Tesis

Leptin dan Skor Mortalitas 4C sebagai Prediktor Luaran Buruk Pasien COVID 19 Terkonfirmasi Selama Perawatan = Leptin and 4C Mortality Score as Predictors of Poor Outcomes in Confirmed COVID 19 Patients.

Latar belakang: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) adalah virus menyebabkan infeksi saluran pernafasan dan memiliki manifestasi klinis ringan sampai berat serta dapat menyebabkan kematian. Tingginya angka morbiditas dan mortalitas akibat infeksi COVID 19 menyebabkan diperlukannya stratifikasi resiko terhadap pasien saat masuk ke rumah sakit serta prediktor terjadinya luaran buruk pada pasien. Tujuan: Mengetahui kemampuan skor mortalitas 4C dan kadar leptin dalam memprediksi luaran buruk pasien COVID 19 terkonfirmasi selama perawatan Metode: Penelitian ini merupakan kohort prospektif dari 375 pasien COVID-19 yang dirawat di RSUPN Cipto Mangunkusumo sejak November 2020 hingga April 2021. Pasien dilakukan pemeriksaan fisik, CRP, Ureum serta pemeriksaan kadar leptin saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan skor mortalitas 4C dan leptin untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas. Analisis korelasi dan regresi linier dengan STATA 15. Hasil: Dari analisis data pada 375 pasien didapatkan skor mortalitas 4C dapat memprediksi luaran buruk pasien COVID 19 selama rawat inap dengan area under curve (AUC) 0,68 (IK 0,61-0,75) dan titik potong skor mortalitas 4C adalah 6. Dari analisis multivariat didapatkan leptin tidak dapat memprediksi luaran buruk pasien COVID 19 selama rawat inap dengan area under curve (AUC) 0,52 (IK 0,44-0,60) Kesimpulan: Skor mortalitas 4C mampu memprediksi luaran buruk pasien COVID 19 terkonfirmasi selama perawatan sedangkan leptin tidak mampu menjadi prediktor luaran buruk pasien COVID 19 selama perawatan.
Kata kunci: COVID 19, skor mortalitas 4C, leptin, ARDS.


Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is a virus that causes respiratory tract infections and have many clinical manifestations and can cause death. The high morbidity and mortality rates due to COVID 19 infection require risk stratification for patients when admitted to hospital as well as predictors of poor patient outcomes. Objective: To determine the ability of the 4C mortality score and leptin levels in predicting poor outcomes in confirmed COVID 19 patients during treatment. Method: This study is a prospective cohort of 375 COVID-19 patients treated at RSUPN Cipto Mangunkusumo from November 2020 to April 2021. Patients underwent physical examinations, CRP, urea and leptin levels during admission. Multivariate logistic regression analysis was performed to assess the ability of the 4C mortality score and leptin to predict composite adverse outcomes including ARDS and mortality. Correlation and linear regression analysis with STATA 15. Results: Out of 375 patient, it was found that the 4C mortality score could predict poor outcomes for COVID 19 patients during hospitalization with an AUC of 0.68 (CI 0.61 -0.75) and the cut point for the 4C mortality score was 6. From multivariate analysis, it was found that leptin could not predict poor outcomes for COVID 19 patients during hospitalization with an area under curve (AUC) of 0.52 (CI 0.44-0.60). Conclusion: The 4C mortality score is able to predict poor outcomes for confirmed COVID 19 patients during treatment, while leptin is not able to predict poor outcomes for COVID 19 patients during treatment.
Keywords: COVID-19, 4C mortality score, leptin, ARDS