Kadek Surya Atmaja
Intern of Pulmonology and Respiratory Medicine Department, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia

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Dramatic improvement in severe-critical COVID-19 patient after tocilizumab administration: a clinical experience Yesicha Kurniawati; Kadek Surya Atmaja; Ketut Suryana; Wayan Wahyu Semara Putra
Intisari Sains Medis Vol. 12 No. 1 (2021): (Available online : 1 April 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (321.573 KB) | DOI: 10.15562/ism.v12i1.951

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in coronavirus disease 2019 (COVID-19) involve so many inflammatory cytokines, especially Interleukin-6 (IL-6). The usage of tocilizumab as an anti-IL-6 receptor antibody had been approved as COVID-19 medication.Case Presentation: This article reports a 51-year-old woman diagnosed with severe-critical COVID-19. The patient made significant progress after tocilizumab administration. The patient was hospitalized for 14 days before being discharged.Conclusion: Tocilizumab administration showed a significant improvement in COVID-19 patients.  However, further investigations are needed to explain this further.
Hubungan konsentrasi serum C-Reactive Protein dan D-dimer dengan derajat keparahan dan mortalitas pasien COVID-19 Kadek Surya Atmaja; Anak Agung Gede Oka Suta Wicaksana; I Wayan Angga Suarmerta Putra; Wayan Wahyu Semara Putra
Intisari Sains Medis Vol. 12 No. 2 (2021): (Available Online: 1 August 2021)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (429.835 KB) | DOI: 10.15562/ism.v12i2.971

Abstract

Background: Clinical features of COVID-19 are variably from asymptomatic, to severe symptoms including acute respiratory distress syndrome (ARDS), multiple organ failure, and death. A specific biomarker is needed to predict the possibility of COVID-19 patients fall into severe complications and disease severity. D-dimer and C-Reactive Protein (CRP) are biomarkers that are elevated in COVID-19 patients.Method: This is an observational analytic study. The purpose of this research is to explore the correlation between D-dimer serum concentration and CRP with disease severity and mortality in hospitalized COVID-19 patients. This research used secondary data from a medical record with inclusion criteria patient more than 18 years old, confirmed COVID-19 by real-time Polymerase chain reaction (rt-PCR), that hospitalized in Wangaya General Hospital during July 2020 until December 2020.Result: Statistical analysis show that there is significant mean difference between D-dimer and CRP concentration based on COVID-19 disease severity (p <0.001 dan p <0.001). AUC value on ROC curve for CRP and D-dimer concentration in predict the mortality of COVID-19 patient are 0.88 (p <0.001, 95% CI: 0.829 – 0.48) and 0.88 (p < 0.001, 95% CI = 0.821 – 0.950) respectively. In this research, serum D-dimer with concentration more than 4,181 ng/mL statistically significant affect the mortality of COVID-19 patient (OR = 11.713; CI = 1.620 - 84.682; p = 0.015). CRP concentration statistically is not significant affect the mortality of COVID-19 patient.Conclusion: There is a statistically mean difference in both D-dimer and CRP concentration based on COVID-19 disease severity. D-dimer concentration of more than 4,181 ng/mL significantly affects the COVID-19 mortality. CRP concentration is not correlated with COVID-19 mortality Latar Belakang: Fitur klinis pasien dengan COVID-19 bervariasi dari tanpa gejala maupun dengan gejala ringan hingga terjadinya acute respiratory distress syndrome (ARDS), gagal multi organ, dan kematian. Dibutuhkan suatu biomarker yang dapat digunakan dalam memprediksi kemungkinan pasien yang akan jatuh kedalam derajat penyakit maupun komplikasi yang berat. D-dimer dan C-Reactive Protein (CRP) merupakan biomarker yang diketahui meningkat pada pasien COVID-19.Metode: Penelitian ini merupakan penelitian analitik observasional, yang bertujuan untuk mengetahui hubungan konsentrasi D-dimer serum dan CRP dengan derajat keparahan dan mortalitas pasien COVID-19 yang dirawat inap. Penelitian ini menggunakan data sekunder yang bersumber dari rekam medis dengan kriteria inklusi pasien usia diatas 18 tahun dengan diagnosis terkonfirmasi COVID-19 dengan real-time Polymerase chain reaction (rt-PCR), yang dirawat inap di RSUD Wangaya Denpasar periode Juli 2020 hingga Desember 2020.Hasil: Hasil uji statistik menunjukan terdapat perbedaan rerata konsentrasi D-dimer dan CRP berdasarkan derajat keparahan pasien COVID-19 yang bermakna secara statistik (p <0,001 dan p <0,001). Nilai AUC kurva ROC konsentrasi CRP dan D-dimer dalam memprediksi mortalitas pasien secara berturut-turut didapatkan  sebesar  0.88 (p <0,001,  95% IK: 0,829 – 0,48 ) dan 0.88 (p <0,001,  95% IK: 0,821 – 0,950). D-dimer serum dengan konsentrasi diatas 4.181 ng/mL pada penelitian ini terbukti  secara statistik bermakna  mempengaruhi mortalitas pasien COVID-19 (OR OR 11,713; IK:1,620-84,682; p=0,015). Konsentrasi CRP serum tidak terbukti secara statistik bermakna dalam mempengaruhi mortalitas pasien COVID-19.Simpulan:  Terdapat perbedaan rerata yang bermakna secara statistik konsentrasi serum D-dimer dan CRP berdasarkan derajat keparahan penyakit COVID-19. Konsentrasi serum D-dimer diatas 4.181 ng/mL terbukti mempengaruhi mortalitas pasien dengan COVID-19 secara bermakna. Konsentrasi CRP tidak berhubungan terhadap mortalitas pada pasien COVID-19.