Hubungan penyakit komorbiditas terhadap derajat klinis COVID-19
Authors: Karya Kadek Wisnu Segara , Suwidnya I Made , Wijaya Beny Surya 
Published: February 2022

Pendahuluan: Coronavirus Disease 2019 (COVID-19) adalah penyakit infeksi virus yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Komorbiditas merupakan faktor risiko keparahan dan mortalitas pada pasien COVID-19. Tingginya prevalensi COVID-19 disertai dengan variasi klinis yang luas mengindikasikan bahwa telaah prediktor derajat klinis COVID-19 sangat diperlukanMetode: Penelitian analitik potong lintang dilakukan di Rumah Sakit Bhayangkara Denpasar. Data demografi dan klinis pasien rawat inap usia usia ?18 tahun dengan COVID-19 dikumpulkan pada periode Agustus 2020-Januari 2021 dengan metode Total Sampling. Kriteria inklusi meliputi pasien usia ?18 tahun yang menjalani rawat inap dengan diagnosis COVID-19 yang terkonfirmasi dengan pemeriksaan RT-PCR SARS-CoV-2. Sampel dikategorikan menjadi derajat berat-kritis dan sedang. Analisis data dilakukan secara deskriptif dan analitikHasil: Terdapat 153 pasien COVID-19 dengan rerata usia 47±15 tahun dan mayoritas laki-laki (60%). Sebagian besar pasien mengalami gejala sedang (77,1%). Gejala utama meliputi demam (71,9%), sesak (16,3%) dan batuk (7,2%). Sebagian pasien memiliki komorbiditas (42,8%). Komorbiditas yang ada paling banyak ditemukan adalah hipertensi (21,6%) dan diabetes melitus (17,6%), diikuti dengan gagal ginjal kronis (5,9%) dan penyakit jantung (4,6%). Sebagian besar pasien (71,9%) menunjukkan hasil bacaan x-ray thorax normal. Mayoritas pasien tidak dirujuk (86,3%) dengan median lama rawat inap 12,5 hari. Hanya 2% pasien yang meninggal. Hasil analisis bivariat menunjukkan pasien dengan usia >50 tahun, adanya komorbid dan gambaran x-ray thorax abnormal berhubungan dengan derajat berat-kritis. Komorbiditas hipertensi, diabetes melitus dan gagal ginjal kronik yang masing-masing berhubungan dengan derajat klinis COVID-19 berat-kritis. Pada analisis multivariat hanya gambaran x-ray thorax abnormal dan adanya penyakit komorbiditas yang berhubungan dengan derajat klinis COVID-19 berat-kritis.Simpulan: Adanya penyakit komorbid hipertensi, diabetes melitus, penyakit ginjal kronis disertai gambaran x-ray thoraks abnormal merupakan faktor prediktor infeksi COVID-19 derajat berat-kritis.  Introduction: Coronavirus Disease 2019 (COVID-19) is a viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Comorbidity is a risk factor for severity and mortality in COVID-19. The high prevalence of COVID-19 accompanied by a wide clinical variation makes determining the predictors of COVID-19 clinical severity an important endeavor.Methods: A cross-sectional study was conducted at Bhayangkara Hospital Denpasar. Demographic and clinical data of inpatients aged 18 years with COVID-19 were collected from August 2020-January 2021 with the total sampling method. Inclusion criteria included 18 years of age hospitalized with a confirmed COVID-19 diagnosis by SARS-CoV-2 RT-PCR examination. The samples were categorized into severe-critical and moderate infection. Data was analyzed in both descriptive and analytics manner.Results: There were 153 COVID-19 patients with an average age of 47±15 years, and the majority were male (60%). Most experienced moderate symptoms (77.1%). The main symptoms included fever (71.9%), shortness of breath (16.3%) and cough (7.2%). Almost half had comorbidities (42.8%). The most common were hypertension (21.6%) and diabetes mellitus (17.6%), followed by chronic kidney disease (5.9%) and heart disease (4.6%). Most of the patients (71.9%) had a normal chest x-ray. Most patients did not need a referral (86.3%) and were treated with a median length of stay of 12.5 days. The mortality rate was 2%. The results of bivariate analysis showed that patients aged >50 years, comorbidities and abnormal chest x-rays were associated with severe infection. Comorbidities of hypertension, diabetes mellitus and chronic kidney disease were associated with severe-critical infection. In the multivariate analysis, only abnormal chest x-ray images and the presence of comorbid diseases were associated with the clinical degree of severe-critical COVID-19.Conclusion: The presence of comorbid hypertension, diabetes mellitus, chronic disease accompanied by an abnormal chest x-ray was a predictor of severe-critical COVID-19 infection.