Clinical and Laboratory Features of COVID-19 in Ulin Referral Hospital of South Kalimantan: Predictors of Clinical Outcome

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

Comparison of Inflammation Parameters in the Elderly and Adults to the Outcomes of Confirmed Covid-19 Patients

“…The results of this study are similar to previous studies conducted at RSUD Ulin regarding the clinical and laboratory features of confirmed COVID-19 patients treated at RSUD Ulin by Haryati., et al, in the form of significant differences between age and gender in patient outcomes. 18 However, in this study, it was found that comorbidities also had a significant difference between the outcomes of patients who survived versus those who did not. This could be due to the heterogeneity of the wider sample due to the larger number of samples compared to previous studies.…”

“…Women are thought to be more capable of fighting viruses because of the protection of the X chromosome and sex hormones (estrogens) which play an important role in innate and adaptive immunity. [18][19][20] COVID-19 infection is also more likely to have an adverse outcome in patients with preexisting comorbidities than those without comorbidities. Shi., et al reported that the risk of death in COVID-19 patients with any comorbidities was 2.85 times higher than in the group without comorbidities.…”

“…23 When compared with a study conducted at Ulin Hospital itself, a significant increase in NLR and CRP values was also reported in the non-survive group compared to the survivors. 18 Regarding the differences in the elderly population with adults, a systematic review of clinical features in the elderly group by Neumann-Podczaska., et al, reported the incidence of lymphopenia with an increase in median CRP and ESR (> 10 mg/L and > 35 mm/hour) in various studies that were reviewed, although not accompanied by the results of the meaningfulness test. 24 CRP is a non-specific acute phase reactant that is induced by IL-6 in the liver.…”

The Correlations Between Clinical Characteristics and Inflammation Markers with Chest X-rays in COVID-19 Patients at Ulin Hospital

“…1 Other parameters, like inflammation markers, have also been used as predictors for prognosis. 3 These variables complement each other. Based on those considerations, this study aimed to examine their connection and to find their correlation.…”

Supplementation of Nigella sativa as Antioxidant in COVID-19 Patients: In silico Study via the Nrf2-Keap1 Pathway

“…1,2 There were 4,260,677 confirmed COVID-19 patients in Indonesia between March 2, 2020 and December 20, 2021, with 144,013 deaths. 2 COVID-19 infection is caused by viruses that enter cells and increase oxygen consumption, causing hypoxia in the cells, which causes oxidative stress and increased activity of antioxidant enzymes like peroxidase, catalase, and superoxide dismutase. Furthermore, oxidative stress can activate a number of transcription factors, including nuclear factor kappa-B (NF κB), p53, HIF-hypoxia-inducible factor 1α, peroxisome proliferator-activated receptor γ (PPAR-γ), β-catenin/Wnt, and Nrf2.…”