Risk-Factor for COVID-19 Patients with Ventilator Status at Sanglah Hospital: Cross-Sectional Study
Abstract
Abstract
Corona Virus Disease 19 is a contagious infectious disease that has a major impact on all aspects of life. This study explores the factors associated with the need for ventilators use in COVID-19 patients. This cross-sectional study uses secondary data from medical records, taken by total sampling technique, of patients treated at Sanglah Hospital from March 2020 to August 2020. Only complete and clear medical record of patients diagnosed with COVID-19 were analyzed using chi-square and stepwise logistic regression with SPSS for windows 25 software. This study had received ethical approval from the Udayana University independent ethics commission with the number 1839/UN 14.2.2.VII/LT/2020. Patients with aged ≥ 50 years (OR 2.8; 95% CI 1.45—5.54)), BMI > 25 kg/m2 (OR 4.5; 95% CI 1.57—13.03), alcohol consumption history (OR 3.8; 95% CI 1.35—10.81), hemoglobin level <10 g/dl (OR 3.8; 95% CI 1.74—9.15), or WBC ≥ 12.000 (OR 2.3; 95% CI 1.05—5.12), were at higher risk to use ventilator. Gender, smoking history, employment history, length of stay, having comorbidity had no significant difference in the need for a ventilator. The most dominant risk factor causing worsening outcomes of COVID-19 was BMI > 25 kg/m2.
Keywords: risk factor, ventilator status, COVID-19, body mass index
Abstrak
Corona Virus Disease 19 merupakan penyakit menular yang berdampak besar pada semua aspek kehidupan. Studi ini mengeksplorasi faktor-faktor yang berhubungan dengan kebutuhan penggunaan ventilator pada pasien COVID-19. Penelitian ini merupakan studi potong lintang menggunakan data sekunder dari rekam medis. Pengumpulan data menggunakan teknik total sampling dengan melakukan eksplorasi rekam medis pasien yang dirawat mulai bulan Maret 2020 sampai Agustus 2020 di RSUP Sanglah. Kriteria rekam medis yang digunakan dalam penelitian adalah rekam medis yang lengkap dan jelas dari pasien terdiagnosis COVID-19. Analisis dilakukan secara deskriptif dan analitik menggunakan uji chi-square, dan regresi logistik bertahap dengan software SPSS dari windows versi 25. Penelitian ini telah mendapatkan persetujuan etik dari komisi etik independen Universitas Udayana nomor 1839/UN 14.2.2.VII/LT/2020. Total sebanyak 331 rekam medis yang dianalisis. Pasien berumur ≥ 50 tahun (OR 2,8; 95%CI 1.45-5.54), indeks massa tubuh > 25 kg/m2 (OR 4.5; 95% CI 1.57—13.03), riwayat konsumsi alkohol (OR 3.8; 95% CI 1.35—10.81), kadar hemoglobin <10 g/dl (OR 3.8; 95% CI 1.74—9.15), jumlah lekosit ≥ 12.000 (OR 2.3; 95% CI 1.05—5.12), mempunyai risiko lebih besar untuk menggunakan ventilator selama perawatan. Jenis kelamin, riwayat merokok, riwayat pekerja migran, lama perawatan di rumah sakit, dan komorbiditas tidak berhubungan bermakna dengan penggunaan ventilator. Indeks massa tubuh >25 kg/m2 merupakan faktor risiko paling dominan terhadap perburukan pasien COVID-19 yang dinilai dari penggunaan ventilator selama dirawat di rumah sakit
Kata kunci: indeks massa tubuh, penggunaan ventilator, faktor risiko, COVID-19
References
World Health Organization (WHO). Novel Coronavirus ( 2019-nCoV ) 22 January 2020. WHO Bull [Internet]. 2020;(JANUARY):1–7.[cited 2021/01/05]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200122-sitrep-2-2019-ncov.pdf
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol. 2020;92(4):401–2. doi:10.1002/jmv.25678
Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid-19 - Studies needed. N Engl J Med. 2020;382(13):1194–6. doi:10.1056/NEJMp2002125
Bassetti M, Vena A, Giacobbe DR. The novel Chinese coronavirus (2019-nCoV) infections: Challenges for fighting the storm. Eur J Clin Invest. 2020;50(3). doi:10.1111/eci.13209
Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929–36. doi:10.1056/NEJMoa2001191
Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92(4):441–7. doi:10.1002/jmv.25689
Ren LL, Wang YM, Wu ZQ, Xiang ZC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020;133(9):1015–24. doi:10.1097/CM9.0000000000000722
Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV- 2: A prospective cohort study. Eur Respir J. 2020;55(5). doi:10.1183/13993003.00524-2020
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6). doi:10.1542/peds.2020-0702
Sattar N, McInnes IB, McMurray JJ V. Obesity a Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms. Circulation. 2020;44(0):1–8. doi:10.1161/circulationaha.120.047659
Kusumastuti A, Arawindha U, Harjo IWW. Indonesia migrant worker’s strategy toward covid-19: Study of migrant’s knowledge and host countries’ policy. Proc Int Conf Ind Eng Oper Manag [Internet]. 2020;(August):3061–70. [cited 2021/01/05]. Available from: http://www.ieomsociety.org/detroit2020/papers/623.pdf
Group WB. Summary of Key Messages. Gend Dimens COVID-19 pandemic [Internet]. 2020;18(April):964–9. [cited 2021/01/05]. Available from: http://pubdocs.worldbank.org/en/232551485539744935/WDR17-BP-Gender-based-violence-and-the-law.pdf
Agrawal H, Das N, Nathani S, Saha S, Saini S, Kakar SS, et al. An Assessment on Impact of COVID-19 Infection in a Gender-Specific Manner. Stem Cell Rev Reports. 2021;17(1):94–112.doi:10.1007/s12015-020-10048-z
Sayad B, Afshar ZM, Mansouri F, Rahimi Z. Leukocytosis and alteration of hemoglobin level in patients with severe COVID-19: Association of leukocytosis with mortality. Heal Sci Reports. 2020;3(4):2–4. doi:10.1002/hsr2.194
Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology. 2021;64(1):36–47. doi:10.1159/000512592
Peres KC, Riera R, Martimbianco ALC, Ward LS, Cunha LL. Body Mass Index and Prognosis of COVID-19 Infection. A Systematic Review. Front Endocrinol (Lausanne). 2020;11(August). doi:10.3389/fendo.2020.00562
Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Heal. 2020;8(April):1–6. doi:10.3389/fpubh.2020.00152
Liu Y, Mao B, Liang S, Yang JW, Lu HW, Chai YH, et al. Association between age and clinical characteristics and outcomes of COVID-19. Eur Respir J. 2020;318(6). doi:10.1183/13993003.01112-2020
Cortis D. On Determining the Age Distribution of COVID-19 Pandemic. Front Public Heal. 2020;8(May):1–3. doi:10.3389/fpubh.2020.00202
Chang WH. Understanding the COVID-19 pandemic from a gender perspective. Taiwan J Obstet Gynecol. 2020;59(6):801–7. doi:10.1016/j.tjog.2020.09.004
Elgendy IY, Pepine CJ. Why are women better protected from COVID-19: Clues for men? Sex and COVID-19. International J Cardiol. Int J Cardiol. 2020;315:105-106. doi:10.1016/j.ijcard.2020.05.026
Martin PL. Labor Migration in Asia. International Migration Review. 1991;25(1):176-193. doi:10.1177/019791839102500108
Economic and Social Commission for Western Asia (ESCWA). Impact of COVID-19 on Migrants and Refugees in the Arab Region. In 2020. Available from: https://www.ilo.org/beirut/publications/WCMS_764756/lang--en/index.htm
Vardavas CI, Nikitara K. COVID-19, and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;18:20. Published 2020 Mar 20. doi:10.18332/tid/119324
Chodkiewicz J, Talarowska M, Miniszewska J, Nawrocka N, Bilinski P. Alcohol consumption reported during the COVID-19 pandemic: The initial stage. Int J Environ Res Public Health. 2020;17(13):1–11. doi:10.3390/ijerph17134677
Rehm J, Kilian C, Ferreira-Borges C, Jernigan D, Monteiro M, Parry CDH, et al. Alcohol use in times of the COVID 19: Implications for monitoring and policy. Drug Alcohol Rev. 2020;39(4):301–4.doi:10.1111/dar.13074
Xu J, Li Y, Xia Q, Shi Q. Association between thyroid disease and severe coronavirus disease 2019 (COVID-19) infection: A meta-analysis. Iran J Public Health. 2021;50(8):1517-1525. doi:10.18502/ijph.v50i8.6797
Vaduganathan M, Vardeny O, Mcmurray JJ V, Pfeffer MA, Ph.D., Solomon SD. Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med. 2020;382(17):1653-1659. doi:10.1056/NEJMsr2005760
Rossi GP, Sanga V, Barton M. Potential harmful effects of discontinuing ace-inhibitors and arbs in COVID-19 patients. Elife. 2020;9:e57278. Published 2020 Apr 6. doi:10.7554/eLife.57278
Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID-19 [published online ahead of print, 2020 Mar 31]. Diabetes Metab Res Rev. 2020;e3319. doi:10.1002/dmrr.3319
Karimi Shahri M, Niazkar HR, Rad F. COVID-19 and hematology findings based on the current evidence: A puzzle with many missing pieces. Int J Lab Hematol. 2021;43(2):160-168. doi:10.1111/ijlh.13412
Domenica CM, Perla E, Antonio P, John P, Ali T, Paul T. The Covid – 19 Pandemic and Haemoglobin Disorders. In: A contribution of Thalassaemia International Federation to its global patients’ community Federation to its global patients’ community [Internet]. 2020. p. 1–13. [cited 2021/01/05]. Available from: https://www.thalassemia.org/boduw/wp-content/uploads/2020/03/COVID-19-pandemic-and-haemoglobin-disorders_V3.pdf
Algassim AA, Elghazaly AA, Alnahdi AS, Mohammed-Rahim OM, Alanazi AG, Aldhuwayhi NA, et al. Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection. Ann Hematol. 2021;100(1):37-43. doi:10.1007/s00277-020-04256-3
Carsana L, Sonzogni A, Nasr A, Rossi RS, Pellegrinelli A, Zerbi P, et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-center descriptive study. Lancet Infect Dis. 2020;20(10):1135-1140. doi:10.1016/S1473-3099(20)30434-5
Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID-19 infection. [published correction appears in Am J Hematol. 2020 Nov;95(11):1442]. Am J Hematol. 2020;95(6):E131-E134. doi:10.1002/ajh.25774
Rosenzweig JD, McThenia SS, Kaicker S. SARS-CoV-2 infection in two pediatric patients with immune cytopenias: A single-institution experience during the pandemic. Pediatr Blood Cancer. 2020;67(9):e28503. doi:10.1002/pbc.28503
Lopez C, Kim J, Pandey A, Huang T, DeLoughery TG. Simultaneous onset of COVID-19 and autoimmune hemolytic anemia. Br J Haematol. 2020;190(1):31-32. doi:10.1111/bjh.16786
Faghih Dinevari M, Somi MH, Sadeghi Majd E, Abbasalizad Farhangi M, Nikniaz Z. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect Dis. BMC Infect Dis 21, 170 (2021). https://doi.org/10.1186/s12879-021-05868-4
Sun Y, Zhou J, Ye K. White blood cells and severe covid-19: A mendelian randomization study. J Pers Med. 2021;11(3):195. Published 2021 Mar 12. doi:10.3390/jpm11030195
Wang J, Jiang M, Chen X, Montaner LJ. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol. 2020;108(1):17-41. doi:10.1002/JLB.3COVR0520-272R
Rees EM, Nightingale ES, Jafari Y, Waterlow NR, Clifford S, Carl CA, et al. COVID-19 length of hospital stay: A systematic review and data synthesis. BMC Med. 2020;18(1):270. Published 2020 Sep 3. doi:10.1186/s12916-020-01726-3
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7
IHME. Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator-days, and deaths by US state in the next 4 months. medRxiv 2020;114:1–26. doi: 10.1101/2020.03.27.20043752
