Arganita, Fidya Rahmadhany
Department Of Pulmonology And Respiratory Medicine, Faculty Of Medicine, Lambung Mangkurat University/Ulin Hospital, Banjarmasin, South Kalimantan, Indonesia

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Clinical and Laboratory Features of COVID-19 in Ulin Referral Hospital of South Kalimantan: Predictors of Clinical Outcome Haryati, Haryati; Isa, Mohamad; Assagaf, Ali; Nurrasyidah, Ira; Kusumawardhani, Erna; Suhartono, Eko; Arganita, Fidya Rahmadhany
Journal of Tropical Life Science Vol 11, No 3 (2021)
Publisher : Journal of Tropical Life Science

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jtls.11.03.06

Abstract

Corona Virus Disease (COVID-19) is becoming a global pandemic. Indonesia, especially South Kalimantan had recorded increasing cases with a high fatality rate of 3.7%. Information about factors related to outcomes based on clinical and laboratory features in Indonesia is still limited. Identification of the risk is crucial to determine optimal management and reducing mortality. This retrospective study enrolled 455 adults COVID-19 patients, and data were extracted from medical records of Ulin General Hospital Banjarmasin. The latter is COVID-19 referral hospital in South Kalimantan between March-November 2020. Demographic data, comorbidities, and laboratory were all collected. Data were compared between survivors and non-survivors. Fisher’s exact test and chi-square were used to compare categorical variables. The Mann_Whitney U test was used to compare continuous variables. Analysis was continued by multivariate logistic regression then receiver operating characteristic (ROC) curve to determine cut-off value. The multivariate analysis showed that number of comorbidities [odds ratio (OR) 1,339 (95% confidence interval (CI): 1,064-1,685, P = 0,013) was a significant risk factor to the outcome. In laboratory, lactate dehydrogenase (LDH) [OR: 1.001, 95% CI: 1,000-1.002, P = 0.001], Ferritin (OR 1.000, CI: 1,000-1.001, P = 0.013), APTT (OR: 1.045, CI: 1.010-1.082, P = 0.012), and D-dimer (OR: 1.188, CI: 1.064 - 1.327, P = 0.002) were significant predictor factors but only LDH, ferritin, and D- dimer were obtained good AUC 0.731, 0.715, and 0.705, respectively. The cut of the value of LDH was 656.5 U/L, ferritin was 672.18 ng/ml, and D-dimer was 2.28 mg/L. Sensitivity and specificity were 66.7% and 68,0% for LDH, 83,2% and 56,3% for ferritin, and 62,8 and 70,8% for D-dimer. From this research, we revealed that the number of comorbidities was a risk factor for death. Elevated LDH, ferritin, and D-dimer could be good predictive factors for poor outcomes, thereby considering the accelerating management of COVID-19 patients.
Tocilizumab In Severe To Critical Confirmed COVID-19: A Case Series At Ulin Referral Hospital Of South Kalimantan Haryati Haryati; Fidya Rahmadhany Arganita; Widya Ramadhaniati
Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan Vol 15, No 1 (2021): Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan
Publisher : Fakultas Kedokteran UPN Veteran Jakarta Kerja Sama KNPT

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33533/jpm.v15i1.2862

Abstract

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new type of coronavirus that causes pneumonia. The clinical severity of COVID-19 is related to the presence of a “cytokine storm” that causes overproduction of inflammatory mediators such as interleukin (IL)-6. Tocilizumab (TCZ) as an IL-6 inhibitor is subject of major studies as a potential therapeutic agent. This study reported 20 cases of COVID-19 patients being treated with the IL-6 inhibitor TCZ beside standard therapy. Patients were followed up on clinical, laboratory and chest x-rays before and after the administration of therapy which were report descriptively. The oxygen saturation of patients who survived shows rapid improvements. The laboratory results showed that CRP decreased after administration TCZ immediately. Meanwhile, other markers improve slowly, such as leucocytes, Neutrophyl Lymphocyte Ratio (NLR), Absolute Lymphocyte Count (ALC) and Lactate Dehydrogenase (LDH) but ferritin was tended to fluctuate. In chest X-ray’s, infiltrate bilateral on admission began to diminished until almost disappeared on the 14th day after TCZ. From 20 patients, 80% of patients survived with improvement in clinical, laboratory and chest X-rays, while the rest death with a good response on first therapy but fluctuated and worsened before death. Tocilizumab can be considered to provide clinical improvements in severe and critical COVID-19 patients.