Abstract. Introduction: Corona virus disease 2019 (COVID-19) is a new disease that causes millions of deaths worldwide. The majority of deaths are due to pulmonary degeneration leading to respiratory failure. The gold standard for COVID-19 diagnostics is the examination of the nucleic acid of the SARS-CoV-2 virus using RT-PCR which produces CT values for the SARS-CoV-2 gene target and internal control (CT). One of the target genes that is often examined in COVID-19 examination is gene E. This study aims to analyze the relationship between the CT IC/CT gene E ratio and the relative expression of the SARS-CoV-2 E gene with the incidence of respiratory failure. Methods: This study is a cross sectional study conducted at X General Hospital on 196 patients. Data obtained from medical records in the form of patient characteristics and PCR examination results from the laboratory. Relative gene expression was calculated using the livak method (2-ΔΔCT). The CT ratio was calculated by comparing the internal control CT with the CT gene E. The relationship of gene relative expression and CT ratio with the incidence of respiratory failure was analyzed using thestatistic unpaired t-test at 95% confidence level. Results: The results showed that the characteristics of COVID-19 patients were more males, aged 41-60 and 40 of the total patients experienced pulmonary distress. The unpaired t-test showed that there was no relationship between the CT IC/CT gene E ratio and the relative expression of the SARS-CoV-2 gene E and the incidence of respiratory failure, with P values (P=0.2083) and (P=0,8018). Conclusion: The conclusion of this study is that there is no relationship between the ratio of internal control CT/CT of the SARS-CoV-2 gene and the relative expression level of the SARS-CoV-2 E gene with the incidence of respiratory failure in confirmed COVID-19 patients hospitalized at Hospital X. There are several factors that influence the incidence of respiratory failure in addition to comorbidities such as age and gender. Abstrak. Pendahuluan: Corona virus disease 2019 (COVID-19) adalah penyakit baru yang menyebabkan jutaan kematian di seluruh dunia. Mayoritas kematian disebabkan oleh perburukan paru yang berujung pada gagal napas. Standar baku emas diagnostik COVID-19 adalah pemeriksaan asam nukleat virus SARS-CoV-2 dengan menggunakan RT-PCR yang menghasilkan nilai CT target gen SARS-CoV-2 dan internal control (CT). Salah satu gen target yang sering diperiksa pada pemeriksaan COVID-19 adalah gen E. Penelitian ini bertujuan untuk menganalisis hubungan rasio CT IC/CT gen E dan ekspresi relatif gen E SARS-CoV-2 dengan kejadian gagal napas. Metode: Penelitian ini merupakan penelitian cross sectional yang dilakukan di RS X pada 196 pasien. Data diperoleh dari medical record berupa karakteristik pasien dan hasil pemeriksaan PCR dari laboratorium. Ekspresi gen relatif dihitung dengan menggunakan metode livak (2-ΔΔCT). Rasio CT dihitung dengan membandingkan CT internal control dengan CT gen E. Hubungan ekspresi relatif gen dan rasio CT dengan kejadian gagal napas dianalisis menggunakan uji statistik unpaired t-test pada tingkat kepercayaan 95%. Hasil: Hasil penelitian didapatkan karakteristik pasien COVID-19 lebih banyak laki-laki, usia 41−60 dan 40 orang dari total pasien mengalami pulmonary distress. Uji unpaired t-test menujukan tidak terdapat hubungan antara rasio CT IC/CT gen E dan ekspresi relatif gen E SARS-CoV-2 dengan kejadian gagal napas, dengan nilai P berturut-turut P=0,2083 dan P=0,8018. Kesimpulan: Kesimpulan penelitian ini adalah tidak terdapat hubungan antara rasio CT internal control/CT gen E SARS-CoV-2 dan tingkat ekspresi relatif gen E SARS-CoV-2 dengan kejadian gagal napas pada pasien terkonfirmasi COVID-19 yang dirawat inap di RS X. Terdapat beberapa faktor yang memengaruhi kejadian gagal napas selain komorbid seperti usia dan jenis kelamin.
Until now, the world is still facing the COVID-19 pandemic caused by SARS-CoV-2. The number of deaths of COVID-19 patients in Indonesia is quite large when compared to other countries. Clinical manifestations, comorbidities, length of stay, and the mortality of COVID-19 vary widely in each study. This study analyzes clinical characteristics, comorbidities, length of stay, and mortality of COVID-19 patients in RSUD Cideres, Majalengka, West Java. This study is an observational study with total sampling and purposive sampling. Subjects were patients with nasal swabs confirmed SARS-CoV-2 and hospitalized at RSUD Cideres from January to July 2021. Clinical manifestations, comorbidities, length of stay, and mortality of COVID-19 patients aged ≥17 years old, were extracted from medical records. Results showed that the majority of 213 COVID-19 patients were age 41–60 years 114 (53.5%), female 114 (53.5%), with an upper respiratory tract in 207 (97.1%), and shortness of breath in 203 (95.3%) patients. 153 (71.8%) patients had a fever, while headache, diarrhea, and anosmia respectively 49 (23.0%), 19 (8.9%), and 10 (4.6%), respectively. Vital signs were the Glasgow Coma Scale (GCS) normal in 190 (89.2%) patients. Most of patients had respiration rate >20/min in 201 (94.3%), oxygen saturation <90% in 98 (46.0%), and chest x-rays: bronchopneumonia 134 (62.9%) and pneumonia 23 (10.7%). Comorbidities were hypertension, diabetes mellitus, and chronic heart failure in 74 (34.7%), 56 (26.2%), and 46 (11.7%) patients, respectively. The length of stay who died for 1–7 days (22 patients) and 8–14 days (9 patients); means almost all patients (29 of 32) died during the length of stay for 1–14 days. In conclusion, the majority of COVID-19 patients at RSUD Cideres are female, aged 41–60 years, had upper respiratory tract/shortness of breath, GCS normal, saturation oxygen <90%, chest x-rays: bronchopneumonia and pneumonia, comorbidities: hypertension, and length of stay for patients who died 1–7 days. KARAKTERISTIK KLINIS, KOMORBITAS, LAMA RAWAT, DAN MORTALITAS PASIEN COVID-19 DI RSUD CIDERES, MAJALENGKA, JAWA BARATHingga saat ini, dunia masih menghadapi pandemi COVID-19 yang disebabkan oleh SARS-CoV-2. Jumlah kematian pasien COVID-19 di Indonesia cukup besar jika dibanding dengan negara lain. Manifestasi klinis, komorbid, lama rawat, dan mortalitas pasien COVID-19 sangat bervariasi pada setiap penelitian. Tujuan penelitian ini menganalisis karakteristik klinis, komorbiditas, lama rawat, dan mortalitas pasien COVID-19 di RSUD Cideres, Majalengka, Jawa Barat. Penelitian ini adalah penelitian observasional dengan total sampling dan purposive sampling. Subjek adalah pasien dengan nasal swab terkonfirmasi SARS-CoV-2 dan dirawat di RSUD Cideres periode Januari hingga Juli 2021. Data manifestasi klinis, komorbid, lama rawat, dan mortalitas pasien COVID-19 usia ≥17 diambil dari rekam medik. Hasil menunjukkan bahwa mayoritas 213 pasien COVID-19 berusia 41–60 tahun 114 (53,5%) dan wanita 114 (53,5%) dengan keluhan saluran napas atas 207 (97,1%) dan napas pendek 203 (95,3%) pasien. 153 (71,8%) pasien mengalami demam, sedangkan sakit kepala, diare, dan anosmia masing-masing 49 (23,0%), 19 (8,9%), dan 10 (4,6%) pasien. Tanda vital Glasgow Coma Scale (GCS) normal pada 190 (89,2%) pasien. Kebanyakan pasien mempunyai frekuensi napas >20/menit pada 201 (94,3%) pasien, saturasi oksigen <90% pada 98 (46,0%) pasien, serta rontgen toraks: bronkopneumonia pada 134 (62,9%) pasien dan pneumonia pada 23 (10,7%) pasien. Komorbid adalah hipertensi, diabetes melitus, dan chronic heart failure pada 74 (34,7%), 56 (26,2%), dan 46 (11,7%) pasien berturut-turut. Lama rawat pasien yang meninggal 1–7 hari (22 pasien) dan 8–14 hari (9 pasien), berarti hampir semua pasien (29 dari 32) meninggal selama rawat 1–14 hari. Simpulan, mayoritas pasien COVID-19 di RSUD Cideres adalah wanita, berusia 41–60 tahun, keluhan saluran napas atas/napas pendek, GCS normal, rontgen toraks: bronkopneumonia dan pneumonia, komorbid: hipertensi, serta lama rawat pasien yang meninggal paling banyak 1–7 hari.
Introduction: Real time quantitative PCR is the gold standard for detection of SARS-CoV-2 which is specific, sensitive, and simple quantitative. The target of RT-qPCR is to assess the expression level of the SARS-CoV-2 gene through cycle threshold values (CT-value). The purpose of this study was to analyze the association of the level of SARS-CoV-2 gene expression and the severity of COVID-19 in patients hospitalized. Method: This research is an analytic observational study with cross sectional method. While the research sample was taken using a consecutive sampling technique from the Medical Records of Sumedang Hospital and Cideres Hospital, West Java, Indonesia from December 2020 to March 2021. Patient parameters include analysis of age, sex, comorbidity, and disease severity. The severity of the patient is classified based on complaints and oxygen saturation. The expression level of the SARS-CoV-2 N gene and E gene were assessed by calculating the relative quantification by comparing the expression of the E and N gene with the expression of the internal control gene by Livak formula (2-ΔΔCT Formula). Result: The Spearman correlation test showed that there was a relationship between the expression of SARS-CoV-2 genes E and N genes with the severity of COVID-19 patients (with r=0.374 and p<0.0001) and (with r=0.452 and p<0.0001). Conclusions: There is an correlation between the level of expression of genes E and gene N with the severity of patients.
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