The Differences in INR and D-dimer on Mortality of COVID-19 Patients at RSUD Dr. Saiful Anwar Malang
DOI:
https://doi.org/10.11594/jk-risk.03.2.2Keywords:
COVID-19, time of death, comorbidities, platelets, PT, APTT, INR, D-dimer, ferritin, fibrinogen, time of death, comorbidities, platelets, PT, APTT, INR, D-dimer, ferritin, fibrinogenAbstract
Abstrak
Pendahuluan: Pada Juli 2022, COVID-19 menginfeksi 565 juta orang, dengan 6,3 juta kasus kematian di seluruh dunia. Hubungan parameter laboratorium dengan waktu kematian dan komorbiditas belum banyak diteliti. Studi ini untuk mengetahui perbedaan INR dan D-dimer terhadap mortalitas pasien COVID-19 di RSUD Dr Saiful Anwar Malang.
Metode: Studi kohort retrospektif dilakukan pada April 2020-September 2021, total 229 subjek COVID-19 terdiagnosis swab PCR. Analisis data berupa waktu kematian sejak masuk rumah sakit terbagi menjadi <7 hari dan >7 hari, data laboratorium, data komorbiditas dan tanpa komorbiditas. Uji data dengan Chi Square untuk data kategorik, serta Mann-Whitney, dan Kruskall Wallis untuk data numerik.
Hasil: Pada subjek tanpa komorbiditas, kadar D-Dimer signifikan lebih tinggi pada subjek dengan waktu kematian >7 hari dibanding <7 hari. Pada subjek dengan waktu kematian <7 hari, kadar PT dan INR signifikan lebih tinggi pada subjek dengan komorbiditas dibanding tanpa komorbiditas. Pada subjek dengan waktu kematian >7 hari, kadar D-Dimer dan feritin signifikan lebih rendah pada subjek dengan komorbiditas dibanding tanpa komorbiditas. Secara keseluruhan, kadar INR ditemukan signifikan lebih tinggi pada subjek dengan komorbiditas dibanding subjek tanpa komorbiditas (p<0.05).
Pembahasan: Pada tahap awal COVID-19, dapat terjadi hiperfibrinolisis lokal pada parenkim paru, dan hipofibrinolisis sistemik. Hal ini berujung pada peningkatan D-dimer tanpa diikuti pemanjangan parameter perdarahan, hal ini sesuai dengan subjek waktu kematian <7 hari tanpa komorbiditas. Selain itu, terjadi perubahan kondisi hiperkoagulabel menjadi hiperfibrinolisis akibat konsumsi faktor koagulan yang berlebihan, mengakibatkan meningkatnya PT dan INR pada kondisi COVID-19 yang berat.
Kesimpulan: Secara keseluruhan ditemukan bahwa kadar INR signifikan lebih tinggi pada subjek dengan komorbiditas dibanding tanpa komorbiditas, serta D-dimer pada subjek dengan waktu kematian >7 hari tanpa komorbiditas signifikan lebih tinggi dibanding kelompok subjek lain.
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