Tesis

Faktor Prognostik yang Memengaruhi Fungsi Pernapasan Jangka Panjang Pasien Anak Pasca-COVID-19 = Prognostic Factors for Long Term Respiratory Function in Children After COVID-19.

Latar belakang. Dewasa ini, keadaan mengenai kondisi multiorgan pascainfeksi akut dan komplikasi pada penyintas COVID-19 menjadi perhatian, terutama dampak pada fungsi pernapasan. Akan tetapi, laporan mengenai fungsi pernapasan anak pasca-infeksi COVID-19 serta faktor yang terkait masih jarang ditemukan, terutama di Indonesia. Tujuan. Mengetahui prevalens, karakteristik, dan faktor prognostik yang memengaruhi fungsi pernapasan jangka panjang pada pasien anak pasca-COVID-19. Metode. Penelitian ini merupakan penelitian analitik observasional dengan desain kohort retrospektif yang mengevaluasi fungsi pernapasan dengan spirometri setelah sembuh minimal lebih dari 6 bulan pasca-COVID-19 dan faktor prognostik yang terkait. Subyek yang diteliti adalah pasien anak usia 5–18 tahun dengan riwayat terkonfirmasi COVID- 19. Penelitian dilakukan sejak Januari hingga Juni 2024. Faktor prognostik yang dianalisis, antara lain klasifikasi klinis COVID-19, jenis kelamin, usia, komorbid, riwayat penggunaan ventilator, riwayat rawat inap dan gejala persisten. Hasil. Terdapat 100 subyek yang memenuhi kriteria inklusi dan eksklusi dalam penelitian. Sebaran pasien anak penyintas COVID-19 sebanyak 53% berjenis kelamin perempuan, 52% berusia ≥ 12 - 18 tahun, 76% memiliki setidaknya 1 komorbid, dengan jenis komorbid terbanyak adalah obesitas (27%), gizi kurang/buruk (1 9%) dan penyakit ginjal kronik (16%). Mayoritas (73%) memiliki riwayat terkonfirmasi COVID-19 dengan derajat ringan dan lebih dari setengah total subyek (78%) tidak dirawat inap saat terkonfirmasi COVID-19. Prevalens gangguan fungsi paru pada anak penyintas COVID- 19 adalah sebesar 47%, didominasi dengan gangguan paru tipe restriktif. Prevalens long COVID adalah sebesar 18% dengan gejala persisten berupa kelelahan (13%), batuk (11 %), sesak napas (8%), pilek (1%), nyeri tulang (1%), dan hiposmia (1%). Gejala persisten berhubungan secara signifikan dengan luaran spirometri abnormal (p = 0,03, RR 1,99; IK 95% 1,38 – 2,87). Dari analisis multivariat dengan regresi logistik, status gizi kurang/buruk dan klasifikasi klinis COVID-19 sedang-berat-kritis merupakan faktor prognostik terhadap gangguan fungsi pernapasan anak pasca-COVID-19 dengan nilai p = 0,002, aOR 5,64; IK 95% 1,89 – 16,85 dan p = 0,006, aOR 5,18; IK 95% 1,59 – 16,89 secara berurutan. Simpulan. Gejala persisten, status gizi kurang/buruk dan klasifikasi klinis COVID-19 sedang-berat-kritis merupakan faktor prognostik gangguan fungsi paru pada pasien pascaCOVID-19.
Kata kunci: anak, COVID-19, fungsi paru, long COVID


Background. The situation regarding post-acute multiorgan conditions and complications in COVID-19 survivors is becoming a concern nowadays, especially the impact on respiratory function. However, reports on respiratory function in children after COVID-19 infection and its prognostic factors are still rare, especially in Indonesia. Objectives. To determine the prevalence, characteristics, and prognostic factors that influence long term respiratory function in children after COVID-19. Method. This study is an observational analytical study with a retrospective cohort design that evaluates respiratory function with spirometry after recovery for at least 6 months from COVID-19 and it’s related factors. The subjects studied were pediatric patients aged 5–18 years with a confirmed history of COVID-19. The research was conducted in January – June 2024. The prognostic factors analyzed included clinical classification of COVID-19, gender, age, comorbidities, history of ventilator use, and history of hospitalization. Result. There were 100 subjects who met the inclusion and exclusion criteria in the study. The distribution of child COVID-19 survivors was 53% female, 52% aged ≥ 12 - 18 years, 76% had at least 1 comorbidity, with the most common types of comorbidities being obesity (27%), undernourished (19%) and chronic kidney disease (16%). The majority (73%) had a history of confirmed mild COVID-19 and more than half of the total subjects (78%) were not hospitalized when confirmed with COVID-19. The prevalence of impaired lung function in children after COVID-19 was 47%, dominated by restrictive lung pattern. The prevalence of long COVID was 18% with persistent symptoms such as fatigue (13%), cough (11%), shortness of breath (8%), runny nose (1%), bone pain (1%), and hyposmia (1%). Persistent symptom is significantly associated with abnormal spirometry result (p = 0.03, RR 1.99; 95% CI 1 .38 – 2.87). From multivariate analysis with logistic regression, undernourished status and moderate-severe-critical COVID-19 significantly influence long-term respiratory function in pediatric patients after COVID- 19 with p value = 0.002, aOR 5.64; CI 95% 1.89 – 16.85 and p = 0.006, aOR 5.18; IK 95% 1 .59 – 16.89, respectively. Conclusion. Persistent symptoms, undernourished status and moderate-severe-critical clinical classification of COVID-19 are the prognostic factors for poor long term respiratory function in post-COVID-19 pediatric patients.
Keywords: pediatric, COVID-19, lung function, long COVID