Agung Prasetyo, 2022, Tesis. Interleukin 6 dan Tumor Necrosis Factor Alpha Sebagai Prediktor Mortalitas Pasien COVID-19. Supervisor I: Dr. dr. Harsini, dr. Sp.P(K), MMR, FISR; Supervisor II: Prof. Dr. dr. Yusup Subagio Sutanto, Sp.P(K), FISR, FAPSR. Program Pendidikan Dokter Spesialis Pulmonologi dan Kedokteran Respirasi, Fakultas Kedokteran, Universitas Sebelas Maret, Surakarta.

RINGKASAN

INTERLEUKIN 6 DAN TUMOR NECROSIS FACTOR ALPHA SEBAGAI PREDIKTOR MORTALITAS PASIEN COVID-19

Agung Prasetyo, Harsini, Yusup Subagio Sutanto

Bagian Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Sebelas Maret Surakarta/ RSUD dr. Moewardi Surakarta

Pendahuluan: Coronavirus disease 2019 (COVID-19) merupakan penyakit infeksi akibat SARS-CoV-2. Derajat keparahan COVID-19 bervariasi dari asimptomatis hingga derajat kritis. Pemeriksaan penanda inflamasi sepeti interleukin 6 (IL-6) dan tumor necrosis factor alpha (TNF-?) dapat membantu klinisi dalam menilai outcome pasien infeksi. Namun untuk memprediksi mortalitas pasien COVID-19 masih belum jelas.

Metode: Penelitian ini merupakan uji diagnostik dengan metode analitik dengan rancangan prospektif antara kadar serum interleukin 6 dan TNF-?. Subjek adalah pasien COVID-19 yang dirawat di bangsal isolasi RSUD Dr. Moewardi selama bulan Januari dan Februari 2022. Metode pengambilan subjek yang digunakan adalah consecutive sampling. Data diuji dengan uji mann whitney. Kurva ROC untuk menentukan nilai cut off dari pemeriksaan IL-6 dan TNF-?. Hasil penentuan cut off tersebut didapat hasil nilai sensitivitas, spesifisitas, nilai duga positif (NDP) dan nilai duga negatif (NDN).

Hasil: Interleukin 6 memiliki nilai AUC 0,686. Nilai cut off  IL-6 sebagai prediktor mortalitas ? 49,50 pg/ml memiliki sensitivitas 0,688; spesifisitas 0,709 dengan nilai p<0 CI]=1,604-17,924).>Tumor necrosis factor alpha mendapat nilai AUC 0,594. Nilai cut off TNF-? sebagai prediktor mortalitas ? 17,40 pg/ml memiliki sensitivitas 0,563; spesifisitas 0,637 dengan nilai p=0,088 (95% confidence interval [CI]=0,848- 8,239).

Kesimpulan: Interleukin 6 dapat dipertimbangkan sebagai prediktor awal mortalitas pasien COVID-19 derajat ringan, sedang, berat dan kritis.

Kata kunci: COVID-19, prediktor mortalitas, interleukin 6, tumor necrosis factor alpha

Agung Prasetyo, 2022, Thesis. Interleukin 6 and Tumor Necrosis Factor Alpha as Predictors of Mortality in COVID-19 Patients. Supervisor I: Dr. Harsini, dr. Sp.P(K), MMR, FISR; Supervisor II: Prof. Dr. dr. Yusup Subagio Sutanto, Sp.P(K), FISR, FAPSR. Department of Pulmonology and Respiratory Medicine. Medical Faculty of Sebelas Maret University Surakarta/ Dr.Moewardi General Hospital Surakarta.

INTERLEUKIN 6 AND TUMOR NECROSIS FACTOR ALPHA AS PREDICTORS OF MORTALITY IN COVID-19 PATIENTS

Agung Prasetyo, Harsini, Yusup Subagio Sutanto

Pulmonary and Respiratory Medicine

Medical Faculty of Sebelas Maret University / Dr. Moewardi General Hospital Surakarta, Central Java

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. The severity of COVID-19 varies from asymptomatic to critical. Examination of inflammatory markers such as interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-?) can assist clinicians in assessing the outcome of infected patients. However, it is not clear how to predict the mortality of COVID-19 patients.

Methods: This study is a diagnostic test using an analytical method withprospective design between serum levels of interleukin 6 and TNF- ? in COVID-19 patients. The subject is a COVID-19 patient who is being treated in the isolation ward of the RSUD Dr. Moewardi during January and February 2022. The method of taking the subject used was consecutive sampling. The data were tested by the Mann Whitney test. ROC curve to determine the cut-off value of IL-6 and TNF-? assays. The results of the determination of the cut off obtained the results of the value of sensitivity, specificity, positive predictive value and negative predictive value.

Results: Interleukin 6 has an AUC value of 0.686. The cut off value of IL-6 as a predictor of mortality 49.50 pg/ml has a sensitivity of 0.688; specificity 0.709 with p value <0 xss=removed xss=removed CI]=0,848->

Conclusion: Interleukin 6 can be considered as an early predictor of mortality in mild, moderate, severe and critical COVID-19 patients.

Keywords: COVID-19, mortality predictor, interleukin 6, tumor necrosis factor alpha