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"Latar belakang: Saat ini, pasien Coronavirus Disease-19 (COVID-19) derajat sedang dan berat umumnya menerima antibiotik secara dini (<24 jam) dengan pertimbangan kemungkinan infeksi sekunder atau ko infeksi bakteri yang merupakan faktor risiko kematian. Hal ini mengakibatkan pengunaan antibiotik yang berlebihan karena proporsi rendah infeksi sekunder dan ko-infeksi bakteri pada pasien COVID-19 yang meninkatkan risiko resistensi antibiotik. Pemeriksaan penunjang untuk membuktikan keberadaan infeksi sekunder dan ko-infeksi bakteri dapat mengarahkan pemberian antibiotik pada pasien yang tepat. Pada studi ini, pengaruh pemberian antibiotik dini terhadap mortalitas pasien COVID-19 derajat sedang dan berat akan diteliti. Metode: Penelitian ini merupakan jenis penelitian analitik observasional dengan desain retrospektif kohort. Data penelitian diperoleh melalui rekam medis elektronik pasien COVID-19 yang diadmisi mulai Desember 2020 sampai Maret 2021. Pasien yang menerima antibiotik dini adalah pasien yang menerima antibiotik >24 jam setelah admisi. Analisis data dilakukan dengan program SPSS versi 20. Hasil: Dari 180 pasien rawat inap dengan COVID-19, 72 pasien dieksklusi karena tidak memenuhi kriteria eligibilitas sampel. Dari 108 pasien yang terinklusi, 74 (68.5%) pasien memiliki COVID-19 derajat sedang dan 34 pasien (31.5%) memiliki COVID-19 derajat berat. Antibiotik dini diberikan pada 79 (73.1%) pasien dengan median waktu mulai antibiotik 2 hari pada pasien yang tidak menerima antibiotik dini. Hasil analisis univariat tidak menemukan pengaruh signifikan pemberian antibiotik dini pada pasien COVID-19 sedang dan berat (p=0.42). Analisis sub-group berdasarkan derajat penyakit juga tidak menemukan hasil yang signifikan. Kesimpulan: Tidak terdapat hubungan pemberian antibiotik dini terhadap mortalitas pasien COVID-19 derajat sedang dan berat.

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Introduction: Currently, moderate and severe Coronavirus Disease-19 (COVID-19) patients receive early antibiotic (<24 hours) considering the possibility of bacterial secondary infection or co-infection which is a risk factor for mortality. This practice results in overuse of antibiotic because of low proportion of  bacterial secondary infection or co-infection in COVID-19 patients. Evaluation of patients to establish the bacterial infection before antibiotic administration could reduce the use of antibiotic in COVID-19 patients. However, there is no evidence that has proven the safety of delaying the antibiotic administration in moderate and severe COVID-19 patients. Method: This study is an observational study with retrospective cohort design. The study data came from electronic health record of Ciptomangunkusumo hospital from December 2020 to March 2021. Patients that receive antibiotic at the day of admission is categorized as early antibiotic and those who don’t is categorized as not early antibiotic. Data analysis is done by using SPSS ver.20. Result: Out of 180 inpatients with COVID-19, 72 patients were excluded because of ineligibility. From 108 included patients, 75 (68.5%) had moderate COVID-19 and 34 (31.5) had severe COVID-19. Early antibiotic was administered in 79 (73.1%) patients with 2 days median time of antibiotic administration in patients who did not receive early antibiotic. Univariate analysis did not find significant association between early antibiotic administration with mortality (p=0.42). Subgroup analysis of COVID-19 severity also did not show any significant association. Conclusion : Early antibiotic administration does not impact mortality of moderate and severe COVID-19 patients."

"Perdarahan saluran cerna (PSC) merupakan salah satu komplikasi COVID-19 dengan angka mortalitas yang tinggi, namun hingga kini besaran kasusnya belum pernah dilaporkan di Indonesia. Selain itu, hasil penelitian sebelumnya mengenai faktor yang mempengaruhi kejadian PSC juga masih bervariasi. Penelitian ini bertujuan untuk menghitung proporsi kejadian PSC pada COVID-19 serta mendapatkan faktor-faktor yang mempengaruhinya. Penelitian merupakan studi potong-lintang dengan subjek pasien dewasa COVID-19 derajat sedang hingga kritis di RS Rujukan COVID-19 Pertamina Jaya dan RS Darurat Wisma Haji Pondok Gede, Jakarta, selama periode Juni-September 2021. Dari 414 subjek yang memenuhi kriteria inklusi dan eksklusi didapatkan kejadian PSC sebesar 17,63%. Mayoritas subjek memiliki komorbid hipertensi (51%), diabetes melitus tipe 2 [DMT2] (43,2%), penyakit serebrokardiovaskular [PSKV] (31,4%), serta riwayat penyakit ulkus peptikum dan PSC sebelumnya (23,9%). Median nilai neutrofil absolut ialah 4.842,5[1.116-70.000], kadar CRP 65,5[9-275] mg/dL, dan kadar D-dimer 890[200-5010] µg/L. Berdasarkan uji bivariat, terdapat tujuh variabel yang bermakna secara statistik, namun pada analisis multivariat generalized linear model menggunakan family regresi Poisson dan fungsi link log dengan robust error variance diperoleh empat variabel akhir yang bermakna secara statistik, yaitu hipertensi (aRR 2,67; IK95% 1,52-4,41; p<0,001), PSKV (aRR 1,90; IK95% 1,27-2,84; p=0,002), terapi kortikosteroid dosis tinggi (aRR 1,82; IK95% 1,22-2,73; p=0,004), dan terapi proton pump inhibitor (PPI) dosis tinggi (aRR 0,41; IK95% 0,27-0,60; p<0,001). Uji Pearson goodness-of-fit menunjukkan nilai p=0,999 dan nilai AUC 0,755 (IK95% 0,694-0,815; p<0,001). Sebagai kesimpulan, proporsi kejadian PSC pada COVID-19 derajat sedang-kritis ialah 17,63 (IK95% 14,1-21,6%). Faktor yang dapat mempengaruhi kejadian PSC ialah hipertensi, PSKV, serta penggunaan kortikosteroid dan PPI.

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Gastrointestinal bleeding (GIB) is a COVID-19 complication with high mortality rate whose magnitude and impact have not been reported in Indonesia. Moreover, the resutls of previous studies on factors influencing GIB in COVID-19 still varied widely. This study aimed to measure the proportion of GIB cases in COVID-19 and investigate the factors influencing GIB in COVID-19. This was a cross sectional study on adults with moderate to critical COVID-19 in Pertamina Jaya Referral Hospital and Wisma Haji Pondok Gede Field Hospital, Jakarta from June to September 2021. We found that out of 414 subjects that met the inclusion and exclusion criteria, 17.63% had cases of GIB. Most subjects had comorbidities, including hypertension (51%), type 2 diabetes mellitus [T2DM] (43.2%), cerebrocardiovascular disease [CCVD] (31.4%), and history of peptic ulcer and previous GIB (23.9%). Median[min-max] number of absolute neutrohil was 4,842.5 [1,116-70,000], CRP levels was 65.5 [9-275] mg/dL, and D-dimer levels was 890 [200-5,010] ug/L. Bivariate analysis showed that there were seven variables that were statistically significant. However, according to generalized linear model analysis withPoisson regression family and log link function with robust error variance, there were four final variables that were statistically significant. There variabels as follow hypertension (aRR 2.67; 95%CI 1.52-4.41; p<0.001), CCVD (aRR 1.90; 95%CI 1.27-2.84; p=0.002), high dose corticosteroid therapy (aRR 1.82; 95%CI 1.22-2.73; p=0.004), and high dose proton pump inhibitor [PPI] therapy (aRR 0.41; 95%CI 0.27-0.60; p<0.001). Pearson goodness-of-fit test showed p=0.999 and AUC value of 0.755 (95%CI 0.694-0.815; p<0.001). In conclusion, the proportion of GIB incidence in moderate-critical COVID-19 was 17.63% (95%CI 14.1-21.6%). Factors that influence GIB were hypertension, CCVD, the use of corticosteroid, and PPI."

"Pandemi Coronavirus disease-19 (COVID-19) telah secara drastis mempengaruhi kesehatan global. Salah satu komplikasi COVID-19 yang berbahaya adalah pneumonia. Berbagai jenis antibiotik telah digunakan untuk pencegahan dan pengobatan pneumonia pada pasien COVID-19. Pemberian antibiotik yang tidak sesuai dapat memicu resistensi antibiotik sehingga berdampak pada peningkatan mortalitas pasien. Penelitian ini bertujuan untuk menganalisis pengaruh kesesuaian pemberian antibiotik berdasarkan diagram alir Gyssen terhadap luaran klinis pasien terkonfirmasi COVID-19 dengan pneumonia. Penelitian ini merupakan penelitian cross-sectional. Sampel penelitian adalah 72 pasien rawat inap yang mendapat diagnosis COVID-19 terkonfimasi dan pneumonia di RSUP Fatmawati Jakarta pada periode Maret hingga Desember 2020 yang memenuhi kriteria inklusi. Pasien terkonfirmasi COVID-19 dengan pneumonia memiliki rerata usia 53,13 ± 12,61 tahun. Pasien dengan derajat penyakit COVID-19 berat atau kritis (66,7%) lebih banyak dibandingkan non-berat (33,3%). Jumlah pasien meninggal yang dilaporkan dalam penelitian ini adalah 36 (50%). Berdasarkan evaluasi antibiotik menggunakan diagram alir Gyssen diperoleh hasil sejumlah 11 dari 72 (15,3%) pasien menggunakan regimen antibiotik yang tidak sesuai. Karakteristik ketidaksesuaian antibiotik, meliputi: ketidaktepatan pemilihan antibiotik (2,8%) dan durasi antibiotik (12,5%). Kesesuaian pemberian antibiotik berdasarkan diagram alir Gyssen tidak berpengaruh secara bermakna terhadap luaran klinis pasien terkonfirmasi COVID-19 dan pneumonia.

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The COVID-19 pandemic affected global health drastically. COVID-19 becomes more dangerous if pneumonia attacks COVID-19 patients as a complication. Numerous types of antibiotics were used for the prevention and treatment of pneumonia in COVID-19 patients. Inappropriate administration of antibiotics caused antibiotic resistance and influenced patient mortality. This research aims to analyze the effect of appropriate antibiotics administration according to Gyssen flowchart on clinical outcomes of confirmed COVID-19 patients with pneumonia. This research was conducted using a cross-sectional design. A total of 72 COVID-19 confirmed inpatients with pneumonia diagnosis from March to December 2020 at Fatmawati Hospital Jakarta whose met inclusion criteria were included in our study. The mean age of all patients was 53.13 ± 12.61 years. The percentage of critical or severe ill patients (66.7%) was higher than those who were having noncritical diseases (33.3%). 36 (50%) death were reported in our patient population. 11/72 (15.3%) antibiotic regimens were found to be inappropriate. Characteristics of inappropriate antibiotics included: incorrect choice (2.8%) and duration of antibiotics (12.5%). We conclude that appropriate administration of antibiotics based on the gyssen flowchart was not significantly associated with the clinical outcomes of confirmed COVID-19 with pneumonia patients."

"Latar Belakang: Angka mortalitas pasien Coronavirus Disease 2019 (COVID-19) di Indonesia cukup tinggi, salah satu organ yang terlibat dalam memengaruhi tingginya mortalitas ini adalah jantung. Evaluasi ekokardiografi dapat membantu mengidentifikasi secara dini gangguan jantung yang berhubungan dengan mortalitas pasien. Saat ini data kelainan jantung dengan pemeriksaan ekokardiografi pada pasien COVID-19 derajat berat-kritis di Indonesia.Tujuan: Penelitian ini bertujuan untuk mencari hubungan antara kelainan ekokardiografi dengan mortalitas pada pasien COVID-19 derajat berat dan kritis.Metode: Data pasien COVID-19 derajat berat dan kritis di RSCM diambil berdasarkan rekam medis lalu dilakukan analisis data dengan menampilkan tabel deskriptif, analisis bivariat dengan chi-square dan multivariat dengan regresi logistik.Hasil: Dari total 83 pasien, sebanyak 48 pasien (57,8%) meninggal. Kelainan fungsional yang paling banyak ditemukan pada ekokardiografi adalah mPAP yaitu sebanyak 51 pasien (68%) dan gangguan struktural terbanyak adalah remodelling konsentrik ventrikel kiri yaitu 48 pasien (58%). Hasil analisis chi-square terhadap variabel ekokardiografi memperlihatkan bahwa Tricuspid Annular Plane Systolic Excursion (TAPSE) dengan RR 7,29 (IK95%; 0,98 - 54,36), Right Ventricular Systolic Pressure (RVSP) dengan RR 10,21 (IK95%; 1,41 - 74,04), mean Pulmonary Artery Pressure (mPAP) dengan RR 1,44 (IK95%; 1,02 - 2,04), Pulmonary Acceleration Time (PAT) dengan RR 2,36 (IK95%; 1,14 - 4,86), dan Right Atrial Pressure (RAP) dengan RR 3,40 (IK95%; 1,06 - 10,95), memiliki hubungan signifikan dengan mortalitas. Sedangkan Left Ventricular Ejection Fraction (LVEF), disfungsi diastolik ventrikel kiri (E/e’) dan cardiac output (CO) tidak terdapat hubungan yang signifikan. Analisis multivariat dengan regresi logistik menunjukan bahwa variabel ekokardiografi yang secara independen berhubungan dengan mortalitas adalah RVSP dan RAP.Simpulan: Kelainan ekokardiografi yang berhubungan dengan mortalitas pasien COVID 19 derajat berat dan kritis adalah TAPSE, RVSP, mPAP, PAT dan estimasi RAP.

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Background: The mortality rate of Coronavirus Disease 2019 (COVID-19) patient in Indonesia is high and one of the organ that may contribute mortality is heart problem. Echocardiography can help clinician to identify early functional abnormalities and structural defect of heart that may correlates to mortality and patient’s prognosis. Currently, there are limited data in Indonesia about cardiac abnormalities in severe-critically ill COVID-19 patients that evaluated with echocardiography.Objective: This study aims to determine the relationship between echocardiography abnormalities and mortality in severe and critically ill COVID-19 patients.Methods: Severe and critically ill COVID-19 patients data taken from medical records and then analyzed by presenting descriptive table, bivariate analysis using chi square and multivariate analysis using logistic regression.Results: Out of total 83 patients, 48 ​​patients (57.8%) died. The most common functional abnormality found on echocardiography was mPAP found in 51 patients (68%) and the most common structural defect was left ventricular concentric remodeling in 48 patients (58%). The results of chi-square analysis of echocardiographic variables are Tricuspid Annular Plane Systolic Excursion (TAPSE) RR 7,29 (95%CI; 0,98 - 54,36), Right Ventricular Systolic Pressure (RVSP) RR 10,21 (95% CI; 1,41 - 74,04), mean Pulmonary Artery Pressure (mPAP) RR 1,44 (95%CI; 1,02 - 2,04), Pulmonary Acceleration Time (PAT) RR 2,36 (95%CI; 1,14 - 4,86), dan Right Atrial Pressure (RAP) RR 3,40 (95% CI; 1,06 - 10,95)had a significant relationship with mortality. Meanwhile, left ventricular ejection fraction (LVEF), left ventricular diastolic dysfunction (E/e') and cardiac output (CO) had no significant relationship. Multivariate analysis using logistic regression showed that RVSP and RAP were independent variables that correlates to mortality.Conclusions: Echocardiography abnormalities that associated with mortality in severe-critically ill patients are TAPSE, RVSP, mPAP, PAT and estimated RAP"

"Latar Belakang: Secara global, jumlah penduduk usia lanjut terus meningkat yang diiringi dengan jumlah pasien usia lanjut yang menjalani pembedahan juga meningkat. Pasien usia lanjut memerlukan perhatian khusus dalam persiapan, saat pembedahan dan pasca pembedahan karena kemunduran sistem fisiologis dan farmakologi sehingga lebih berisiko mengalami komplikasi. Tujuan: Mendapatkan angka mortalitas, model prediksi, serta performa model prediksi pasien usia lanjut yang menjalani pembedahan elektif di RSCM. Metode: Penelitian menggunakan desain kohort retrospektif dengan metode sampling konsekutif. Data sekunder rekam medis pasien usia lanjut yang menjalani pembedahan elektif di RSCM periode Januari 2015-Desember 2017 dianalisis dengan program statistik SPSS Statistics 20.0 untuk analisis univariat, bivariat, multivariat, Receiving Characteristics Operator (ROC), dan analisis bootstrapping pada uji kalibrasi Hosmer-Lemeshow.Hasil: Terdapat 747 subjek penelitian yang dianalisis untuk mendapatkan angka mortalitas dan prediktor yang bermakna untuk disertakan sebagai komponen sistem skor. Sebanyak 108 (14,5%) pasien meninggal pascabedah. Variabel status fungsional, komorbiditas, kadar albumin serum preoperatif, jenis pembedahan, dan status fisik ASA merupakan variabel yang secara statistik independen berhubungan dengan mortalitas. Sistem skor yang dibuat memiliki nilai AUC = 0,900 (KI 95% 0,873-0,927). Kalibrasi sistem skor baik dengan nilai p>0,05. Hasil ini konsisten setelah dilakukan bootstrapping. Kesimpulan : Angka mortalitas pasien geriatri yang menjalani pembedahan elektif adalah 14,5%. Prediktor dan komponen skor prediksi mortalitas pembedahan elektif pada pasien usia lanjut yaitu status fungsional, komorbiditas, kadar albumin serum preoperatif, jenis pembedahan, dan kategori ASA. Model prediksi memiliki kualitas kalibrasi dan diskriminasi yang baik dan kuat.

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Background: Globally, the number of elderly population continues to grow. It is accompanied by the increasing number of older people undergoing surgery. Elderly patients need certain care in preoperative, intraoperative,and postoperative phase since they are more likely to develop postoperative complication due to physiological and pharmacological deterioration. Aim: To get mortality rate, predictive model, and the performance of predictive model in elderly patients undergoing elective surgery in RSCM. Methods: This study is a retrospective cohort study with consecutive sampling method. Secondary data from patients' medical record who underwent elective surgery from January 2015-December 2017 is analysed using SPSS Statistics 20.0 for univariate, bivariate, multivariate, and Receiving Operator Characteristics (ROC) and SPSS Statistics 20.0 for bootstrapping analysis in Hosmer-Lemeshow calibration test.Results: All 747 subjects are analysed to get mortality rate and predictor variables thatare statiscally significant included as scoring system components. A hundred eight patients (14.5%) died within thirty days after surgery. Functional status, comorbidities, preoperative serum albumin level, type of surgery, and ASA physical status are independently associated with mortality. A scoring system composed of above predictors has an AUC value at 0.900 (95% CI 0.873-0.927). This scoring system shows good calibration with p>0,05 and this result is consistent even after bootstrapping analysis.Conclusion: The mortality rate of elderly patients undergoing elective surgery in RSCM is 14.5%. Scoring system for predicting mortality in elderly patients undergoing elective surgery consist of functional status, comorbidities, preoperative serum albuminlevels, type of surgery and ASA physical status. The predictive model shows good calibration and strong discrimination."

"Latar belakang: Cedera kepala merupakan kegawatan di bidang Neurologi yang sering menyebabkan kematian dan kecacatan. Prognosis yang dapat dibuat diawal terjadinya cedera kepala akan membantu klinisi dalam memberikan tatalaksana yang tepat. Penelitian faktor prognostik pada cedera kepala dengan luaran skor GOSE yang dilakukan dalam tiga waktu pemantauan yang berbeda belum pernah dilakukan di RSUPN. Cipto Mangunkusumo.Metode penelitian: Penelitian ini merupakan uji prognostik dengan disain kohort prospektif dan retrospektif untuk mengetahui faktor prognostik luaran GOSE pasien cedera kepala sedang dan berat pada hari 90 sebagai luaran primer, juga luaran pada hari 14 dan 30. Populasi yaitu pasien cedera kepala di RSUPN. Cipto Mangunkusumo selama bulan Oktober 2019- Maret 2021. Analisis data bivariat dengan chi-square dilanjutkan analisis multivariat dengan regresi logistik.Hasil: Dari 139 sampel cedera kepala sedang dan berat didapatkan data demografik yaitu 81.3% sampel merupakan laki-laki dan usia rerata 40±44. Didapatkan sebaran klinis, SKG 3-8 16 sampel (11.5%), hipotensi 20 sampel (14.4%), Hipoksia sebanyak 11 sampel (7.9%), Anemia sebanyak 13 sampel (9.4%), hiperglikemi sebanyak 30 sampel ( 21.6%), skor ISS > 24 sebanyak 6 sampel (4.3%), skor Rotterdam > 4 sebanyak 56 sampel (45.2%). Pupil tidak reaktif bilateral 3.6%, reaktif unilateral 7.2%, reaktif bilateral 89.2%Untuk luaran GOSE hari 90 sebagai luaran primer yaitu luaran baik 60.4% dan luaran buruk 39.6%. Luaran hari 30 luaran baik 46.8% dan luaran buruk 53.2%. Luaran fase awal yaitu hari 14 luaran baik 31.7% dan luara buruk 68.3%.Analisis multivariat didapatkan faktor yang signifikan mempengaruhi luaran pada hari 14 yaitu usia di atas 60 tahun dan skor Rotterdam > 4. Analisis multivariat luaran hari 30 tidak didapatkan faktor yang signifikan mempengaruhi luaran GOSE. Pada hari 90 didapatkan faktor yang signifikan mempengaruhi luaran GOSE yaitu hipotensi < 100 mmHg.Kesimpulan: Didapatkan faktor prognostik pada hari 14 yaitu usia dan skor Rotterdam dan faktor prognostik pada hari 90 yaitu hipotensi.

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Background: Brain injury is an emergency in Neurology that often causes death and disability. Prognosis that can be made early in the occurrence of head injury will assist clinicians in providing appropriate management. The study of prognostic factors in head injury with GOSE score outcome that was conducted in three different monitoring times had never been done in RSUPN. Cipto Mangunkusumo.

Research method: Prognostic test with a prospective and retrospective cohort design to determine the prognostic factors for GOSE outcome in moderate and severe brain injury patients on day 90 as the primary outcome, as well as outcomes on days 14 and 30. The population was brain injury patients at the RSUPN. Cipto Mangunkusumo during October 2019-March 2021. Bivariat analysis with chi-square was followed by multivariate analysis with logistic regression.

Results: 139 samples of moderate and severe brain injury, demographic data were obtained, 81.3% of the sample were male and the mean age was 40±44. Obtained clinical distribution, SKG 3-8 16 samples (11.5%), hypotension 20 samples (14.4%), Hypoxia in 11 samples (7.9%), Anemia in 13 samples (9.4%), hyperglycemia in 30 samples (21.6%), ISS score > 24 for 6 samples (4.3%), Rotterdam score > 4 for 56 samples (45.2%). Bilateral unreactive pupils 3.6%, unilateral reactive 7.2%, bilaterally reactive 89.2%

For the 90 day GOSE outcome as the primary outcome, 60.4% good outcome and 39.6% bad outcome. The 30 day output is 46.8% good and 53.2% bad. The output of the initial phase was on day 14, good outcome was 31.7% and bad outcome was 68.3%.

Multivariate analysis found that the factors that significantly affected the outcome on day 14 were age over 60 years and Rotterdam score > 4. Multivariate analysis on day 30 did not find any significant factor influencing the outcome of GOSE. On day 90, it was found that a significant factor affecting the outcome of GOSE was hypotension < 100 mmHg.

Conclusion: In patients with moderate and severe brain injury, there were different prognostic factors for monitoring GOSE outcomes on days 14, 30 and 90."

"Latar Belakang: Acute Kidney Injury pada COVID-19 merupakan komplikasi penting dan dikaitkan dengan peningkatan risiko kematian diduga diperantarai kondisi inflamasi dan disregulasi imun, baik di awal maupun selama perawatan. Tujuan: Untuk mengetahui hubungan antara IL-6, IL-10, TNF-" dengan AKI dan memprediksi perburukan hematuria, dan kejadian AKI Metode: Studi potong lintang dan prospektif kohort melibatkan 43 pasien COVID-19 derajad sedang dan berat yang dirawat di Rumah Sakit Pertamina Pusat di Jakarta, Indonesia dari bulan November 2020 hingga Januari 2021. Selama observasi dilakukan pemeriksaan darah lengkap, serum kreatinin, urinalisis, kadar IL-6, IL-10, TNF-" pada hari pertama dan hari ketujuh pengobatan atau sebelum hari ketujuh jika pasien meninggal atau dipulangkan, dan perubahannya di analisis. Insiden AKI ditentukan ketika perubahan serum kreatinin dan urin output memenuhi kriteria pedoman Kidney Disease Improving Global Outcomes. Uji korelasi dilakukan terhadap peningkatan sitokin dengan perubahan hematuria dan kreatinin. Uji Wilcoxon dilakukan untuk mengetahui perbedaan kadar sitokin diantara status albuminuria. Selanjutnya dilakukan uji Receiver Operator Characteristic untuk melihat kemampuan prediksi IL-6, IL-10, TNF-" terhadap perburukan hematuria dan kejadian AKI, menggunakan AUC minimal 0,7 dengan batas bawah IK 95% lebih dari 0,5 dan nilai p <0,05 Hasil: Terdapat korelasi antara peningkatan kadar serum IL-10 dengan perubahan serum kreatinin (r= -0,343; p 0,024) tetapi tidak pada perubahan IL-6 dan TNF-a. Perubahan hematuria tidak berkorelasi dengan peningkatan ketiga kadar sitokin. Juga tidak ada perbedaan dalam kadar sitokin di antara kelompok albuminuria. Kadar serum TNF-" dihari pertama perawatan dapat memprediksi AKI pada hari ke tujuh, AUC 85%; p=0,045 (IK 0,737-0,963), tetapi tidak dapat memprediksi perburukan hematuria Kesimpulan: Terdapat korelasi antara peningkatan IL-10 dengan perubahan serum kreatinin. TNF-! pada hari pertama perawatan dapat memprediksi kejadian AKI di hari ketujuh perawatan pasien COVID-19 derajat sedang dan berat.

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Background: Acute Kidney Injury is an important complication and is associated with increased risk of death in COVID-19 due to inflammatory conditions and immune dysregulation, both at the beginning and during treatment. Aim: To determine the relationship between IL-6, IL-10, TNF-α with AKI and their ability to predict the worsening of hematuria, and the incidence of AKI. Methods: 43 moderate and severe COVID-19 patients treated from November 2020 to January 2021 at Pertamina Central Hospital in Jakarta, Indonesia were included in this cross-sectional and prospective cohort study. During observation, tests including complete blood count, serum creatinine, urinalysis, levels of IL-6, IL-10 and TNF-α were performed on the first and seventh day of treatment, or before day 7 if the patient died or was discharged, and the changes were analyzed. The incidence of AKI is determined when changes in serum creatinine and urine output meet the criteria in the Kidney Disease Improving Global Outcomes guidelines. Correlation test was performed on increased cytokines with changes in hematuria and creatinine. Wilcoxon test was performed to obtain differences in cytokine levels among albuminuria status. Receiver Operator Characteristic test was then carried out to see the predictive ability of IL-6, IL-10, TNF- α on the worsening of hematuria and the incidence of AKI. Results: There was a correlation between increased serum IL-10 levels with changes in serum creatinine (r= -0.343; p 0.024), but not in IL-6 and TNF-a levels. On the other hand, changes in hematuria did not correlate with an increase in the levels of the three cytokines. There was also no significant difference in the levels of cytokines among albuminuria groups. Serum TNF-! levels on the first day of treatment were able to predict AKI on the seventh day (AUC 85%; p=0.045; 95%CI 0.737-0.963), but did not predict the worsening of hematuria. Conclusion: There was a correlation between increased serum IL-10 with changes in serum creatinine. TNF-! on the first day of treatment can predict the incidence of AKI on the seventh day of treatment for moderate and severe COVID-19 patients."

"Latar Belakang: Penyakit COVID-19 yang disebabkan oleh virus SARS-CoV-2 bisa menyebabkan kelainan pada paru-paru berupa pulmonary intravascular coagulation, suatu koagulopati akibat infeksi. Banyak menduga keadaan ini disebabkan oleh cytokine strorm yang salah satu komponen utamanya adalah IL-6. Sampai saat ini belum diketahui hubungan antara IL-6 dengan koagulopati pada penyakit ini. Tujuan: Kami ingin megetahui apakah IL-6 memiliki korelasi dengan pertanda koagulopati d-Dimer, fibrinogen, dan prothrombin time, serta apakah IL-6 memiliki korelasi dengan ferritin sebagai acute phase reactant. Kami juga ingin mengetahui apakah IL-6, ferritin, fibrinogen, d-Dimer, dan PT berkorelasi dengan perburukan subjek COVID-19 derajat sedang dan berat. Metode: Kami melakukan penelitian kohort prospektif pada pasien COVID-19 derajat sedang dan berat di suatu rumah sakit khusus yang menangani perawatan pasien COVID-19 mulai dari Juni 2020 sampai Januari 2021. Kami melakukan pemeriksaan serial IL-6, d-Dimer, fibrinogen, ferritin dan prothrombin time (PT), serta observasi keadaan pasien tersebut saat masuk rawat dan pada hari ke 14 hari atau sebelum hari ke 14 jika terjadi perbaikan, perburukan, atau pulang; mana yang lebih dahulu terjadi. Penelitian ini sudah mendapat persetujuan dari Panitia Tetap Etik Penelitian Kedokteran FKUI-RSUPN Cipto Mangunkusumo. Hasil: Selama Juni 2020 sampai dengan Januari 2021 kami temukan sebanyak 374 pasien COVID-19 derajat sedang dan berat. Tujuh puluh tiga subjek masuk kriteria inklusi 61 orang termasuk kategori berat, dan 12 orang sedang. Jumlah pasien perburukan adalah 35 dari 61 pasien derajat berat, dan 1 dari 12 pasien derajat sedang. Uji korelasi Spearman antara IL-6 dengan ferritin, d-Dimer, fibrinogen, dan PT berturut-turut koefisien korelasinya 0,08 (p=0,5), -0,13 (p=0,27), 0,01 (p=0,91), 0,03 (p=0,77). Uji korelasi Spearman antara ferritin dengan d-Dimer, fibrinogen, dan PT berturut-turut 0,17 (p=0,14), 0,05 (p=0,63), dan 0,07 (p=0,51). ROC yang memiliki luas lebih dari 60% adalah selisih d-Dimer dan selisih IL-6 (74,77% dan 71,32%). Kesimpulan: Tidak ditemukan korelasi antara IL-6 dengan d-Dimer, fibrinogen, PT. Ferritin tidak berkorelasi dengan d-Dimer, fibrinogen dan PT. IL-6 tidak berkorelasi dengan ferritin. Perubahan IL-6 dan d-Dimer dapat memprediksi perburukan pada pasien COVID-19 derajat sedang dan berat.

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Background: COVID-19 disease caused by the SARS-CoV-2 virus can cause abnormalities in the lungs in the form of pulmonary intravascular coagulation, a coagulopathy due to infection. Many suspect this situation is caused by cytokine storm, one of the main components of which is IL-6. Until now, there is no known relationship between IL-6 and coagulopathy in this disease.

Objectives: We wanted to know whether IL-6 correlated with markers of d-Dimer coagulopathy, fibrinogen, and prothrombin time, and whether IL-6 correlated with ferritin as an acute phase reactant. We also wanted to find out whether IL-6, ferritin, fibrinogen, d-Dimer, and PT correlated with moderate and severe worsening of COVID-19 subjects.

Methods: We conducted a prospective cohort study of moderate and severe COVID-19 patients in a specialized hospital that treats COVID-19 patients from June 2020 to January 2021. We performed serial tests of IL-6, d-Dimer, fibrinogen, ferritin and prothrombin time (PT), as well as observing the patient's condition at the time of admission and on day 14 or before day 14 if there is improvement, worsening, or discharge; whichever happens first. This research has been approved by the Permanent Committee of Medical Research Ethics FKUI-RSUPN Cipto Mangunkusumo.

Results: During June 2020 to January 2021, we found 374 moderate and severe COVID-19 patients. Seventy-three subjects entered the inclusion criteria, 61 people were included in the heavy category, and 12 people were moderate. The number of deteriorating patients was 35 of 61 severe grade patients, and 1 of 12 moderate grade patients. Spearman correlation test between IL-6 and ferritin, d-Dimer, fibrinogen, and PT, respectively, the correlation coefficients were 0.08 (p=0.5), - 0.13 (p=0.27), 0.01 ( p=0.91), 0.03 (p=0.77). Spearman correlation test between ferritin and d-Dimer, fibrinogen, and PT was 0.17 (p=0.14), 0.05 (p=0.63), and 0.07 (p=0.51) . ROCs that have areas of more than 60% are the d-Dimer-difference and IL-6-difference (74.77% and 71.32%).

Conclusions: No correlation was found between IL-6 and d-Dimer, fibrinogen, PT. Ferritin did not correlate with d-Dimer, fibrinogen and PT. IL-6 was not correlated with ferritin. Changes in IL-6 and d-Dimer can predict worsening in moderate and severe COVID-19 patients."

"Seluruh aspek kehidupan telah dipengaruhi oleh pandemi COVID-19 termasuk bidang kesehatan. Disisi lain, terdapat peningkatan jumlah penderita kanker setiap tahunannya. Hubungan karakteristik klinis kanker ginekologi dengan infeksi COVID-19 terhadap mortalitas belum banyak diteliti. Dalam penelitian ini digunakan metode retrospective cross-sectional yang menggunakan data pasien penderita kanker ginekologi dengan infeksi COVID-19 yang terdaftar pada Departemen Obstetri Ginekologi RSPUN Dr. Cipto Mangunkusumo pada tahun 2020-2022. Penelitian ini menggunakan analisis uji Chi Square untuk menentukan variable yang akan dimasukan kedalam analisis regresi logistik backward stepwise. Dalam penelitian ini ditemukan usia >59 (OR, 0.020; Cl 95% 0.001-0.577; P= 0.023), anemia(OR,0.053; Cl 95% 0.005-0.565; P= 0.015), ARDS (OR, 50,010; CL 95%, 1,145-2185.101; P = 0.042), Hyperkalemia (OR, 11,189; Cl 95% 1,491-83.992; P = 0.019), Sepsis (OR, 18,386; Cl 95% 2,220-152.253; P= 0.007), ECOG >2 (OR, 12.859; Cl 95% 2.582-64.020; P= 0.002), and Degree of Severe-Critical COVID-19 (OR, 111.310; Cl 95% 3.961-3128.117; P= 0.006). Dapat disimpulkan ARDS, hyperkalemia, sepsis, ECOG >2, dan derajat COVID-19 berat-kritis memiliki signifikansi baik terhadap statistik maupun klinis dengan mortalitas, namun usia > 59 dan anemia secara klinis tidak memiliki signifikansi.

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All aspects of life have been affected by the COVID-19 pandemic, including the health sector. On the other hand, the number of cancer patients is continuously increasing every year. The relationship between clinical characteristics of gynecological cancer with COVID-19 infection and mortality has not been widely studied. This study used a retrospective cross-sectional method using data on patients with gynecological cancer with COVID-19 infection registered in the gynecology department of Dr. Cipto Mangunkusumo Hospital in 2020-2022. This study used chi-squared test analysis to determine the variables to be included in backward stepwise logistic regression analysis. In this study, it was found that age >59 (OR, 0.020; Cl 95% 0.001-0.577; P = 0.023), anemia (OR, 0.020; Cl 95% 0.001-0.578; p= 0.023), ARDS (OR, 48.796;  Cl 95%, 1.131-2105.921; P=0.043), hyperkalemia (OR, 10.960; Cl 95% 1.462-82.187; p= 0.020), sepsis (OR, 18.087; Cl 95% 2.192-149.271; P= 0.007), ECOG >2 (OR, 12.629; Cl 95% 2.538-62.854; P= 0.002), and degree of severe-critical COVID-19 (OR, 108.771; Cl 95% 3.917-3020.095; P= 0.006). It can be concluded that ARDS, hyperkalemia, sepsis, ECOG >2 and degree of severe-critical COVID-19 have both statistical and clinical significance with mortality, but age >59 and anemia have no clinical significance."

"Latar Belakang: Sepsis merupakan salah satu penyebab utama kematian di unit perawatan intensif. Dalam kasus infeksi, pemberian cairan intravena dan agen vasoaktif sangat direkomendasikan sebagai salah satu tatalaksana pasien sepsis. Namun, banyak studi yang belum dapat menunjukkan temuan positif sesuai dengan studi orisinil EGDT. Tujuan: Tujuan penelitian ini adalah mengetahui hubungan antara mortalitas pasien sepsis dengan waktu pemberian vasoaktif selama proses resusitasi cairan di Unit Perawatan Intensif Rumah Sakit Cipto Mangunkusumo. Metode: Studi ini menggunakan metode cohort retrospective dengan 188 subjek yang didapatkan melalui pemenuhan kriteria penelitian dari rekam medis pasien. Subjek dibagi menjadi dua kelompok, yaitu pasien sepsis yang mendapatkan terapi vasoaktif dalam enam jam pertama dan setelah enam jam. Hasil: Terdapat karateristik sosiodemografi dari subjek, antara lain jenis kelamin, usia, total cairan rerata, status transfusi, jenis cairan, jenis vasoaktif, penyakit penyerta, dan lama rawat di unit perawatan intensif. Dari hasil uji Chi-square didapatkan waktu pemberian vasoaktif terhadap mortalitas, bernilai P=0.282 dengan RR 1.060 95 CI 0.974-1.153. Diskusi: Hasil penelitian ini menunjukkan tidak adanya hubungan mortalitas dengan perbedaan waktu pemberian terapi vasoaktif tersebut.

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Background: Sepsis is the leading cause of death in intensive care unit. In case of infection, intravenous resuscitation and vasoactive agent are very recommended as one of the treatment for septic patient. However, many studies not yet able to show the positive findings in accordance with the EGDT original study.

Objectives: This study aims to find out the association between septic patient rsquo s mortality and the time of vasoactive administration during fluid resuscitation in Intensive Care Unit of Cipto Mangunkusumo Hospital.

Method: This is a cohort retrospective study with 188 subject which meet the criteria from medical record. The subjects are divided into two groups septic patients that are given vasoactive therapy within six hours and after six hours during fluid resuscitation.

Results: This study shows sociodemographic characteristics of the subjects, such as gender, age, total fluid average, transfusion status, type of fluid, type of vasoactive, comorbidities, and length of stay in ICU. Based on Chi Square test, relationship between mortality and timing of vasoactive administration, sequentially P 0.282 with RR 1.060 95 CI 0.974 1.153.

Discussion: No association between septic patient rsquo s mortality and time difference in administrating the vasoactive therapy. "