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"Pendahuluan: Heparin dapat digunakan sebagai terapi bagi pasien COVID-19. Namun, indikasi dan efeknya masih berbeda di berbagai penelitian. Oleh karena itu, penelitian ini bertujuan untuk menilai efektivitas pemberian heparin dalam menurunkan keparahan gejala klinis. Metode :Studi retrospektif dilakukan dari rekam medis pasien COVID-19 kondisi sedang-berat yang dirawat di Rumah Sakit Universitas Indonesia (RSUI). Parameter yang diperiksa adalah kondisi klinis pasien (tingkat mortalitas dan total lama perawatan), kadar D-dimer, dan trombosit pada dua kelompok, kelompok yang diberikan heparin dan yang tidak. Hasil:Penelitian ini menyertakan 110 subjek penelitian. Terdapat tingkat mortalitas yang lebih tinggi pada kelompok heparin dibandingkan kontrol (45,3% vs 5 10,9%; p<0,01). Hal ini dapat disebabkan perbedaan derajat sedang dan berat. Mayoritas kelompok heparin berkondisi berat (58,1% vs 28,2%) jika dibandingkan kontrol. Pada pengecekan laboratorium, heparin menurunkan kadar D-dimer (790 ke 500 vs 725 ke 4.475 µg/L) dan trombosit (366 ke 208x103 vs 217 ke 318x103/µL)secara signifikan (p<0,01). Kesimpulan: Kelompok heparin memiliki tingkat mortalitas yang tinggi akibat tingkat kondisi yang lebih berat, tetapi kadar D-dimer dan trombosit menurun dibandingkan kelompok kontrol.

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Introduction: Heparin can be used as therapy for COVID-19 patients. However, the indications and effects still differ in various studies. Therefore, this study aims to assess the effectiveness of heparin administration in reducing the severity of clinical symptoms. Methods: A retrospective study was conducted from medical records of moderate-severe COVID-19 patients treated at the University of Indonesia Hospital (RSUI). The parameters examined were the patient's clinical condition (mortality rate and total length of treatment), D-dimer levels, and platelets in two groups, those given heparin and those not. Results: This study included 110 research subjects. There was a higher mortality rate in the heparin group compared to controls (45.3% vs 5 10.9%; p<0.01). This is due to the difference in moderate and severe degrees. The majority of the heparin group had severe conditions (58.1% 28.2%) when compared to controls. In laboratory tests, heparin reduced the levels of D-dimer (790 to 500 vs 725 to 4,475 µg/L) and platelets (366 to 208x103 vs 217 to 318x103/µL) significantly (p<0.01). Conclusion: The heparin group had a high mortality rate due to more severe conditions, but D-dimer and platelet levels decreased compared to the control group"

"Latar Belakang: Deep Vein Thrombosis (DVT) merupakan salah satu masalah dengan angka mortalitas jangka pendek dan morbiditas jangka panjang. Sebanyak 60% kasus DVT tidak memiliki gejala. Seiring bertambahnya usia, insiden DVT akan terus meningkat. Sekitar 1 dari 100.000 orang tiap tahunnya akan menderita DVT dibawah usia 50 tahun dan meningkat menjadi 1000 dari 100.000 per tahun di usia 85 tahun. Pada satu pertiga kasus bermanifestasi sebagai emboli paru, sedangkan dua pertiga lainnya hanya sebatas DVT. Terdapat kenaikan kadar fibrinogen maupun d-dimer pada pasien dengan keganasan.Penelitian ini bertujuan menganalisa dan membandingkan kadar fibrinogen, d-dimer dan dosis heparin terapeutik pada pasien DVT dengan keganasan dan non keganasan. Metode: Penelitian ini merupakan kohort retrospektif menggunakan rekam medis di RS Cipto Mangunkusumo. Variabel bebas adalah terapi pada pasien DVT sedangan variabel terikatnya adalah kadar D-dimer, fibrinogen dan aPTT terapeutik. Analisa statistic menggunakan SPSS versi 20, nilai p<0.05 menunjukkan terdapat hubungan bermakna secara statistik. Hasil: 63 pasien masuk dalam penelitian, didapatkan pasien DVT dengan keganasan sebanyak 33 pasien (52,4%) dan pasien DVT non keganasan sebanyak 30 pasien (47,6%). Kadar fibrinogen, D-dimer awal dan akhir pada pasien DVT dengan keganasan memiliki kadar yang lebih tinggi secara bermakna dibandingkan dengan DVT non keganasan (p<0,001). Terdapat perbedaan signifikan pada penurunan D-dimer pasien DVT dengan keganasan dibandingakan dengan pasien DVT non kegananasan. Dosis heparin awal pasien DVT dengan keganasan memiliki nilai tidak bermakna dibandingkan dengan DVT non keganasan (p>0,001). Dosis heparin terapeutik pada pasien DVT dengan keganasan bermakna signifikan lebih tinggi dibandingkan DVT non keganasan (p<0,001). Simpulan: Terdapat perbedaan yang bermakna pada kadar fibrinogen, d-dimer awal dan akhir yang bermakna antara pasien DVT keganasan dengan pasien DVT non keganasan. Terdapat perbedaan yang bermakna pada penurunan D-dimer pasien DVT dengan keganasan dan DVT non keganasan. Ditemukan perbedaan bermakna pada dosis heparin terapeutik pasien DVT dengan keganasan dan DVT non keganasan.

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Background: Deep Vein Thrombosis (DVT) is a problem with short-term mortality and long-term morbidity. As many as 60% of DVT cases have no symptoms. With age, the incidence of DVT will continue to increase. About 1 in 100,000 people each year will suffer from DVT under the age of 50 years and this increases to 1000 from 100,000 per year at the age of 85 years. In one third of cases it manifests as a pulmonary embolism, while in the other two thirds only a DVT is present. There is an increase in the levels of fibrinogen and d-dimer in patients with malignancy. This study aims to analyze and compare the levels of fibrinogen, d-dimer and therapeutic doses of heparin in malignant and non-malignant DVT patients.

Method: This study is a retrospective cohort using medical records at Cipto Mangunkusumo Hospital. The independent variable is therapy in DVT patients while the dependent variable is the level of D-dimer, fibrinogen and therapeutic aPTT. Statistical analysis using SPSS version 20, p value <0.05 indicates that there is a statistically significant relationship.

Results: 63 patients were included in the study, 33 patients with malignant DVT were found (52.4%) and 30 patients with non-malignant DVT (47.6%). The initial levels of fibrinogen in patient with malignant DVT were significantly higher than those of non malignant DVT (p<0.05). The final levels of fibrinogen in patient with malignant DVT were significant higher than those of non malignant DVT (p<0,05).There was significant higher of D-dimer initial levels beetween patient with malignant DVT and patient with non malignant DVT (p<0,05). There was significant higher of D-dimer final levels beetween patient with malignant DVT and patient with non malignant DVT (p<0,05). There was a significant difference in the decrease of d-dimer levels between DVT patients with malignancy compared to non-malignant DVT patients who were given heparin therapy. The initial heparin dose in patients with malignant DVT had no significant value compared to non malignant DVT (p>0.001). The therapeutic dose of heparin in patients with malignant DVT was significantly higher than that of non malignant DVT (p<0.001).

Conclusion: There was a significant difference in the levels of fibrinogen and D- dimer initial and final which was significant between malignant DVT patients and non-malignant DVT patients. There is a significant difference in the decrease in D-dimer in patients with malignant DVT and non-malignant DVT. A significant difference was found in the therapeutic dose of heparin in patients with malignant DVT and non-malignant DVT."

"Penyakit akibat infeksi corona virus jenis baru yang disebut COVID-19 telah diumumkan oleh Badan Kesehatan Dunia (World Health Organization/WHO). Penyakit ini selain utamanya menyerang sistem pernapasan juga menyebabkan komplikasi lain seperti koagulopati. Untuk mencegah koagulopati yang terjadi pasien COVID-19 yang dirawat di rumah sakit diberikan antikoagulan profilakis berupa heparin subkutan. Salah satu respon fisiologi tidak diinginkan yang terjadi akibat pemberian intervensi ini adalah pembentukan hematoma di area penyuntikan. Hal tersebut memberikan tantangan bagi perawat untuk meminimalisir kejadian pembentukan hematoma pasca pemnerian heparin subkutan. Penelitian ini bertujuan untuk melihat apakah penyuntikkan berpindah searah jarum jam heparin subkutan dapat menurunkan insiden hematoma. Paper melaporkan sebuah kasus pada seorang laki-laki 57 tahun pasien positif COVID-19 yang dirawat di ruang rawat inap isolasi COVID-19 dan mendapat terapi heparin secara rutin selama 5 hari. Injeksi dilakukan di tiga area berbeda yaitu lengan kanan, lengan kiri dan perut. Hasil menunjukan tidak ditemukan pembentukan hematoma di tiga area injeksi heparin tersebut.

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The disease caused by infection with a new type of corona virus called COVID-19 has been announced by the World Health Organization (WHO). This disease in addition to primarily attacking the respiratory system also causes other complications such as coagulopathy. To prevent coagulopathy that occurs, patients with COVID-19 who are hospitalized are given prophylactic anticoagulants in the form of subcutaneous heparin. One of the undesirable physiological responses that occur as a result of this intervention is the formation of a hematoma in the injection area. This poses a challenge for nurses to minimize the incidence of hematoma formation after subcutaneous heparin administration. This study aimed to see whether clockwise injection of subcutaneous heparin can reduce the incidence of hematoma. Paper reports a case of a 57-year-old man who was a positive COVID-19 patient who was treated in the COVID-19 isolation ward and received routine heparin therapy for 5 days. The injections are performed in three different areas, namely the right arm, left arm and abdomen. The results showed that no hematoma formation was found in the three heparin injection areas. "

"Latar Belakang: Proses inflamasi dengan respons maladaptif merupakan mekanisme terjadinya disfungsi multiorgan dan kematian pada sepsis. Heparin merupakan sediaan yang digunakan secara luas untuk terapi gangguan koagulasi, secara in-vitro heparin juga memiliki pengaruh sebagai antiinflamasi melalui penurunan aktivitas nuclear factor kappa B (NFkB) dan tumor necrosis factor alpha (TNF-. Penggunan heparin pada sepsis, khususnya sebagai antiinflamasi, masih merupakan kontroversi dan memerlukan penelitian lebih lanjut.Tujuan Penelitian: Tujuan primer penelitian ini adalah mengetahui pengaruh terapi heparin terhadap konsentrasi NFkB, inhibitor kappa B kinase beta (IKK dan TNF-pada pasien sepsis berat Tujuan sekunder adalah menilai pengaruh terapi heparin terhadap mortalitas dan perbaikan disfungsi organ.Metode: Uji klinis acak tersamar ganda membandingkan terapi heparin tidak terfraksinasi, dosis 10 unit/kg berat badan/24 jam, infus kontinu selama 72 jam, dengan plasebo. Kriteria inklusi adalah: subjek usia 18 tahun atau lebih dengan sepsis berat awitan maksimal 48 jam dan bersedia berpartisipasi dalam penelitian. Seleksi subjek dilakukan secara konsekutif dengan alokasi subjek secara acak. Pemantauan terhadap respons klinis dilakukan dengan menilai mortalitas 14 hari serta perbaikan skor APACHE II. Analisis intention to treat (ITT) dilakukan terhadap subjek yang telah mendapat terapi heparin minimal selama 24 jam, pada subjek yang melengkapi seluruh protokol penelitian dilakukan analisis per-protocol (PP).Hasil: Sebanyak 115 subjek telah diinklusi dan dirandomisasi, 58 subjek mendapat heparin dan 57 subjek plasebo. Rentang usia 21 hingga 82 tahun dengan rerata 51 tahun. Analisis ITT dan PP dilakukan terhadap masing-masing 46 dan 22 subjek kelompok heparin dan 50 dan 28 subjek kelompok kontrol. Tidak didapatkan perbedaan yang bermakna konsentrasi NFkBterfosforilasi dan IKK terfosforilasi kelompok heparin dibandingkan kontrol. Didapatkan penurunan konsentrasi TNF-pada kelompok heparin dibandingkan kontrol walaupun secara statistik belum bermakna. Didapatkan penurunan mortalitas pada analisis PP (RR 0,212 [IK 95% 0,053 - 0,815], p = 0,008), dengan ARR 33,8 % dan NNT 3. Terdapat kecenderungan perbaikan disfungsi organ pada kelompok heparin, walaupan secara statistik belum menunjukkan kemaknaan.Simpulan: Terapi heparin memberikan pengaruh terhadap proses inflamasi pada pasien sepsis berat, terlihat dari penurunan konsentrasi TNF-, walaupun pada pengujian statistik tidak didapatkan perbedaan bermakna. Tidak didapatkan pengaruh terapi heparin terhadap penurunan konsentrasi IKKdanNFkB. Heparin memberikan manfaat terhadap penurunan mortalitas, terutama pada subjek yang mendapat heparin selama 72 jam. Pada pengamatan selama 72 jam, heparin belum telihat memberikan pengaruh terhadap perbaikan disfungsi organ.

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Background. Multiple organ dysfunction and mortality in sepsis are developed as the consequence of the inflammation with maladaptive host response. Heparin has been widely used as an anticoagulant treatment. Based on in vitro evaluation, heparin has an antiinflammatory property by reducing the activity of nuclear factor kappa B (NFkB) and tumor necrosis factor alpha (TNF-. However, the effect of heparin as the anti-inflammatory agent is still controversial. To ascertain the anti-inflammatory effects of heparin in sepsis, further study is needed.Objectives. The primary aim of this study was to determine the effect of heparin in severe sepsis based on the concentration of NFkB, Inhibitor kappa B kinase beta (IKK), and TNF-. Secondary objective was to determine the effect of heparin on mortality rate and improvement of organ dysfunction.Methods. A randomized, double-blind, clinical trial was conducted to compare the unfractionated heparin (UFH) treatment, in dosage of 10 units/ kg BW for 24 hours, continuous infusion for 72 hours, in comparison to placebo. The inclusion criteria were subject 18 years old or above, with severe sepsis in maximum 48 hours after onset and agreed to participate in this study. Furthermore, subjects were consecutively selected and randomly allocated. Clinical responses were monitored by evaluating the 14-days mortality rate and improvement of APACHE II score. Subjects who had received heparin treatment for at least 24 hours were analyzed by intention to treat (ITT), while others who had completed all the protocol, were analyzed by per protocol (PP).Results. There were 115 subjects included and randomly assigned to heparin (n = 58) and placebo (n = 57) groups. The range of age was 21 to 82 years, mean of age was 51 years. ITT and PP analysis were conducted to 46 and 22 subjects in heparin group; 50 and 28 subjects in control group respectively. There were no significant differences in concentration of Phosphorylated-NFkB and Phosphorylated-IKK in both groups. The concentration of TNF-decreased in heparin groups, although statistically was not significant. The 14 days mortality rate reduced in PP analysis (RR 0.212 [95% CI 0.053 – 0.815], p = 0.008), with ARR 33.8 % and NNT 3. Moreover, there are trend of organ dysfunction improvement in heparin group, yet not statistically significant.Conclusion. Heparin treatment has an impact on inflammatory process in severe septic patients; as shown in the reduction of the TNF- concentration, although was not significant statistically. There was no clear impact of heparin treatment on IKK and NFkB concentration. Moreover, heparin shows benefit in reducing the mortality, especially in subjects who has received heparin for 72 hours. No benefit on improvement of organ dysfunction was shown in 72-hour monitoring of heparin treatment."

"Latar Belakang COVID-19 berdampak secara signifikan bagi dunia. Tingginya prevalensi dan insidensi, serta banyaknya kasus berderajat keparahan sedang-berat, mendorong dunia dan Indonesia untuk mencari terapi yang tepat. Salah satunya adalah anti-interleukin-6 untuk mengatasi badai sitokin yang kerap terjadi pada pasien COVID-19. Anti-interleukin-6 berupa Tocilizumab yang digunakan untuk mengatasi COVID-19 derajat sedang-berat hingga saat ini masih minim diteliti di dunia maupun di Indonesia. Maka, Peneliti berharap penelitian ini dapat berkontribusi pada perkembangan dunia medis di Indonesia. Metode Penelitian ini dilakukan dengan desain kohort retrospektif yang dilakukan di Rumah Sakit Universitas Indonesia. Penelitian ini menggunakan rekam medis pasien COVID-19 berderajat sedang-berat guna menilai hubungan antara pemberian Tocilizumab dengan tingkat mortalitas, lama rawat, dan kadar biomarker inflamasi yaitu C-reactive protein dan D-dimer. Hasil Diperoleh 52 pasien yang diberikan obat Tocilizumab dan 52 pasien kontrol. Pada kelompok pasien yang diberikan Tocilizumab, 48 pasien dirawat pada bulan Januari-Juni dan 4 pasien dirawat pada bulan Juli-Desember. Pada kelompok kontrol, 32 pasien dirawat pada bulan Januari-Juni dan 20 pasien dirawat pada bulan Juli-Desember. Ditemukan sebanyak 40,4% pasien yang memperoleh Tocilizumab hidup dan sembuh, sedangkan pada kelompok kontrol hanya 16,4% pasien yang sembuh (p=0,014). Rata-rata lama rawat pasien kelompok uji mencapai 20,9±11,5 hari, lebih lama dibandingkan kelompok kontrol yaitu 16,5±12,4 hari (p=0,007). Rata-rata penurunan kadar CRP pada kelompok uji adalah -74,65±72,59 mg/L, sedangkan pada kelompok kontrol meningkat (p=0,001). Kadar D-dimer pasien yang diberikan Tocilizumab mengalami penurunan namun tidak signifikan. Kesimpulan Tocilizumab terbukti menurunkan angka mortalitas, menurunkan kadar CRP, dan cenderung menurunkan kadar D-dimer pada pasien COVID-19 derajat sedang-berat.

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Introduction COVID-19 has a significant impact globally. The high prevalence and incidence, also the large number of moderate-severe cases, encouraged the world and Indonesia to look a better therapy. One of them is anti-interleukin-6 to overcome cytokine storm that occurs in COVID-19 patients. Today, there is minimal research that learn about anti-interleukin-6, Tocilizumab. This research hope could contribute to the development of the medical sector in Indonesia. Method This research conducted with a retrospective cohort design at Universitas Indonesia Hospital. This study used medical records of COVID-19 moderate-severe patients to assess the relation between Tocilizumab administration and mortality, length of stay, and levels of C-reactive protein and D-dimer. Result There were 52 moderate-severe COVID-19 patients receiving Tocilizumab and 52 control patients. In the test group, 48 patients treated in January-June and 4 patients treated in July-December. In the control group, 32 patients treated in January-June and 20 patients treated in July-December. It was found that 40,4% of patients who were given Tocilizumab survived, while in the control group only 16,4% of patients survived (p=0,014). The average length of stay for test group reached 20,9±11,5 days, longer than the control group, which was 16,5±12,4 days (p=0,007). The average CRP levels decrease in test group was -74.,65±72,59 mg/L, while it increased in the control group (p=0,001). The D-dimer levels of patients given Tocilizumab decreased but not significant. Conclusion Tocilizumab has been proven to reduce mortality rates, lower CRP levels, and tends to reduce D-dimer levels in moderate-severe COVID-19 patients."

"Latar belakang. Coronavirus disease-2019 (COVID-19) memiliki spektrum penyakit yang sangat luas dari gejala ringan sampai berat, hingga kematian. Reaksi inflamasi berat akibat dari COVID-19 ini menimbulkan gangguan hemostasis yang disebut dengan COVID-19 associated coagulopathy. Penelitian ini bertujuan untuk menilai profil koagulasi pada pasien dalam pemantauan (PDP) ataupun terkonfirmasi COVID-19 serta hubungannya terhadap mortalitas 30-hari pasien. Metode. Studi ini merupakan studi kohort retrospektif di RS Cipto Mangunkusumo (RSCM) selama Maret 2020 hingga Juni 2020. Sebanyak 106 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Dilakukan pengambilan data berupa data demografik, klinis atau hemodinamik pasien, profil koagulasi saat subjek ditentukan sebagai PDP atau terkonfirmasi COVID-19, pemberian terapi tromboprofilaksis heparin, dan status mortalitas 30 hari setelah admisi. Perhitungan statistik dilakukan dengan menggunakan Statistical Package of Social Science (SPSS) versi 24.0. Profil koagulasi subjek penyintas 30 hari dibandingkan dengan subjek yang mengalami mortalitas. Variabel profil koagulasi yang bermakna kemudian dianalisis dengan analisis bivariat dan regresi logistik multivariat. Hasil. Pada kelompok yang mengalami mortalitas 30-hari ditemukan adanya peningkatan jumlah leukosit (p: 0,022), penurunan kadar trombosit (p: 0,016), dan waktu protrombin (PT) dan waktu activated partial thromboplastin time (APTT) yang lebih panjang (p: 0,002 dan p: 0,018) dibandingkan pada kelompok penyintas 30-hari. Tidak ditemukan perbedaan fibrinogen dan d-Dimer yang bermakna secara statistik. PT merupakan suatu profil koagulasi tunggal yang dapat digunakan sebagai prediktor mortalitas 30-hari dengan odds ratio (95% CI) sebesar 1,407 (1,072 – 1,846), nilai p: 0,014.Simpulan. Terdapat hubungan antara faktor koagulasi pasien COVID-19 dengan mortalitas 30 hari di RSCM, khususnya PT yang dapat digunakan sebagai prediktor mortalitas 30-hari.

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Background. Coronavirus disease-2019 (COVID-19) has a very broad spectrum of disease from mild to severe symptoms, to death. The severe inflammatory reaction as a result of COVID-19 infection causes a hemostasis disorder called COVID-19 associated coagulopathy. This study aims to assess the coagulation profile of patients under monitoring (PDP) or confirmed COVID-19 and its relationship with 30-day mortality.

Method. This retrospective cohort study was conducted at RS Cipto Mangunkusumo (RSCM) from March 2020 to June 2020. A total of 106 subjects who met the inclusion criteria were analyzed from medical record data. Data were collected in the form of patient demographic, clinical or hemodynamic data, coagulation profile when the subject was determined as PDP or confirmed as COVID-19, administration of heparin thromboprophylaxis therapy, and mortality status 30 days after admission. Statistical calculations were performed using the Statistical Package of Social Science (SPSS) version 24.0. We compared the coagulation profiles of the survivor group in contrast to the non-survivor group. Significant coagulation profile variables were analyzed using bivariate analysis and multivariate logistic regression.

Results. There was elevated number of leukocytes (p: 0.022), reduced platelet levels (p: 0.016), and longer prothrombin time (PT) as well as activated partial thromboplastin time (APTT) (p: 0.002 and p: 0.018, consecutively) in non-survivor group. There were no statistical differences in fibrinogen and d-Dimer levels in both groups. Additionally, PT is a single coagulation profile which predicted 30- day mortality with an odds ratio (95% CI) of 1.407 (1.072 - 1.846), and p value: 0.014.

Conclusion. This present study shows abnormal coagulation results are associated with 30-day mortality in COVID-19 patients at RSCM. Prolonged PT was an independent predictor for 30-day mortality in COVID-19 patients."

"Latar BelakangCOVID-19 adalah sebuah infeksi virus yang memiliki angka mortalitas yang sangat tinggi dalam periode waktu yang sangat sempit. Infeksi COVID-19 akan menyebabkan inflamasi di jaringan paru tubuh yang dapat diukur dengan serum D-dimer. Keparahan gejala dari infeksi COVID-19 dapat dilihat dalam gejala klinis dan keterlibatan segmen paru pada gambaran CT-Scan. Penelitian ini bertujuan untuk mengetahui hubungan antara level D-dimer dengan keparahan klinis pasien COVID-19 serta dengan keterlibatan lobus paru pada gambaran CT-Scan pasien COVID-19MetodePenelitian ini menggunakan metode potong lintang retrospektif dengan uji korelasi gamma untuk melihat hubungan antara level d-dimer dengan keparahan klinis dan keparahan gambaran CT-Scan pada pasien COVID-19. Penelitian ini menggunakan data sekunder dari penelitian “Implementasi Pencitraan Diagnostik Foto Toraks dan CT- Scan Toraks Coronavirus Disease 2019 (COVID-19) Menggunakan Artificial Intelligence” oleh Kamelia T, dkk. di tiga rumah sakit (Rumah Sakit Bunda Menteng, Rumah Sakit Bunda Depok, dan Rumah Sakit dr. Cipto Mangunkusumo) dalam periode 2020-2024, dimana terdapat 50 subjek yang melakukan pemeriksaan laboratorium (D- dimer) dan pemeriksaan CT-Scan.HasilDidapatkan 50 subjek dimana terdapat 25 (50%) subjek yang mengalami peningkatan level D-dimer dan 25 (50%) subjek dengan level D-dimer normal. Uji korelasi antara level D-dimer dengan keparahan klinis memiliki nilai P <0,001 dengan koefiesien korelasi sebesar 0,806. Uji korelasi antara level D-dimer dengan keparahan CT-Scan memiliki nilai P 0,012 dengan koefisien korelasi sebesar 0,528. Koefisien korelasi yang dianggap bermakna pada penelitian ini adalah 0,4.KesimpulanLevel D-dimer memiliki korelasi sangat kuat dengan keparahan klinis serta korelasi sedang dengan keparahan CT-Scan, sehingga dapat menjadi biomarker potensial untuk menentukan tingkat keparahan gejala klinis pasien dan keparahan gambaran CT-Scan thoraks pasien COVID-19.

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Introduction

COVID-19 is a viral infection associated with a high mortality rate within a relatively short period. The infection triggers inflammation in lung tissues, which can be measured using serum D-dimer levels. The severity of COVID-19 symptoms can be assessed through clinical manifestations and the extent of pulmonary segment involvement observed on CT-Scan imaging. This study aims to determine the correlation between D- dimer levels and the clinical severity of COVID-19, as well as the involvement of pulmonary lobes on CT-Scan images of COVID-19 patients.

Method

This study employed a retrospective cross-sectional method with a gamma correlation test to examine the relationship between D-dimer levels, clinical severity, and CT-Scan severity in COVID-19 patients. This study utilized secondary data from the research “Implementation of Diagnostic Imaging of Chest X-rays and CT-Scans for Coronavirus Disease 2019 (COVID-19) Using Artificial Intelligence” by Kamelia T, et al., conducted at three hospitals (Bunda Menteng Hospital, Bunda Depok Hospital, and Dr. Cipto Mangunkusumo Hospital) from 2020 to 2024, involving 50 subjects who underwent laboratory (D-dimer) and CT-Scan examinations.

Results

A total of 50 subjects were included, with 25 (50%) showing elevated D-dimer levels and 25 (50%) with normal D-dimer levels. The correlation test between D-dimer levels and clinical severity showed a p-value <0.001 with a correlation coefficient of 0.806. The correlation test between D-dimer levels and CT-Scan severity yielded a p-value of 0.012 with a correlation coefficient of 0.528. A correlation coefficient of 0.4 or higher was considered significant in this study.

Conclusion

D-dimer levels can serve as a potential biomarker for determining the severity of clinical symptoms and the severity of thoracic CT-Scan findings in COVID-19 patients."

"Latar BelakangPandemi COVID-19, yang disebabkan oleh SARS-CoV-2, berdampak global, termasuk di Indonesia, dengan komplikasi utama seperti trombosis terkait peningkatan kadar D- dimer, biomarker pembekuan darah. Kadar D-dimer yang tinggi dikaitkan dengan prognosis buruk, seperti risiko trombosis, lama rawat inap yang lebih lama, dan kematian. Penelitian ini bertujuan mengeksplorasi hubungan antara kadar D-dimer, tingkat keparahan penyakit, dan lama rawat pasien COVID-19 di RSUP Persahabatan.MetodePenelitian ini bersifat observasional-analitis dengan desain potong lintang pada pasien COVID-19 derajat sedang, berat, dan kritis di RSUP Persahabatan, Jakarta, selama Januari–Desember 2021. Data dikumpulkan dari rekam medis dan dianalisis dengan metode consecutive sampling, melibatkan 57 sampel. Penelitian mencakup pengukuran kadar D-dimer, tingkat keparahan penyakit, dan lama rawat inap. Analisis data dilakukan menggunakan SPSS 25.0 dengan uji univariat dan bivariat, termasuk uji Chi-square atau Fisher’s exact untuk memeriksa hubungan antarvariabel.HasilHasil penelitian ini menunjukkan bahwa tidak ada hubungan signifikan antara kadar D- dimer awal dengan tingkat keparahan COVID-19 (p=0,364), meskipun subjek dengan kadar D-dimer ≥500 ng/mL lebih banyak mengalami kondisi sedang dan berat. Di sisi lain, kadar D-dimer yang lebih tinggi (≥500 ng/mL) berhubungan dengan durasi rawat inap yang lebih lama (≥14 hari) dengan p=0,044, menunjukkan perbedaan signifikan antara kadar D-dimer dan lama rawat inap pasien COVID-19.KesimpulanPenelitian ini menunjukkan bahwa tidak ada hubungan signifikan antara kadar D-dimer awal dengan tingkat keparahan COVID-19 (p=0,364), namun kadar D-dimer ≥500 ng/mL berhubungan dengan durasi rawat inap yang lebih lama (≥14 hari) (p=0,044).

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Introduction

The COVID-19 pandemic, caused by SARS-CoV-2, has had a global impact, including in Indonesia, with major complications such as thrombosis associated with elevated D- dimer levels, a biomarker of blood coagulation. High D-dimer levels are linked to poor prognosis, including the risk of thrombosis, prolonged hospital stays, and mortality. This study aims to explore the relationship between D-dimer levels, disease severity, and length of hospitalization in COVID-19 patients at RSUP Persahabatan.

Method

This study is an observational-analytical research with a cross-sectional design conducted on COVID-19 patients with moderate, severe, and critical conditions at RSUP Persahabatan, Jakarta, from January to December 2021. Data were collected from medical records and analyzed using consecutive sampling methods, involving 57 samples. The study includes measurements of D-dimer levels, disease severity, and length of hospitalization. Data analysis was performed using SPSS 25.0 with univariate and bivariate tests, including Chi-square or Fisher’s exact tests to examine the relationships between variables.

Results

The results of this study indicate that there is no significant relationship between initial D-dimer levels and the severity of COVID-19 (p=0.364), although subjects with D-dimer levels ≥500 ng/mL were more likely to experience moderate and severe conditions. On the other hand, higher D-dimer levels (≥500 ng/mL) are associated with longer hospital stays (≥14 days) with a p-value of 0.044, indicating a significant difference between D- dimer levels and the duration of hospitalization in COVID-19 patients.

Conclusion

This study shows that there is no significant relationship between initial D-dimer levels and COVID-19 severity (p=0.364), but D-dimer levels ≥500 ng/mL are associated with longer hospital stays (≥14 days) (p=0.044)."

"Latar Belakang: Pandemi COVID-19 di Indonesia belum resmi berakhir, dan karena perilaku protektif yang terlihat diabaikan, menjadi sangat penting untuk terus dikampanyekan guna meningkatkan kesadaran masyarakat dan menerapkan protokol kesehatan dalam rangka mengendalikan penyebarannya. Oleh karena itu, penelitian ini bertujuan untuk menganalisis persepsi risiko dan pengalaman masyarakat terhadap penularan COVID-19 di Indonesia. Metode: Penelitian ini menggunakan metode lintang potong dan dilakukan pada bulan Juli hingga Agustus 2022 dengan menggunakan survei daring. Kuesioner dikembangkan berdasarkan kuesioner standar (ECOM, 2015) tentang persepsi risiko wabah penyakit menular. Kuesioner ini kemudian didistribusikan melalui berbagai platform media sosial, termasuk WhatsApp, Facebook, dan Instagram. Hasil: Penelitian ini mengungkapkan bahwa responden wanita lebih banyak daripada pria (61,3%), memiliki pendidikan sarjana (38,5%), bekerja di perusahaan swasta (32,3%), dan pernah tertular Covid (43,8%). Responden yang memiliki skor persepsi risiko di atas rata-rata adalah 60%. Menurut kesepuluh data distribusi persepsi risiko, sebagian besar responden menganggap COVID-19 sebagai ancaman. Memakai masker, rutin mencuci tangan, jaga jarak fisik, dan tinggal di rumah tetap menjadi pilihan dan efektif untuk mencegah penularan. Hal ini menunjukkan bahwa sebagian besar responden memiliki penularan COVID-19 yang intens secara langsung maupun tidak langsung.Kesimpulan: Meskipun sebagian besar responden khawatir akan penularan Covid-19, mereka menyatakan siap untuk penularan dan sadar bagaimana mengendalikan dan mencegah penularan.

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Background: The COVID-19 pandemic in Indonesia has not officially ended, and due to the apparent underestimation of protective behavior, it is imperative to continuously promote public awareness and implement health  protocols  to control its spread. Therefore, this study aims to analyze the community's risk perception and experiences of COVID-19 transmission in Indonesia.

Methods: This cross-sectional study was conducted from July to August 2022 using an online survey. The questionnaire was developed based on a standard questionnaire (ECOM, 2015) on the risk perception of an infectious disease outbreak. It was then distributed through various social media platforms, including WhatsApp, Facebook, and Instagram.

Result: This study revealed that there were more female respondents than men (61.3%), held bachelor’s degree (38.5%), work in private company (32.3%), and been infected by Covid (43.8%). Respondents who have risk perception score above average is 60%. According to all ten risk perception distribution data, most respondents considered COVID-19 a threat. Wearing mask, regularly wash hands, physical distancing, and stay at home still options and effective to prevent the transmission. This showed that most respondents had intense COVID-19 transmission directly or indirectly.

Conclusion: Although most of respondents worry of Covid-19 transmission, they stated ready for transmission and aware how to control and prevent the transmission."

"Dalam dua tahun terakhir pandemi corona virus disease 2019 (COVID-19) telah menginfeksi > 220 juta orang dan 5 juta orang meninggal. Di Indonesia > 4 juta orang terinfeksi dan > 140.000 orang meninggal. Pada puncak pandemi, kebutuhan perawatan tidak seimbang dengan sarana rumah sakit sehingga WHO menganjurkan untuk memprioritaskan pasien secara ekual. Untuk itu diperlukan prediktor luaran pasien COVID-19. Penelitian ini bertujuan menyusun prediktor luaran pasien COVID-19 menggunakan regresi logistik dan machine learning.Penelitian terdiri atas 2 tahap. Tahap pertama adalah kohort retrospektif untuk menyusun prediktor kematian di rumah sakit dengan regresi logistik dan machine learning (decision tree, random forest, support vectore machine, gradient boost and extreme gradient boost). Pasien terkonfirmasi COVID-19 diinput di data registri REG-COVID-19 pada bulan Maret–Juli 2020 di RS Persahabatan (RSP) dan RS Universitas Indonesia (RSUI). Tahap kedua adalah kohort prospektif pada pasien COVID-19 di RSP, RSUI dan RSPI Suliati Saroso pada bulan Maret–Mei 2021. Data yang diinput adalah data demografi, gejala klinis, komorbid, laboratorium, skor Brixia dari radiografi toraks, luaran pasien dari perawatan dan lama rawat.Pada tahap penyusunan diperoleh 271 subjek untuk analisis machine learning, 239 subjek untuk model 1, sebanyak 180 subjek model 2, dan 152 subjek model 3 dan model 4. Hasil analisis regresi logistik model 1 terdiri atas 7 variabel yaitu demam, diabetes melitus, frekuensi napas, saturasi O2, leukosit, SGOT dan CRP dengan AUC 0,930. Model 2 memberikan hasil hampir sama tetapi SGOT menjadi SGPT dengan AUC 0,926. Model 3 memiliki AUC 0,919 dan model 4 memberikan AUC 0,924 dengan variabel D dimer > 2000 menjadi salah satu prediktor. Validasi semua model regresi logistik dan machine learning menunjukkan penurunan AUC, tetapi tidak berbeda bermakna (uji perbandingan AUC, p = 0,683–0,736). Perbandingan model regresi logistik dan machine learning juga tidak berbeda bermakna (uji perbandingan AUC dengan rumus Hanley, p = 0,492–0,923).Disimpulkan prediksi kematian pasien COVID-19 menggunakan regresi logistik dan machine learning memiliki akurasi yang baik sehingga regresi logistik dan machine learning dapat dijadikan prediktor luaran pasien COVID-19.

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Corona virus disease 2019 (COVID-19) pandemic has lasted almost 2 years worldwide with more than two hundred million world population were infected and almost 5 million (2%) death. In Indonesia, there have been more than 4 million people were infected with more than 140.000 (3.5%) death. At the peak of the outbreak there were discrepancy between health care facilities and demands. WHO recommended to prioritize patient equally, to avoid patient discrimination by social class, race, and gender. The best prediction tool should be valid, reliable and feasible. Many studies develop assessment with logistic regression and machine learning with the goal to improve accuracy. Some study showed variety of predictors in outcome prediction, in this study we developed and validated assessment tool to predict hospital mortality comparing logistic regression and machine learning, included support vector machine (SVM), decision tree (DT), random forest (RF), gradient boost (GB) and extreme gradient boost (XGB). Our study was conducted in 2 stages. The first stage study was cohort retrospective to develop assessment tool to predict hospital mortality by comparing logistic regression and machine learning among hospitalized COVID-19 patients from March to July 2020. The second was cohort prospective study among the same population, to validate the tools. The development data were collected from Persahabatan hospital and Universitas Indonesia hospital who registered in REG-COVID-19, 271subjects were eligible for machine learning analysis and 239 subjects for logistic regression data set 1; 180 subjects for data set 2; 152 for data set 3 and 4. Analysis of data set 1 resulted in 8 variables as mortality prediction include fever, DM, respiratory rate (RR), oxygen saturation, leucocyte, ALT > 42, CRP > 88, with AUC 0,930. Data set 2 resulted in similar variables except AST, with AUC 0,926. Data set 3 resulted in 6 variables with AUC 0,919 and Data set 4 resulted in 7 variables included fever, HR, RR, leucocyte, age above 52, CRP > 86 and D-dimer > 2000 with AUC 0,924. Validation of all models showed decreasing AUC. Machine learning analysis resulted in 5 models with the best was XGB among all set data with AUC between 0,8–0,9. There were decreasing of AUC of all models, but not statistically different (p 0.683–0.736). Comparing developed models with logistic regression and machine learning showed there were differences but not statistically significant. (p 0.492-0.923)"