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Acta Medica Indonesiana ; 53(4):407-415, 2021.
Article in English | MEDLINE | ID: covidwho-1624206


BACKGROUND: Many studies identified the risk factors and prognostic factors related to in-hospital COVID-19 mortality using sophisticated laboratory tests. Cost and the availability of supporting blood tests may be problematic in resource-limited settings. This multicenter cohort study was conducted to assess the factors associated with mortality of COVID-19 patients aged 18 years and older, based on history taking, physical examination, and simple blood tests to be used in resource-limited settings. METHODS: The study was conducted between July 2020 and January 2021 in five COVID-19 referral hospitals in Indonesia. Among 1048 confirmed cases of COVID-19, 160 (15%) died during hospitalization. RESULTS: Multivariate analysis showed eight predictors of in-hospital mortality, namely increased age, chronic kidney disease, chronic obstructive pulmonary disease, fatigue, dyspnea, altered mental status, neutrophil-lymphocyte ratio (NLR) >= 5.8, and severe-critical condition. This scoring system had an Area-under-the-curve (AUC) of 84.7%. With cut-off score of 6, the sensitivity was 76.3% and the specificity was 78.2%. CONCLUSION: The result of this practical prognostic scoring system may be a guide to decision making of physicians and help in the education of family members related to the possible outcome.

Acta Medica Indonesiana ; 53(2):194-201, 2021.
Article in English | MEDLINE | ID: covidwho-1305092


Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects.

Acta Medica Indonesiana ; 53(2):233-241, 2021.
Article in English | MEDLINE | ID: covidwho-1305090


Pulmonary fibrosis due to COVID-19 is recognized as sequel of ARDS characterized by failed alveolar re-epithelization, fibroblast activation, excessive collagen deposition and other extracellular matrix components that disrupt the normal lung architecture. There are risk factor for pulmonary fibrosis namely advanced age, severe ARDS infection, mechanical ventilation due to ventilator-induced lung injury, smoking and chronic alcoholism. Diagnosis of post-COVID pulmonary fibrosis can be made by clinical symptoms and characteristic finding from lung CT scan. To date, there is no definitive treatment for post-inflammatory pulmonary fibrosis after COVID-19 infection, however some of antifibrotic therapies may be considered. Beside medical treatment, pulmonary rehabilitation program and long-term oxygen treatment should be included as part of comprehensive treatment for pulmonary fibrosis due to COVID-19.

Acta Medica Indonesiana ; 53(2):141-142, 2021.
Article in English | MEDLINE | ID: covidwho-1305089


Since December 2019, COVID-19 caused by SARS-CoV-2 infection has been spread rapidly in the world. Beside acute respiratory distress syndrome found in acute phase of infection, there is also pulmonary fibrosis as a chronic complication due to COVID-19. With the global pandemic of COVID-19, more and more autopsy and puncture histopathological results have been published.Until now there is no specific therapy to handle post-inflammatory pulmonary fibrosis due to COVID-19 infection. Several studies are ongoing to determine an effective treatment for this chronic complication. While ARDS appears to be the main cause of pulmonary fibrosis in COVID-19, the pathogenesis of ARDS caused by SARS-CoV-2 is different from the typical ARDS. Some therapies may be considered for reducing the fibrosis process in lung after COVI-19 infection namely pirfenidone, nintedanib and mesenchymal stem cells. Many patients are still recovering spontaneously in the first six weeks after acute COVID-19 infection and do not generally require fast-track entry into a pulmonary rehabilitation programme. However, those who have significantly persistent respiratory illness may need to be supported by pulmonary rehabilitation. Multidisciplinary intervention based on personalized evaluation and treatment which includes exercise training, education and behavioral modification can be given to improve the physical and psychological condition of patients with post-COVID pulmonary fibrosis.