Penelitian covid rssm suyoso

PNI (prognostic nutritional index)

Dummy table

Table 1 karakteristik subyek berdasarkan tingkat keparahan

Total Non berat Berat

Subyek P value
(n=155) (n=86 ) (n= 69)
Data klinis
Umur (M ± SD) tahun 0.47±0.5 56.23±13.1 0.844
>= 60 tahun 71 48.37±6.7 44.5±5.9 0.649
< 60 tahun 84 68± 9.4 68.25±13 0.380
Jenis kelamin (%)
Laki-laki (%) 85 45(52.3) 40(57.9)
0.483
Perempuan (%) 70 41 (47.6) 29(42.02)
Status gizi baik (%)
Komorbid
Diabetes Melitus tipe 2
Tidak 102 55 47
0.587
Ya 53 31(36) 22(31.8)
Obesitas
Tidak 153 84 69
0.202
Ya 2 2(2.3) 0
PJK atau gagal jantung
Tidak 70 60
0.350
Ya 25 16 (18.6) 9 (13.04)
Kelainan ginjal
Tidak 82 60
0.061
Ya 13 4 (4.65) 9 (13.04)
Kelainan liver
Tidak 84 69
0.202
Ya 2 2 (2.32) 0
Lain lain (kanker,
 dislipiedmia, hipertensi,
autoimun dll)
Hepatitis

Laboratorium (M ± SD)
Hb (g/dl) 13.5 ± 2.09 13.1 ± 2.49 0.258
Leukosit (x 109/L) 9.36 ± 4.19 9.47 ± 5.1 0.890
Platelet/Trombosit (x 109/L) 243 ± 94.15 272 ± 137.48 0.119
Neutrophil (x 109/L) 7.26 ± 3.99 7.39 ± 4.76 0.857
Limfosit (x 109/L) 1.26 ± 0.85 1.37 ± 0.94 0.471
Monosit (x 109/L) 0.72 ± 0.57 0.61 ± 0.32 0.136
NLR (M + SD) 7.41 ± 5.71 7.99± 11.26 0.674
dNLR (M + SD) 4.13 ± 2.95 4.23 ± 3.27 0.834
LMR (M + SD) 2.21 ± 1.73 2.49 ± 1.30 0.261
PLR (M + SD) 234 ± 143.15 256 ± 198,22 0.414
1267.97 ±
ALC/TLC (M + SD) 1373.30 ±949.40 0.468
850.67

Laboratoritum Fungsi Liver

ALT / SGPT (U/L) 52.37 ± 110.85 42.38 ± 40.19 0.478
AST / SGOT (U/L) 53.05 ± 49.75 48.65 ± 30.32 0.521
Albumin (g/L) 3.64 ± 0.66 3.65 ± 0.74 0.883
PNI (M + SD) 36.4 ± 6.68 36.59 ± 7.45 0.882

Laboratorium fungsi
koagulasi
(M ± SD)
Prothrombin time
(normal range 11.5–14.5)
Activated partial
thromboplastin time
(normal range 29.0–42.0)
International normalized ratio
(normal range 0.80–1.20)
D-Dimer
3.04 ± 3.59 2.33 ± 2.73 0.180
(μg/ml; normal range 0.0–0.5)

Laboratorium lain
CRP (mg/L) (M + SD)
BUN (mg/dL) 20.64 ± 15.74 30.58 ± 38.47 0.032
Creatinin (mg/dL) 1.48 ± 1.84 2.51 ± 4.01 0.037
Asam urat (mg/dL)

Terapi
Heparin 96 51 (59.3) 45 (65.2) 0.451
Enoxaparin (Lovenox) 33 19 (22.09) 14 (20.2) 0.785
Fondaparinux (Arixtra) 30 16 (18.6) 14 (20.2) 0.792

Luaran
Kematian 46 30 (34.8) 16 (23.1)
0.155
Sembuh 102 51 (59.3) 51 (73.9)
Lama perawatan 10.63 ± 6.01 12.57 ± 6.86 0.063
Pertanyaan penelitian

Predictive Value of Prognostic Nutritional Index on COVID-19 Severity and outcome ? 1

Background: The prognostic nutritional index (PNI) has been described as a simple
risk-stratified tool for several diseases. We explored the predictive role of the PNI on
coronavirus disease 2019 (COVID-19) severity.
Methods: A total of 101 patients with COVID-19 were included in this retrospective
study from January 2020 to March 2020. They were divided into two groups according to
COVID-19 severity: non-critical (n=56) and critical (n=45). The PNI was calculated upon
hospital admission: 10×serumalbumin (g/dL)+0.005×total lymphocyte count (/mm3).
Critical COVID-19 was defined as having one of the following features: respiratory failure
necessitating mechanical ventilation; shock; organ dysfunction necessitating admission
to the intensive care unit (ICU). The correlation between the PNI with COVID-19 severity
was analyzed.
Results: The PNI was significantly lower in critically ill than that in non-critically ill patients
(P <0.001). The receiver operating characteristic curve indicated that the PNI was a good
discrimination factor for identifying COVID-19 severity (P < 0.001). Multivariate logistic
regression analysis showed the PNI to be an independent risk factor for critical illness
due to COVID-19 (P = 0.002).
Conclusions: The PNI is a valuable biomarker that could be used to discriminate
COVID-19 severity.

Pertanyaan penelitian kedua

D-dimer level is associated with the severity of COVID-19. 2

Introduction: Abnormal coagulation function has been demonstrated to be involved in the disease
progression of COVID-19. However, the association between D-dimer levels and the severity of COVID-
19 is not clear. The study was aimed to investigate the association between D-dimer levels and the
severity of COVID-19 based on a cohort study and meta-analysis.
Materials and methods: Demographic and clinical data of all confirmed cases with COVID-19 on
admission to Tongji Hospital from January 27 to March 5, 2020, were collected and analyzed, and
coagulation function parameters were described and compared between patients with severe infection
and those with non-severe infection. Cohort studies reporting risk estimates for the D-dimer and
severity of COVID-19 association were searched and included to perform a meta-analysis.
Results: In our cohort study, patients with severe disease were more likely to exhibit dysregulated
coagulation function, and a significantly higher D-dimer level (median 1.8 μg/ml [interquartile range 0.9–
4.6] vs 0.5 [0.3–1.1], p < 0.001) was found in severe cases than the mild ones, on admission. In the meta-
analysis of 13 cohort studies (including the current study), patients with severe disease had an increase
in mean D-dimer value by 0.91 (95% confidence interval, 0.51–1.31, p < 0.001) μg/ml compared to those
with non-severe disease, and odds of severe infection was associated with D-dimer greater than 0.5
μg/ml (odds ratio = 5.78, 95% confidence interval, 2.16–15.44, p < 0.001) on admission.
Conclusions: Patients with severe COVID-19 have a higher level of D-dimer than those with non-severe
disease, and D-dimer greater than 0.5 μg/ml is associated with severe infection in patients with COVID-
19.
Pertanyaan penelitian ketiga

The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients 3

Aim: To accumulate evidence that indicated the key role played by virus-triggered inflammation in the
2019- novel coronavirus disease (COVID-19) which emerged in Wuhan City and rapidly spread
throughout China.
Methods: Age, neutrophil(NEU)-to-lymphocyte (LYM) ratio (NLR), lymphocyte-to-monocyte (MON) ratio,
platelet- to-lymphocyte ratio (PLR), and C-reactive protein (CRP) of 93 patients with laboratory
confirmed COVID-19 were investigated and compared. The receiver operating characteristic curve was
applied to determine the thresholds for five bio-markers, and their prognostic values were assessed via
the Kaplan–Meier curve and multivariate COX regression models.
Results: The median age was 46.4 years old, and 37cases were females. A total of 27.8% of patients had
been to Wuhan, and 73.1% had contacted with people from Wuhan. Fever (83.8%) and cough (70.9%)
were the two most common symptoms. Elevated NLR and age were significantly associated with illness
severity. The binary logistic analysis identified elevated NLR (hazard risk [HR] 2.46, 95% confidence
interval [CI] 1.98–4.57) and age (HR 2.52, 95% CI 1.65–4.83) as independent factors for poor clinical
outcome of COVID-19. NLR exhibited the largest area under the curve at 0.841, with the highest
specificity (63.6%) and sensitivity (88%).
Conclusions: Elevated age and NLR can be considered independent biomarkers for indicating poor
clinical outcomes

Pertanyaan penelitian keempat

C-REACTIVE PROTEIN AS AN EARLY PREDICTOR OF COVID-19 SEVERITY 4

Background: Data for predicting severity of patients with COVID-19 infection are sparse and still under
investigation. We retrospectively studied whether the admission serum C-reactive protein level (CRP)
can serve as nearly predictor of disease severity during COVID-19 infection in comparison with other
hematologic and inflammatory markers.
Methods: We included all consecutive patients who were admitted in Cheikh Khalifa International
University Hospital, Casablanca, Morocco, between February to April 2020, with a confirmed diagnosis
of COVID-19 infection using SARS-CoV-2 viral nucleic acid via RT-PCR. The complete blood count and
serum CRP level were routinely measured on admission. All clinical and laboratory data of patients were
collected and analyzed. The classification of the disease severity was in accordance with the clinical
classification of the WHO interim guidance, and the management of patients were adapted to the
national management guideline. We estimated receiver operating characteristic (ROC) curves of blood
routine parameters as well as their association with COVID-19 disease severity.
Results: 145 COVID-19 patients were included in the study. The median age (range) was 50 (32–63)
years, and 75 (51.7%) were men. 101 patients were classified in the non-severe group and 44 patients in
the severe group. Based on disease severity, significant differences were observed in the age, gender,
comorbidities, and respiratory symptom. Similarly, the biological analysis found significant differences
for the neutrophil count, lymphocyte count, eosinophil count, and CRP level. However, according to
ROC curves of these laboratory biomarkers, the AUC of CRP at 0.872 was significantly higher than all
other parameters. Further, CRP was independently associated with severity of COVID-19 disease (OR =
1.11, 95% IC (1.01–1.22) and OR = 1.13, 95% IC (1.04–1.23)).
Conclusions: This study found that the CRP level at admission represent a simple and independent
factor that can be useful for early detection of severity during COVID-19 and the easy guidance of
primary care