Hartantri Yovita, Debora Josephine, Widyatmoko Leonardus, Giwangkancana Gezy, Suryadinata Hendarsyah, Susandi Evan, Hutajulu Elisabeth, Hakiman Assica Permata Amalya, Pusparini Yesy, Alisjahbana Bachti
Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Clinical Pathology Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Lancet Reg Health Southeast Asia. 2023 Apr;11:100167. doi: 10.1016/j.lansea.2023.100167. Epub 2023 Feb 9.
Indonesia had the second-highest number of COVID-19 cases and deaths in South-East Asia. We aimed to determine the factors associated with this mortality and the effect of the recommended COVID-19 treatment regimen during the first 10 months of the epidemic.
This was a retrospective cohort study using secondary data from medical records. In total, 689 adult COVID-19 inpatients hospitalized between March and December 2020 were enrolled. Clinical characteristics, laboratory parameters, and treatments were analyzed by survival outcome. Kaplan-Meier statistics were used to estimate survival.
Of the 689 patients enrolled, 103 (14.9%) died. Disease severity was highly associated with mortality (hazard ratio [HR]: 7.69, < 0.001). Other clinical factors associated with mortality were older age and comorbidities. Based on laboratory parameters, higher procalcitonin and C-reactive protein contents and a neutrophil-to-lymphocyte ratio >3.53 were also linked to mortality. Favipiravir was associated with lower mortality, with adjusted HRs of 0.24 (0.11-0.54) and 0.40 (0.17-0.98) among the mild/moderate and severe cases, respectively. Among patients with severe disease, steroids showed some beneficial effects in the early days of hospitalization.
Older age and comorbidities were associated with disease severity and, consequently, higher mortality. Higher mortality after the second week of hospitalization may be related to secondary bacterial infection. Favipiravir showed significant benefit for COVID-19 survival, while steroids showed benefit only in the early days of admission among patients with severe disease.
This research did not receive a specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
印度尼西亚是东南亚新冠病毒病病例数和死亡数第二高的国家。我们旨在确定与这种死亡率相关的因素以及疫情前10个月推荐的新冠病毒病治疗方案的效果。
这是一项回顾性队列研究，使用病历中的二手数据。总共纳入了2020年3月至12月期间住院的689例成年新冠病毒病患者。通过生存结局分析临床特征、实验室参数和治疗情况。采用Kaplan-Meier统计方法估计生存率。
在纳入的689例患者中，103例（14.9%）死亡。疾病严重程度与死亡率高度相关（风险比[HR]：7.69，<0.001）。与死亡率相关的其他临床因素是年龄较大和存在合并症。基于实验室参数，降钙素原和C反应蛋白含量较高以及中性粒细胞与淋巴细胞比值>3.53也与死亡率相关。法匹拉韦与较低死亡率相关，在轻症/中症和重症病例中，调整后的HR分别为0.24（0.11 - 0.54）和0.40（0.17 - 0.98）。在重症患者中，类固醇在住院早期显示出一些有益效果。
年龄较大和存在合并症与疾病严重程度相关，因此死亡率较高。住院第二周后死亡率较高可能与继发细菌感染有关。法匹拉韦对新冠病毒病生存显示出显著益处，而类固醇仅在重症患者入院早期显示出益处。
本研究未接受公共、商业或非营利部门任何资助机构的特定资助。
