Pengkajian Terapi COVID-19 Pada Pasien Rawat Inap Komorbid Hipertensi Terhadap Derajat Keparahan Penyakit di RSJPD Harapan Kita

Adin Hakim Kurniawan, Nanda Puspita, Tri Indriyani Meitinawati, Lestiani Lestiani

Abstract

Kematian akibat Covid-19 menurut Centers for Disease Control and Prevention di Amerika Serikat terjadi pada pasien rentan dan memiliki riwayat komorbid penyakit seperti hipertensi. Virus SARS Cov-19 masuk kedalam sel manusia dan menginfeksi melalui ikatan dengan reseptor Angitensin Converting Enzym 2 (ACE 2). Terapi farmakologi pada penanganan Covid-19 dengan riwayat komorbid hipertensi dalam tahap pengujian secara klinis masih perlu dilakukan monitoring pengobatan yang tepat dan rasional sehingga perlu pengkajian farmakoterapi berdasarkan derajat keparahan penyakit. Penelitian ini bertujuan memahami faktor yang mempengaruhi derajat keparahan penyakit dan karakteristik terapi Covid-19 pada pasien rawat inap komorbid hipertensi. Penelitian ini menggunakan desain penelitian cohort retrospective. Pengambilan data di RSJPD Harapan menggunakan rekam medis pasien rawat inap dengan pasien Covid-19  pada komorbid hipertensi pada periode November 2020 sampai April 2021. Teknik pengambilan sampel menggunakan consequtive sampling dan Analisis statistik Chi square. Hasil penelitian menunjukan,dari 80 pasien, subjek penelitian laki-laki sebanyak 45 pasien (56,31%), usia produktif 45 pasien (56,30%). Kesesuaian peresepan dosis dan frekuensi terapi Covid-19sebesar 99,03%. Hasil analisis bivariat menunjukan adanya perbedaan bermakna pada pemberian terapi suportif Covid-19 (p=0,034), saturasi oksigen (p=0,024) serta lama perawatan pasien (p=0,008) terhadap derajat keparahan penyakit. Adapun hasil terapi Covid-19 memiliki perbedaan bermakna terhadap derajat keparahan, terdapat pada terapi levofloxacin (p=0,034);osetalmivir (p=0,030); favipiravir (p=0,027); remdesivir (p=0,009) dan spironolakton (p=0,034).

Keywords

derajat keparahan; komorbid hipertensi; terapi Covid-19

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References

Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E., Oczkowski, S., Levy, M. M., Derde, L., Dzierba, A., Du, B., Aboodi, M., Wunsch, H., Cecconi, M., Koh, Y., Chertow, D. S., Maitland, K., Alshamsi, F., Belley-Cote, E., Greco, M., Laundy, M., Morgan, J.L., Kesecioglu, J., McGeer, A., Mermel, L., Mammen, M.J., Alexander, P.E., Arrington, A., Centofanti, J.E., Citerio, G., Baw, B., Memish, Z.A., Hammond, N., Hayden, F.G., Evans, L., dan Rhodes, A. (2020). Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine. https://doi.org/10.1007/s00134-020-06022-5

Alsagaff, M. Y., Mulia, E. P. B., Maghfirah, I., Luke, K., Nugraha, D., Rachmi, D. A., Septianda, I., dan A’yun, M. Q. (2021). Association of calcium channel blocker use with clinical outcome of COVID-19: A meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15(5), 102210. https://doi.org/10.1016/j.dsx.2021.102210

Bajwah, S., Wilcock, A., Towers, R., Costantini, M., Bausewein, C., Simon, S. T., Bendstrup, E., Prentice, W., Johnson, M. J., Currow, D. C., Kreuter, M., Wells, A. U., Birring, S. S., Edmonds, P., dan Higginson, I. J. (2020). Managing the supportive care needs of those affected by COVID-19. European Respiratory Journal, 55(4), 2000815. https://doi.org/10.1183/13993003.00815-2020

Barlow, A., Landolf, K. M., Barlow, B., Yeung, S. Y. A., Heavner, J. J., Claassen, C. W., dan Heavner, M. S. (2020). Review of Emerging Pharmacotherapy for the Treatment of Coronavirus Disease 2019. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 40(5), 416–437. https://doi.org/10.1002/phar.2398

Bean, D. M., Kraljevic, Z., Searle, T., Bendayan, R., Kevin, O., Pickles, A., Folarin, A., Roguski, L., Noor, K., Shek, A., Zakeri, R., Shah, A. M., Teo, J. T. H., dan Dobson, R. J. B. (2020). Angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID‐19 infection in a multi‐site UK acute hospital trust. European Journal of Heart Failure, 22(6), 967–974. https://doi.org/10.1002/ejhf.1924

Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., Hohmann, E., Chu, H. Y., Luetkemeyer, A., Kline, S., Lopez de Castilla, D., Finberg, R. W., Dierberg, K., Tapson, V., Hsieh, L., Patterson, T. F., Paredes, R., Sweeney, D. A., Short, W. R., Touloumi,G., Lye, D. G., Ohmagari, N., Oh, M., Ruiz-Palacios, G. M., Benfield, T., Fätkenheuer, G.,Kortepeter, M. G., Atmar, R. L., Creech, B., Lundgren, J., Babiker, A. G., Pett, S., Neaton, J. D., Burgess, T. H., Bonnett, T., Green M., Makowski, M., Osinusi, A., Nayak, S., dan Lane, H. C. (2020). Remdesivir for the Treatment of Covid-19 — Final Report. New England Journal of Medicine, 383(19), 1813–1826. https://doi.org/10.1056/NEJMoa2007764

Burhan, E., Dwi Susanto, A., Isbaniah, F., Aman Nasution, S., Ginanjar, E., Wicaksono Pitoyo, C., Susilo, A., Firdaus, I., Santoso, A., Arifa Juzar, D., Kamsul Arif, S., Lolong Wulung, N. G., Muchtar, F., Pulungan, A. B., Ambara Sjakti, H., Prawira, Y., dan Dwi Putri. (2020). PEDOMAN TATALAKSANA COVID-19 Edisi 3. Jakarta: Perhimpunan Dokter Paru Indonesia (PDPI), Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI), Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI), Perhimpunan Dokter Anestesiologi dan Terapi Intensif Indonesia (PERDATIN), Ikatan Dokter Anak Indonesia (IDAI).

Cadegiani, F. A., Goren, A., dan Wambier, C. G. (2020). Spironolactone may provide protection from SARS-CoV-2: Targeting androgens, angiotensin converting enzyme 2 (ACE2), and renin-angiotensin-aldosterone system (RAAS). Medical Hypotheses, 143, 110112. https://doi.org/10.1016/j.mehy.2020.110112

Dalhoff, A. (2005). Immunomodulatory Activities of Fluoroquinolones. Infection, 33(S2), 55–70. https://doi.org/10.1007/s15010-005-8209-8

Fang, L., Karakiulakis, G., dan Roth, M. (2020). Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? The Lancet Respiratory Medicine, 8(4), e21. https://doi.org/10.1016/S2213-2600(20)30116-8

Gauvreau, G. M., dan Denburg, J. A. (2015). Human Mast Cell and Basophil/Eosinophil Progenitors. In Methods in Molecular Biology. 1220, pp. 59–68). Humana Press Inc. https://doi.org/10.1007/978-1-4939-1568-2_4

Gurwitz, D. (2020). Angiotensin receptor blockers as tentative SARS‐CoV‐2 therapeutics. Drug Development Research, 81(5), 537–540. https://doi.org/10.1002/ddr.21656

Kemenkes RI. (2020a). Data Sebaran COVID-19 di Indonesia 2020. Jakarta: Kementerian Kesehatan Republik Indonesia.https://covid19.go.id/

Kemenkes RI. (2020b). Pedoman Pencegahan dan Pengendalian Coronavirus Disease Covid-19 Revisi 5. Jakarta: Kementerian Kesehatan Republik Indonesia.

Kotfis, K., Lechowicz, K., Drożdżal, S., Niedźwiedzka-Rystwej, P., Wojdacz, T. K., Grywalska, E., Biernawska, J., Wiśniewska, M., dan Parczewski, M. (2021). COVID-19—The Potential Beneficial Therapeutic Effects of Spironolactone during SARS-CoV-2 Infection. Pharmaceuticals, 14(1), 71. https://doi.org/10.3390/ph14010071

Li, X., Zhong, X., Wang, Y., Zeng, X., Luo, T., dan Liu, Q. (2021). Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PLOS ONE, 16(5), e0250602. https://doi.org/10.1371/journal.pone.0250602

Lin, K. J., Schneeweiss, S., Tesfaye, H., D’Andrea, E., Liu, J., Lii, J., Murphy, S. N., dan Gagne, J. J. (2020). Pharmacotherapy for Hospitalized Patients with COVID-19: Treatment Patterns by Disease Severity. Drugs, 80(18), 1961–1972. https://doi.org/10.1007/s40265-020-01424-7

Mahmood, A., Elnour, A. A., Ali, A. A. A., Hassan, N. A. G. M., Shehab, A., dan Bhagavathula, A. S. (2016). Evaluation of rational use of medicines (RUM) in four government hospitals in UAE. Saudi Pharmaceutical Journal, 24(2), 189–196.

Marciniec, K., Beberok, A., Pęcak, P., Boryczka, S., dan Wrześniok, D. (2020). Ciprofloxacin and moxifloxacin could interact with SARS-CoV-2 protease: preliminary in silico analysis. Pharmacological Reports. https://doi.org/10.1007/s43440-020-00169-0

Mycroft-West, C. J., Su, D., Li, Y., Guimond, S. E., Rudd, T. R., Elli, S., Miller, G., Nunes, Q. M., Procter, P., Bisio, A., Forsyth, N. R., Turnbull, J. E., Guerrini, M., Fernig, D. G., Yates, E. A., Lima, M. A., dan Skidmore, M. A. (2020). SARS-CoV-2 Spike S1 receptor binding domain undergoes conformational change upon interaction with low molecular weight heparins. BioRxiv. https://doi.org/10.1101/2020.04.29.068486

Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., dan peneliti Consortium COVID 19 di Northwell (2020). Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA, 323(20), 2052. https://doi.org/10.1001/jama.2020.6775

Schiffrin, E. L., Flack, J. M., Ito, S., Muntner, P., dan Webb, R. C. (2020). Hypertension and COVID-19. American Journal of Hypertension, 33(5), 373–374.

Shang, L., Zhao, J., Hu, Y., Du, R., dan Cao, B. (2020). On the use of corticosteroids for 2019-nCoV pneumonia. The Lancet, 395(10225), 683–684. https://doi.org/10.1016/S0140-6736(20)30361-5

Shi, C., Wang, C., Wang, H., Yang, C., Cai, F., Zeng, F., Cheng, F., Liu, Y., Zhou, T., Deng, B., Vlodavsky, I., Li, J. P., dan Zhang, Y. (2020). The Potential of Low Molecular Weight Heparin to Mitigate Cytokine Storm in Severe COVID-19 Patients: A Retrospective Cohort Study. Clinical and Translational Science. https://doi.org/10.1111/cts.12880

Sun, M. L., Yang, J. M., Sun, Y. P., dan Su, G. H. (2020). Inhibitors of RAS Might Be a Good Choice for the Therapy of COVID-19 Pneumonia. Zhonghua Jie He He Hu Xi Za Zhi = Zhonghua Jiehe He Huxi Zazhi = Chinese Journal of Tuberculosis and Respiratory Diseases, 43(3). https://doi.org/10.3760/cma.j.issn.1001-0939.2020.03.016

Tang, N., Bai, H., Chen, X., Gong, J., Li, D., dan Sun, Z. (2020). Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of Thrombosis and Haemostasis.

Toh, H., Lim, Z., Yap, P., dan Tang, T. (2017). Factors associated with prolonged length of stay in older patients. Singapore Medical Journal, 58(3), 134–138.

Wang, M., Cao, R., Zhang, L., Yang, X., Liu, J., Xu, M., Shi, Z., Hu, Z., Zhong, W., dan Xiao, G. (2020). Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. In Cell Research. https://doi.org/10.1038/s41422-020-0282-0

Wang, X., Fang, X., Cai, Z., Wu, X., Gao, X., Min, J., dan Wang, F. (2020). Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis. Research.

World Health Organization. (2020). WHO coronavirus disease (COVID-19) dashboard. https://covid19.who.int/

World Health Organization. (2021). Therapeutics and COVID-19: living guideline. https://apps.who.int/iris/handle/10665/345356

Wrapp, D., Wang, N., Corbett, K. S., Goldsmith, J. A., Hsieh, C.-L., Abiona, O., Graham, B. S., dan McLellan, J. S. (2020). Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science, 367(6483). https://doi.org/10.1126/science.abb2507

Wu, R., Wang, L., Kuo, H.-C. D., Shannar, A., Peter, R., Chou, P. J., Li, S., Hudlikar, R., Liu, X., Liu, Z., Poiani, G. J., Amorosa, L., Brunetti, L., dan Kong, A.-N. (2020). An Update on Current Therapeutic Drugs Treating COVID-19. Current Pharmacology Reports, 6(3), 56–70. https://doi.org/10.1007/s40495-020-00216-7

Yartas Dumanli, G., Dilken, O., dan Urkmez, S. (2020). Use of Spironolactone in SARS-CoV-2 ARDS Patients. Turkish Journal of Anaesthesiology and Reanimation, 48(3), 254–255. https://doi.org/10.5152/TJAR.2020.569

DOI: https://doi.org/10.20961/jpscr.v7i2.53739

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