Tesis

Hubungan Kadar ST2 Terlarut dengan Kelainan Spirometri Pada Penderita Penyakit Kardiovaskular Pasca COVID-19: Studi Komparasi Varian Delta dan Omicron = Association of Soluble ST2 levels and Spirometry Abnormalities in Patients with Cardiovascular Disease Post COVID-19: Comparative Study of Delta and Omicron Variants.

Latar Belakang: Pada pasien dengan penyakit jantung, gangguan pada fungsi paru dapat memperburuk kondisi jantung dengan menyebabkan terjadinya dekompensasi. Infeksi virus SARS-CoV-2 berpotensi mengakibatkan terjadinya fibrosis paru dan gangguan fungsi paru lainnya yang dapat dinilai dengan pemeriksaan spirometri dan kadar ST2 terlarut dalam darah. Infeksi COVID-19 varian Omicron mengakibatkan luaran yang relatif lebih baik dibandingkan varian Delta namun jumlah kasusnya lebih banyak dan tetap dapat mengakibatkan komplikasi tersebut. Oleh sebab itu, penelitian ini akan membandingkan kedua parameter tersebut pada pasien pasca infeksi COVID-19 varian Omicron dan Delta. Tujuan: Mengetahui hubungan kadar ST2 terlarut dan luaran spirometri pada pasien pasca COVID-19 varian Omicron dibandingkan varian Delta pada pasien dengan penyakit kardiovaskular serta perbedaan pada kedua populasi. Metode: Studi observasional potong lintang pada 76 pasien dengan penyakit jantung yang terinfeksi COVID-19 varian Omicron dan Delta dilakukan pemeriksaan spirometri dan kadar ST terlarut 12 minggu pasca konfirmasi negatif. Analisis statistik dilakukan untuk mengetahui hubungan antara kadar ST2 terlarut pada varian Omicron dibandingkan dengan Delta terhadap gangguan fungsi paru menggunakan spirometri dan perbedaan luaran kedua varian. Hasil: Dari 76 subjek penelitian, proporsi pasien dengan varian Omicron lebih banyak dibandingkan Delta (53 orang berbanding 23 orang), dengan perbedaan pada proporsi pasien dengan gagal jantung, penyakit jantung koroner, penerima vaksin dan distres pernafasan akut pada admisi. Kadar ST2 terlarut (p=0.026, OR 1.01 (95% CI 1.00-1.01)) dan kondisi gagal jantung (p=0.019, OR 6.07 (95% CI 1.34- 27.47)) memiliki hubungan terhadap kejadian luaran gambaran spirometri abnormal khususnya gambaran restriksi terutama pada varian Omicron, namun hubungan ini lemah dan kemaknaan klinis tidak signifikan. Kesimpulan: Hasil studi ini mengindikasikan bahwa kadar ST2 terlarut, meskipun lemah, mungkin memiliki asosiasi terhadap kelainan spirometri pada penyintas COVID-19, namun temuan ini terbatasi oleh perbedaan pada masing-masing populasi dari studi ini.
Kata Kunci: Post COVID-19 Syndrome, Soluble ST2, Spirometry, Pulmonary Function, Omicron


Background: In patients with heart disease, impaired lung function can exacerbate cardiac conditions due to decompensation. Infection by the SARS-CoV-2 virus has the potential to cause pulmonary fibrosis and other lung impairment which could be assessed by spirometry and measurement of soluble ST2 levels. Omicron infection resulted in a relatively better outcome than the Delta variant but higher number of cases and it could still cause these complications. Therefore, this study aims to compare these two parameters in survivors of COVID-19 infected by Omicron and Delta variant. Objective: To determine the relationship between soluble ST2 levels and spirometry outcomes in patients with cardiovascular disease after COVID-19 infection by Omicron variant as compared to the Delta variant and the differences in the two populations. Methods: A cross-sectional observational study on 76 patients with heart disease who were infected by Omicron and Delta variant of COVID-19 underwent spirometry and blood sampling for soluble ST levels at the Outpatient clinic in 12 weeks after confirmed negative. Statistical analysis will be performed to find out the association between soluble ST2 levels in the Omicron variant compared to Delta and impairment of lung function using spirometry and the difference in the outcomes of the two variants. Results: From 76 study subjects, the proportion of survivor of Omicron variant was higher than Delta (53 versus 23), with differences in the proportion of patients with heart failure, coronary artery disease, recipients of vaccine and acute respiratory distress syndrome on admission. Soluble ST2 levels (p=0.026, OR 1.01 (95% CI 1.00-1.01)) and heart failure (p=0.019, OR 6.07 (95% CI 1.34-27.47)) have a significant association to abnormal spirometry pattern, especially the restrictive pattern in the Omicron variant, however this relationship may be weak and the clinical implication might be insignificant. Conclusion: The results of this study indicate that soluble ST2 levels, although weak, may have an association with spirometry abnormalities in COVID-19 survivors, but these findings may be limited by differences in each population and study design.
Keywords: Post COVID-19 Syndrome, Soluble ST2, Spirometry, Pulmonary Function, Omicron