RESUMO
Some of coronavirus disease 2019 (COVID-19) patients died after being hospitalized and early mortality is a matter of concern during the pandemic; therefore, it is critical to determine which patients are the most vulnerable of having early mortality. The aim of this study was to determine the risk factors for early mortality among hospitalized COVID-19 patients in Indonesia. A retrospective cohort study was conducted on hospitalized COVID-19 patients from July 2020 to September 2021 at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Demographic data, clinical characteristics, laboratory findings, and mortality were collected. Early mortality was defined as a death before seven days of the hospitalization. Multivariate regression analysis was employed to determine the risk factors associated with early mortality. We included the data of 624 COVID-19 patients who died during the study period. More than half of the patients were male and aged over 50 years old. The average hospitalization period was 10 days and most patients had more than two comorbidities. Chronic lung disease was the most common comorbidity (46.0%) followed by respiratory disease (26.8%) and heart disease (14.3%). Multiple comorbidities and elevated D-dimers exceeding 3376.92 ng/mL were associated with early mortality with OR: 7.029; 95%CI: 2.02-24.43 and OR: 1.000085, 95%CI: 1.000028-1.000142, respectively. In conclusion, early mortality in COVID-19 patients was associated with having multiple comorbidities and elevated D-dimer level. Therefore, it is crucial to assess the presence of comorbidities and routine laboratory test while managing COVID-19 patients in order to prevent the early mortality.
RESUMO
Post coronavirus disease 2019 (COVID-19) syndrome is one of the causes of reduced functional capacity and work productivity, in particular for healthcare workers. The pathophysiology of the post COVID-19 syndrome is related to complex and multisystem inflammatory mechanisms, and cardiopulmonary exercise rehabilitation program is one of the efforts to improve the recovery process for patients with post COVID-19 syndrome. The aim of this study was to determine the correlation between the level of high sensitivity C-reactive protein (Hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) with functional capacity (VO2max) in individuals with post-COVID-19 syndrome who received moderate- and high-intensity supervised cardiopulmonary exercise. A prospective cohort study was conducted at the Integrated Cardiac Rehabilitation Center of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. The supervised cardiopulmonary exercise was conducted for six weeks according to the participant's baseline VO2max. Spearman's and Pearson's correlation tests were used to assess the correlations. A total of 30 individuals (19 and 11 had moderate and high intensity exercise, respectively) were involved in this study. At moderate intensity exercise, the average Hs-CRP and NLR were 3.3 mg/L and 1.99, respectively; while at high intensity, the values were 3.8 mg/L and 1.79, respectively. No significant correlation between Hs-CRP level and functional capacity in both moderate-intensity and high intensity groups. In contrast, NLR was negatively correlated with functional capacity (r=-0.545, p=0.016) in moderate intensity exercise group. In conclusion, NLR value was negatively correlated with functional capacity in individuals with post-COVID-19 syndrome after receiving moderate intensity supervised cardiopulmonary exercise program. Therefore, moderate intensity of cardiopulmonary exercise maybe be used as a program to accelerate the recovery for those with post COVID-19 syndrome.
