Hubungan Rasio Neutrofil-Limfosit (RNL) dengan Derajat Keparahan Pasien COVID-19 di Rumah Sakit Martha Friska Medan Tahun 2021

Nathalia Elizabeth Rouli Sipahutar; Leonardo Basa Dairi; Joseph Partogi Sibarani; Jenny Ria Sihombing

doi:10.36655/njm.v9i1.688

Nathalia Elizabeth Rouli Sipahutar Fakultas Kedokteran Universitas HKBP Nommensen
Leonardo Basa Dairi Departemen Penyakit Dalam Fakultas Kedokteran Universitas HKBP Nommensen Medan
Joseph Partogi Sibarani Departemen Penyakit Dalam Fakultas Kedokteran Universitas HKBP Nommensen Medan
Jenny Ria Sihombing Departemen Patologi Klinik Fakultas Kedokteran Universitas HKBP Nommensen Medan

DOI: https://doi.org/10.36655/njm.v9i1.688

Keywords: COVID-19 severity, neutrophil-lymphocyte ratio

Abstract

ABSTRACT

Background: COVID-19 is a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is rapidly transmitted in humans. Systemic inflammation will cause changes in leukocytes in the circulation which can lead to neutrophilia and lymphocytopenia. In COVID-19, the neutrophil-lymphocyte ratio (NLR) can be used as a predictor of disease severity in the early stages. An increase in NLR can reflect an increased inflammatory process and can predict severity. This study aims to determine relationship between NLR and the severity of COVID-19 patients at Martha Friska Hospital Medan in 2021.

Methods: The design of this research is observational analytic with cross sectional method. Samples was taken from medical records of COVID-19 patients at Martha Friska Hospital Medan from January-March 2021 with consecutive sampling method and obtained 74 samples. This research was done in November 2021. The analysis of the data processed by the univariate frequency distribution table and the SPSS version 25 program was carried out bivariately using the Chi Square test.

Results: From 74 COVID-19 patients, RNL <3.13 obtained 29 people (93%) with mild severity, 2 people (7%) moderate severity and no patients with severe-critical severity. COVID-19 patients with RNL 3.13 is 6 people (14%) with mild severity, 20 people (46%) with moderate severity, 17 people (40%) with severe-critical severity. This study showed there was a relationship between NLR and the severity of COVID-19 patients (p=0.000).

Conclusion: There is a relationship between NLR and the severity of COVID-19 patients.

Keywords : COVID-19 severity, neutrophil-lymphocyte ratio

ABSTRAK

Latar Belakang : COVID-19 adalah suatu penyakit yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) yang bersifat cepat menular sesama manusia. Peradangan yang terjadi secara sistemik dapat menyebabkan perubahan leukosit dalam sirkulasi yang dapat membuat perubahan pada neutrofilia dan limfositopenia. Rasio neutrofil-limfosit (RNL) pada pasien COVID-19 dapat digunakan sebagai prediktor keparahan penyakit pada fase awal infeksi penyakit. RNL yang meningkat dapat diartikan sebagai proses peningkatan inflamasi. Penelitian ini bertujuan untuk mengetahui hubungan antara RNL dengan derajat keparahan pasien COVID-19 di Rumah Sakit Martha Friska Medan tahun 2021.

Metode : Penelitian ini memiliki desain analitik observasional dengan metode cross sectional. Sampel penelitian diambil dari data rekam medik pasien COVID-19 di Rumah Sakit Martha Friska Medan dari Januari-Maret 2021 dengan metode consecutive sampling dan didapatkan 74 sampel. Penelitian dilakukan pada bulan November 2021. Analisis data yang diolah dengan tabel distribusi frekuensi secara univariat dan dengan program SPSS versi 25 dilakukan secara bivariat menggunakan uji Chi Square.

Hasil : Dari 74 pasien COVID-19, nilai RNL 3,13 didapatkan 29 orang (93%) dengan derajat keparahan ringan, 2 orang (7%) derajat keparahan sedang dan tidak didapatkan pasien dengan derajat keparahan berat-kritis. Pasien COVID-19 dengan RNL 3,13, sebanyak 6 orang (14%) derajat keparahan ringan, 20 orang (46%) dengan derajat keparahan sedang, 17 orang (40%) derajat keparahan berat-kritis. Penelitian ini menunjukkan terdapat hubungan antara RNL dengan derajat keparahan pasien COVID-19 (p=0,000).

Kesimpulan : Terdapat hubungan antara RNL dengan derajat keparahan pasien COVID-19.

Katakunci : Derajat keparahan COVID-19, rasio neutrofil-limfosit

References

1. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. NEJM.org [Internet]. 2020 [dikutip 30 Mei 2021 ];382(13):9. Tersedia pada: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121484/pdf/NEJMoa2001316.pdf
2. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. Journal of Translational Medicine [Internet]. [dikutip 6 Juli 2021];18(1):206. Tersedia pada: https://doi.org/10.1186/s12967-020-02374-0
3. PDPI, PERKI, PAPDI, PERDATIN, IDAI. Pedoman tatalaksana COVID-19 Edisi 3 Desember 2020 [Internet]. [dikutip 6 Juli 2021]. Tersedia pada: https://www.papdi.or.id/download/983-pedoman-tatalaksana-covid-19-edisi-3-desember-2020
4. Lee JS, Kim NY, Na SH, Youn YH, Shin CS. Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (United States) [Internet]. 2018 Jun 1 [dikutip 4 Juni 2021];97(26). Tersedia pada: /pmc/articles/PMC6039688/
5. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis [Internet]. Vol. 92, Journal of Medical Virology. John Wiley and Sons Inc.; 2020 [dikutip 4 Juni 2021]. p. 1733–4. Tersedia pada: http://orcid.org/0000-0001-
6. Bunawan NC, Sinto R, Harlivasari AD, Nugroho HM. Sistem Penapisan Pasien Coronavirus Disease 2019 (COVID-19) RSUD Kramat Jati. Indonesia Journal Chest. 2020;7(2):32–9.
7. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA - Journal of the American Medical Association. 2020;323(13):1239–42.
8. Mariana A. Hubungan Kadar Neutrofil/Lymphocyte Ratio (NLR) dan Monocyte/Lymphocyte Ratio (MLR) terhadap CKMB dan Troponin T pada Pasien COVID-19 di RSUP H.Adam Malik. 2021;
9. Lim I. Perbedaan Jumlah Limfosit Pada Pasien Positif Coronavirus Disease 2019(Covid-19) Derajat Ringan, Sedang, Berat, Dan Kritis Di Rumah Sakit Bethesda Yogyakarta. Journal of Chemical Information and Modeling. 2021;53(9):1689–99.
10. Coronavirus Disease-19(COVID-19), Republic of Korea [Internet]. [dikutip 7 Desember 2021]. Tersedia pada: http://ncov.mohw.go.kr/en/
11. Suastika W, Ketut N, Suega K. Diagnostic Value of Neutrophil To Lymphocyte Ratio For Assessing The Disease Severity In Covid-19 Patients. East J Med. 2021;26(2):199–230.
12. Pramana IGAASP, Masyuni PUS, Surawan IDP. Nilai rasio neutrofil-limfosit sebagai prediktor kasus COVID-19 serangan berat pada pasien dewasa. Intisari Sains Medis | Intisari Sains Medis [Internet]. 2021;12(2):530–3.
13. Wang X, Li X, Shang Y, Wang J, Zhang X, Su D, et al. Ratios of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Predict All-Cause Mortality in Inpatients with Coronavirus Disease 2019 (COVID-19): A Retrospective Cohort Study in A Single Medical Center. Epidemiology and Infection. 2020;
14. Eslamijouybari M, Heydari K, Maleki I, Moosazadeh M, Hedayatizadeh-Omran A, Vahedi L, et al. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in COVID-19 patients and control group and relationship with disease prognosis. Caspian Journal of Internal Medicine. 2020;11(Md):S531–5.
15. Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clinica Chimica Acta; International Journal of Clinical Chemistry [Internet].[dikutip 6 Juli 2021];507:174. Tersedia pada: /pmc/articles/PMC7194694/