID-19 Wisma Atlet yang dilakukan rawat inap sejak Oktober 2021 hingga Februari 2022. Pasien dilakukan pemeriksaan kadar 25-OH vitamin D saat admisi kemudian dilakukan analisis bivariat, multivariat dan regresi logistik terhadap luaran yaitu lama rawat, penggunaan ventilasi mekanik, dan kematian Hasil. Didapatkan median kadar 25-OH D 13,5 ng/ml (RIK 3-45,1 ng/ml). Median lama rawat pada kelompok normal, insufisiensi, dan defisiensi adalah 12 hari (minmax 3-12; 4-16; 3-21). Tidak didapatkan perbedaan lama rawat pada ketiga kelompok (p=0,09). Terdapat perbedaan yang signifikan terhadap penggunaan ventilasi mekanik pada ketiga kelompok (p=0,03). Tidak terdapat perbedaan angka kematian pada kelompok normal, insufusiensi, dan defisiensi (p=0,17). Pada penggunaan ventilasi mekanik didapatkan AUC 0,77 (IK 95% 0,67-0,88) dengan nilai kadar 25-OH vitamin D > 9,4 ng/ml memiliki nilai protektif terhadap penggunan ventilasi mekanik dengan sensitifitas sebesar 76% dan spesifisitas sebesar 75%. Pada angka kematian didapatkan AUC 0,81 (IK 95% 0,71-0,93) dengan nilai kada 25-OH vitamin D > 9,2 ng/ml memiliki nilai protektif terhadap kematian dengan sensitifitas sebesar 75,2% dan spesifisitas 76,2%. Kesimpulan. Terdapat perbedaan bermakna penggunaan ventilasi mekanik pada kelompok 25-OH vitamin D normal, insufisiensi, dan defisiensi pada pasien terkonfirmasi COVID-19. Kadar 25-OH vitamin D berhubungan dengan penggunaan ventilasi mekanik dan kematian pada pasien terkonfirmasi COVID-19.
Kata Kunci. Vitamin D, 25-OH vitamin D, luaran, COVID-19, lama rawat, ventilasi mekanik, kematian, mortalitas



Background. Various studies have shown association between low serum 25-OH vitamin D level and risk of COVID-19 infection and poorer prognosis. Deficiency vitamin D in COVID-19 patient shows longer length of stay, higher use of mechanical ventilation, and lower survival rate. Aim. To know the association between 25-OH vitamin D level with outcome of confirmed COVID-19 patients. Method. This study used prospective cohort method on total 191 COVID-19 patients at Cipto Mangunkusumo General Hospital and Wisma Atlet Hospital who were hospitalized during October 2021 to February 2022. 25-OH vitamin D level was checked at admission. Bivariat and multivariat analysis was performed to assess the outcome length of stay, used of mechanical ventilation and mortality during hospitalization. Results. Median length of stay in the normal, insufficiency, and deficiency group was 12 days (min-max 3-12; 4-16; 3-21). There was no difference in length of stay in the three groups (p=0.09). There was significant difference in mechanical ventilation used in the three groups (p=0.03). There was no significant difference in mortality in the normal, insufficiency and deficiency groups. Deficiency 25-OH vitamin D associated with used of mechanical ventilation and mortality. For mechanical ventilation we obtained AUC 0.77 (95% CI 0.67-0.88) with a value of 25-OH vitamin D levels > 9.4 ng/ml has a protective value against used of mechanical ventilation with 76% sensitivity and specificity by 75%. In the mortality rate, the AUC was 0.81 (95% CI 0.71-0.93) with a 25-OH vitamin D level > 9.2 ng/ml having a protective value against mortality with 75.2% sensitivity and 76.2% specificity. Conclusion. There was statistically significant difference in the used of mechanical ventilation in normal, insufficiency, and deficiency 25-OH vitamin D group in patients with confirmed COVID-19. 25-OH vitamin D level associated with the used of mechanical ventilation and mortality in confirmed COVID-19 patients.
Keywords. Vitamin D, 25-OH vitamin D, outcome, COVID-19, length of stay, mechanical ventilation, mortality