Karakteristik dan Keluaran Pasien COVID-19 dengan DM di RS Umum Pusat Dr. Kariadi (Tinjauan pasien periode Maret-Juli 2020)
Authors: Minuljo Tania Tedjo , Anindita Yohana Prima Ceria , Seno Heri Nugroho Hario , Pemayun Tjokorda Gde Dalem , Sofro Muchlis Achsan Udji 
Published: August 2020

Pendahuluan

Jawa Tengah merupakan propinsi dengan kasus COVID-19 terbanyak ke-4 di Indonesia (lebih dari 8.000 kasus). RS Umum Pusat Dr. Kariadi (RSDK) sebagai RS rujukan memiliki 436 kasus terkonfirmasi COVID-19 per 10 Juli 2020. Diabetes mellitus (DM) diketahui menurunkan sistem imun dan memperburuk reaksi inflamasi. Karakteristik dan keluaran pasien COVID-19 dengan DM di RSDK belum pernah dilaporkan sebelumnya.

Metode

Data dari rekam medis RSDK. Diagnosis DM: riwayat DM dan/atau GDS >200 mg/dL atau HbA1c >7%. Diagnosis COVID-19: PCR usapan nasofaring-orofaring positif. Karakteristik dasar: usia, jenis kelamin, keluhan, riwayat kontak, riwayat perjalanan, jenis dan tempat perawatan, lama perawatan, komorbid, serta terapi DM. Pemeriksaan penunjang: GDS, HbA1c, kreatinin, saturasi O2, C-reactive protein (CRP), proklasitonin, D-dimer, dan fibrinogen dikelompokkan berdasarkan keluaran (hidup vs. mati); dilakukan uji beda. Analisis dengan SPSS v.24 (IBM, New York, USA).

Hasil

Pasien COVID-19 dengan DM periode Maret-10 Juli 2020 sebanyak 42 dari total 436 kasus (9,63%). Pria lebih banyak (59,5%). Kasus terbanyak usia >50 tahun (64,3%). Batuk, demam, dan sesak nafas adalah keluhan tersering. Mayoritas pasien menyangkal riwayat kontak ataupun bepergian (>75%). Hampir separuh perlu perawatan intensif sejak awal (40,5%). Komorbid terbanyak hipertensi. Separuh kasus mendapat insulin. Persentase kematian 42,9% (18 dari 42). Rerata kendali glikemik (HbA1c 9,7%) dan saturasi O2 (Sat O2 90%) buruk. Rerata penanda gangguan koagulasi (D-dimer, fibrinogen) dan inflamasi akut (CRP, prokalsitonin) meningkat, berturut-turut 3937,4 ng/mL; 496,1 mg/dL; 16,6 mg/L; 12 ng/mL. Tidak ada beda bermakna antara kelompok hidup dan mati.

Kesimpulan

Mortalitas dan morbiditas COVID-19 sangat tinggi pada DM. Hampir seluruh pasien mengalami gangguan koagulasi dan inflamasi akut.

Kata kunci: COVID-19, DM, RS Kariadi

 

Introduction

Central Java province has the 4th largest cases of COVID-19 in Indonesia with more than 8.000 cases. Dr. Kariadi General Hospital (RSDK) is one of the referral hospital with 436 confirmed cases of COVID-19 until July 10th 2020. Diabetes mellitus (DM) known to decreases the immune system and worsens the inflammatory reaction. The characteristics and outcomes of patients with COVID-19 and DM in the RSDK have not been reported yet.

Method

Data were taken from the RSDK medical record. Diagnosis of DM: history of diabetes and/or RBG >200 mg/dL or HbA1c >7%. Diagnosis of COVID-19 infection: positive PCR from nasopharyngeal-oropharyngeal smear. Baseline characteristics: age, sex, chief complaints, contact and travel history, type and place of care, duration of treatment, comorbidity, and diabetes treatment options. Laboratory result: RBG, HbA1c, creatinine, O2 saturation, C-reactive protein (CRP), proclasitonin, D-dimers, and fibrinogen were grouped according to patient output (life vs. death) and different tests was performed. Data analysis was performed with SPSS v.24 (IBM, New York, USA).

Result

The number of patients with COVID-19 and DM was 42 out of 436 cases (9.63%). Men was more prevalent (59.5%). Most cases were >50 years of age (64.3%). Cough, fever, and shortness of breath were the most prevalent chief complaints. The majority of patients denied contact or travel history (>75%). Nearly half of the cases needed intensive care (40.5%) at arrival. Hypertension was the no.1 comorbid. Half cases received insulin therapy. Percentage of death was 42.9% (18 out of 42). Average of glycemic control (HbA1c 9.7%) and O2 saturation (Sat O2 90%) were poor. Coagulation (D-dimer, fibrinogen) and acute inflammatory (CRP, procalsitonin) markers were increased, respectively 3937.4 ng/mL; 496.1 mg/dL; 16.6 mg/L; 12 ng/mL. There was no significant difference between the life and death groups.

Conclusion

Mortality and morbidity of patients with COVID-19 and DM was very high. Almost all patients suffered from disseminated intravascular coagulation (DIC) and severe acute inflammation.

Key words: COVID-19, DM, Kariadi Hospital