Tesis

Pengaruh D dimer terhadap kesintasan pasien COVID-19 yang menjalani perawatan di RS Cipto Mangunkusumo = The Effect of D Dimer on COVID-19 patient survival in Cipto Mangunkusumo Hospital.

Latar Belakang Infeksi COVID-19 disebabkan oleh virus SARS-CoV-2. Infeksi ini pertama kali terjadi di tahun 2019 kemudian menjadi pandemi pada tahun 2020. Patofisiologi utama COVID-19 adalah imunologi trombosis. Trombosis mempunyai peranan penting dalam perburukan kondisi pasien COVID-19. D-dimer merupakan salah satu penanda yang spesifik terjadinya trombosis Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh D-dimer terhadap kesintasan pasien COVID-19 Metode: Desain penelitian menggunakan kohort retrospektif. Subyek penelitian adalah pasien COVID-19 yang dirawat inap di Kiara RS Cipto Mangunkusumo antara tahun 2020-2022. Kriteria inklusi usia lebih dari 18 tahun, dirawat inap, dan tidak menggunakan ventilator. Analisis yang digunakan adalah analisis Kaplan-Meier dengan HR (IK95%), untuk variabel perancu menggunakan multivariat Cox regression. Hasil: Sebanyak 130 subjek memenuhi kriteria inklusi. Subjek yang berusia lanjut sebanyak 33,08%. Pasien laki-laki sebanyak 63,85%. Kesintasan subjek dengan kadar D-dimer tinggi ( > 1250 ng/mL) lebih rendah daripada subjek dengan kadar Ddimer rendah ( < 1250 ng/mL) 24 hari dengan 27 hari. Hazard ratio D-dimer tinggi terhadap mortalitas adalah sebesar 3,55 (IK95%, 1,3-9,6). Sedangkan Hazard ratio D-dimer > 1250 µg/L terhadap kebutuhan ventilator adalah sebesar 2,949 (IK95% 0,96-9,01). Analisis multivariat didapatkan obesitas merupakan variabel perancu dalam hubungan D-dimer terhadap perburukan klinis. Simpulan: Hazard ratio D-dimer tinggi terhadap mortalitas adalah sebesar 3,55 (IK95%, 1,3- 9,6). Analisis multivariat didapatkan obesitas merupakan variabel perancu dalam hubungan D-dimer terhadap perburukan klinis
Kata kunci: COVID-19, D-dimer, kesintasan


Background: COVID-19 infection is caused by SARS-CoV-2. This viral respiratory infection was found for first time in 2019, then becoming pandemic in 2020. The main pathophysiology of COVID-19 is immunothrombosis. Thrombosis has important role in clinical deterioration. As we know, D-dimer is spesific marker in thrombosis. Objective: The aim of this study is to find the effect of D-dimer in COVID-19 patients survival. Methods: The study was cohort retrospective. The subject were COVID-19 patient treated in Kiara, Cipto Mangunkusumo Hospital between 2020 until 2022. The inclusion criteria is patient’s age >18 years old, hospitalized, and not using ventilator. The statistical analysis was using Kaplan-Meier with Hazard Ratio and Cox regression for confounding factors. Results: As many as 13 subject meet inclusion criteria. Older patient was 33.08%. Obesity was found in 75 patients and become confounding factor. Other comorbidities were diabetes mellitus (6.92%), cardiovascular disease (6.92%), chronic kidney disease (8.46%), and hypertension (41.41%). Twenty two subject had clinical deterioration.The mean survival COVID-19 patients is 26 days. The survival of patients with D-dimer > 1250 ng/mL were lower than patients with D-dimer < 1250 ng/mL (24 days vs 27 days). Hazard ratio high D-dimer was 3.55 (CI95%, 1.3-9.6). Other result, Hazard ratio of high D-dimer and ventilator was 2.949 (CI95% 0.96- 9.01). Multivariate analysis showed obesity is confounding factor of D-dimer and clinical deterioration. Conclusions: The survival of COVID-19 patients with high D-dimer is lower than patients with lower D-dimer (D-dimer > 1250 ng/mL vs D–dimer < 1250 ng/mL was 24 days vs 27 days). Hazard ratio high D-dimer was 3.55 (CI95% 1.3-9.6). Hazard ratio Ddimer > 1250 ng/mL was 2.949 (CI95% 0.96-9.01). Multivariate analysis showed obesity as confounding factor.
Key words: COVID-19, D-dimer, survival