Tesis

Korelasi Perubahan Kadar Soluble Angiotensin Converting Enzyme 2 (sACE2) Terhadap Perubahan Tekanan Darah dan Estimasi Laju Fitrasi Glomerulus dalam Satu Tahun Pasca COVID-19 = Correlation of Changes in Soluble Angiotensin Converting Enzyme 2 (sACE2) Levels with Changes in Blood Pressure and Estimated Glomerular Fitration Rates in One Year After COVID-19.

Latar Belakang : Dampak kerusakan ginjal akibat Corona Virus Disease 2019 (COVID-19) tidak hanya terjadi pada fase akut namun dapat berlanjut sampai tahap pasca COVID-19, yang ditandai dengan adanya penurunan Estimasi Laju Filtrasi Glomerulus (eLFG) dan peningkatan tekanan darah. Angiotensin Converting Enzyme 2 (ACE2) memiliki peran penting dalam disregulasi Renin Angiotensin System (RAS) yang merupakan salah satu penyebab kerusakan ginjal akibat COVID-19. Tujuan : Mengetahui korelasi perubahan kadar sACE2 dengan perubahan tekanan darah dan eLFG dalam satu tahun pasca COVID-19 dan mengetahui hubungan tren kadar sACE2 dengan tren tekanan darah dan eLFG dalam satu tahun pasca COVID-19. Metode : studi analitik dengan desain kohort retrospektif terhadap 79 pasien COVID-19 yang di rawat di ruang isolasi COVID- 19 RSCM dan kontrol tiga bulan dan satu tahun pasca COVID-19 (Desember 2020-Desember 2021 ). Uji korelasi dilakukan untuk untuk menilai hubungan perubahan kadar sACE2 terhadap perubahan tekanan darah dan eLFG dalam 1 tahun pasca COVID-19. Regresi linier dilakukan untuk menilai variabel perancu terhadap hubungan tersebut. Hasil: Pada penelitian ini didapatkan peningkatan tekanan darah dan eLFG 1 tahun pasca COVID-19 dan penurunan kadar sACE2 1 tahun pasca COVID-19. Tidak didapatkan korelasi antara perubahan sACE2 dengan perubahan tekanan darah dan eLFG dalam 1 tahun pasca COVID-19. Namun pada subgrup subjek hipertensi didapatkan korelasi positif pada perubahan sACE2 terhadap perubahan tekanan darah sistolik antara saat rawat inap dengan tiga bulan pasca COVID-19 (r=0,444; p=0,012) dan korelasi negatif pada perubahan sACE2 terhadap perubahan eLFG antara saat rawat inap dengan tiga bulan pasca COVID-19 (r= -0,379; p=0,036). Pada subgrup dengan subjek yang menggunakan terapi ACEi/ARB didapatkan korelasi positif pada perubahan sACE2 terhadap perubahan tekanan darah sistolik (r=0,494; p=0,037), diastolik (r=0,488; p=0,040), MAP (r=0,472; p=0,048) antara saat rawat inap dengan tiga bulan pasca COVID-19 dan korelasi negatif pada perubahan sACE2 terhadap perubahan eLFG antara saat rawat inap dengan tiga bulan pasca COVID-19 (r= -0,522; p=0,026). Simpulan : Tidak didapatkan korelasi antara perubahan sACE2 dengan perubahan tekanan darah dan eLFG dalam 1 tahun pasca COVID-19. Tidak didapatkan hubungan antara tren kadar sACE2 dengan tren tekanan darah dan eLFG dalam 1 tahun pasca COVID-19. Didapatkan peningkatan tekanan darah dan eLFG 1 tahun pasca COVID-19 dan penurunan kadar sACE2 1 tahun pasca COVID-19
Kata kunci : COVID-19, Estimasi Laju Filtrasi Glomerulus, Soluble Angiotensin Converting Enzyme 2, Tekanan darah.


Background: The impact of kidney damage due to Coronavirus Disease 2019 (COVID-19) not only occurs in the acute phase but can persist into the postCOVID-19 stage, marked by a decrease in Estimated Glomerular Filtration Rate (eGFR) and an increase in blood pressure. Angiotensin-Converting Enzyme 2 (ACE2) plays a key role in the dysregulation of the Renin-Angiotensin System (RAS), which is one of the causes of kidney damage in COVID-19. Objective: To determine the correlation of changes in sACE2 levels with changes in blood pressure and eGFR in one year after COVID-19 and to determine the relationship between trends in sACE2 levels with trends in blood pressure and eGFR in one year after COVID-19. Methods: Analytical study using a retrospective cohort design of 79 COVID-19 patients who were treated in the COVID-19 isolation room of RSCM and control three months and one year after COVID-19 (December 2020-December 2021 ). Correlation tests were conducted to assess the relationship between changes in sACE2 levels to changes in blood pressure and eGFR in 1 year after COVID-19. Linear regression was performed to assess confounding variables on the relationship. Results: This study found increased blood pressure and eGFR 1 year after COVID-19 and decreased sACE2 levels 1 year after COVID-19. There was no correlation between changes in sACE2 with changes in blood pressure and eGFR in 1 year after COVID-19. However, in the subgroup of hypertensive subjects, there was a positive correlation between changes in sACE2 and changes in systolic blood pressure between hospitalization and three months after COVID-19 (r=0.444; p=0.012) and negative correlation between changes in sACE2 and changes in eGFR between hospitalization and three months after COVID-19 (r= -0.379; p=0.036). In the subgroup with subjects using ACEi/ARB therapy, there was positive correlation in changes in sACE2 to changes in systolic blood pressure (r=0.494; p=0.037), diastolic (r=0.488; p=0.040), MAP (r=0.472; p=0.048) between hospitalization and three months after COVID-19 and negative correlation in changes in sACE2 to changes in eGFR between hospitalization and three months after COVID-19 (r= -0.522; p=0.026). Conclusion: There was no correlation between changes in sACE2 with changes in blood pressure and eGFR in 1 year after COVID-19. There was no association between the trend of sACE2 levels with the trend of blood pressure and eGFR in 1 year after COVID-19. There was an increase in blood pressure and eGFR 1 year after COVID-19 and a decrease in sACE2 levels 1 year after COVID-19.
Keywords: Blood pressure, COVID-19, Estimated Glomerular Filtration Rate, Soluble Angiotensin Converting Enzyme 2.