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Risk Factors Analysis for Rapid In-Hospital Mortality among Covid-19 Patients in a Tertiary Care Hospital in Indonesia Febriawati, Juwita; Putra, Ngakan Putu Parsama; Listyoko, Aditya Sri; Djajalaksana, Susanthy
Jurnal Kedokteran Brawijaya Vol. 33 No. 2 (2024)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2024.033.02.15

Systemic inflammation plays an important role in pathogenesis of Covid-19, especially in development of ARDS which is characterized by decrease of PaO2/FiO2 ratio. CRP and procalcitonin are inflammatory markers that are closely associated with severity and mortality of Covid-19. Although several studies have addressed benefit of CRP and procalcitonin as markers on Covid-19 severity, the benefit of these inflammatory markers for in-hospital mortality remain inadequately understood. The aim of this study was to analyze PaO2/FiO2 ratio,comorbidity,CRP,and procalcitonin as risk factors that affect time of in-hospital mortality Covid-19 patient. This was a retrospective observational cohort study of 250 Covid-19 patients who died during hospitalization and data was retrieved from medical record. Laboratory data was collected from three different times, including at time of admission,third day of hospital care,and before patient’s death. Data were analyzed using Chi square test,Mann Whitney test,Wilcoxon test, Friedman test, and binary logistic regresion. There were significant differences between CRP and procalcitonin at admission and time of in-hospital mortality (p<0.001; p=0.007). Binary logistic regression analysis revealed significant relationship between CRP and time of in-hospital mortality with p=0.007. ROC curve showed optimal threshold of 11.75mg/L with sensitivity 72.3%; specificity 59.6%, RR 3.24(95% CI: 1.84-5.70). Significant changes were observed regarding PaO2/FiO2 ratio,CRP,and procalcitonin at admission as compared to before patient’s death with p<0.001;p=0.017;p<0.001 respectively. This study showed significant decrease of PaO2/FiO2 ratio, elevated CRP and procalcitonin at admission as compared to before patient’s death. The increase of CRP could serve as predictor for time of in-hospital mortality for Covid-19 patient.

The Effects of N-Acetylcysteine as Adjuvant Therapy To Reduce TNF-Î‘ Level And Increase SPO2/FIO2 Ratio In Improving Hypoxemia In COVID-19 Patients Ramadhan, Fitratul; Putra, Ngakan Putu Parsama; Setyawan, Ungky Agus; Djajalaksana, Susanthy; Listyoko, Aditya Sri; Al Rasyid, Harun
Indonesian Journal of Tropical and Infectious Disease Vol. 9 No. 3 (2021)
Publisher : Institute of Topical Disease Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijtid.v9i3.30874

Tumor Necrosis Factor Alpha (TNF-α) is a pro-inflammatory cytokine that plays a crucial role in COVID-19 disease progression. N-acetylcysteine (NAC) works throughout several GSH-mediated mechanisms and is known to eliminate oxidative stress in acute respiratory distress syndrome (ARDS) in COVID-19. This study aims to analyze the effect of the N-Acetylcysteine as Adjuvant Therapy to reduce TNF-α levels and Increase SpO2/FiO2 ratio in Improving hypoxemia in COVID-19 Patients. This is a quasi-experimental, non-equivalent control group design study. There were 91 subjects selected using non-random sampling, which consisted of 75 patients in the NAC group and 16 patients in the control group. The TNF-α level was measured using the ELISA method, and SpO2/FiO2 ratio was calculated on day 1 (on admission) and day eight after NAC 5000mg/ 72 hours was given. Statistical analysis was conducted using Wilcoxon and Mann-Whitney U Test. There is a significant decrease in TNF-α level in the treatment group (median 1.49±5.22) (p=0.016) compared with the control group (median 1.64±1.99) (p=0.005). The Median SpO2/FiO2 ratio on day 1 is 163.70±69.64 in the control group and 121.49±40.41 in the treatment group (p=0.005). The Median SpO2/FiO2 ratio on day 8 is 249.69±132.26 in the control group and 151.29±59.18 in the treatment group (p=0.001). There is a positive correlation between serum TNF-α level and SpO2/FiO2 ratio after administration of adjuvant therapy NAC (r=0.240, p=0.038). There is a positive correlation and significant decrease of serum TNF-α and SpO2/FiO2 ratio after adjuvant NAC therapy, which improves hypoxemia in COVID-19 patients.

The Correlation between Volatile Organic Compounds (VOC) with Leukotriene B4 and Eosinophil Counts in Chronic Obstructive Pulmonary Disease Patients Santosa, Andrew; Putra, Ngakan Putu Parsama; Listyoko, Aditya Sri; Wardoyo, Arinto Yudi Ponco; Setijowati, Nanik
Medica Hospitalia : Journal of Clinical Medicine Vol. 11 No. 1 (2024): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v11i1.1035

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by increasing Leukotriene B4 (LTB4) and eosinophil counts. Volatile organic compounds (VOCs) have shown promise as non-invasive biomarkers, reflecting COPD pathophysiology. Identifying specific VOCs associated with increased LTB4 and eosinophil counts could lead to the discovery of potential biomarkers for COPD severity or progression. AIMS: This study aims to investigate the correlation between VOCs and leukotriene B4 (LTB4) levels, as well as eosinophil counts counts in COPD patients. METHOD: Using an observational-analytic method with a case-control approach, 20 COPD patients and 20 controls were enrolled from the respiratory outpatient department of Dr. Saiful Anwar General Hospital, Malang. VOC levels were measured using a breath analyzer, while LTB4 levels were determined through enzyme-linked immunosorbent assays. Spearman’s correlation tests examined associations between VOCs, LTB4, eosinophil counts, and comorbidity, with Mann-Whitney tests comparing results against the control group. Data significance was set at p < 0.05. RESULT: There were 40 COPD patients and 40 controls in this study. There were significant differences between VOCs in the COPD group and the control group (p < 0.05). LTB4 level significantly increased in the COPD group than in the control group (p < 0.001), and there was no difference in the eosinophil level. There was a correlation between LTB4 and VOC level of C2H5OH in COPD patients (p = 0.009; r = 0.410). There was no correlation between eosinophil counts and VOCs (p = 0.939). The level of VOCs was significantly different between patients with only COPD and patients with COPD and comorbid lung cancer (p < 0.05). CONCLUSION: There is a correlation between VOC and LTB4 in COPD patients.

Path Analysis in PLS for Assessing the Impact of Metabolic Syndrome on Pulmonary Fibrosis in a Rat Model Yaman, Muli; Djajalaksana, Susanthy; Putra, Ngakan Putu Parsama; Yudhanto, Hendy Setyo
Jurnal Respirologi Indonesia Vol 45 No 3 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v45i3.889

Background: Metabolic syndrome (MetS) is characterized by obesity, dyslipidemia, hyperglycemia, and insulin resistance, which are associated with increased risk for pulmonary fibrosis. This study investigates the impact of MetS on pulmonary fibrosis in a rat model using Partial Least Squares (PLS) path analysis. Methods: Sprague Dawley rats were fed a high-fat, high-fructose diet for 37 weeks to induce MetS. Key metabolic parameters, including body weight, lipid profiles, fasting blood glucose, fibrosis markers and Aschroft scores, were assessed. PLS path analysis was conducted to explore the relationships between these variables and their influence on pulmonary fibrosis. Results: PLS path analysis identified a strong correlation between increased body weight and MetS development (path coefficient=0.977). Dyslipidemia, characterized by elevated triglycerides and reduced HDL cholesterol, was also associated with MetS. A novel association was found between glucose dysregulation and pulmonary fibrosis (R2=0.908; path coefficient=0.947), suggesting that hyperglycemia contributes to lung fibrosis. Reduced PPARγ expression was associated with insulin resistance and inflammation, implicating it in fibrotic processes. Conclusion: This study highlights the role of metabolic disturbances in promoting pulmonary fibrosis in MetS. PLS path analysis effectively identified key metabolic pathways, suggesting potential targets for therapeutic intervention to mitigate MetS effects and prevent fibrosis. Further research is warranted to explore these pathways and develop targeted therapies.

Significance Level of Pleural Fluid Tissue Inhibitor Metalloproteinase-1 (TIMP-1) and Glucose Levels as Biomarkers of Malignant Pleural Effusion Michaela, Cleine; Putra, Ngakan Putu Parsama; Djajalaksana, Susanthy; Setijowati, Nanik; Listyoko, Aditya Sri
Jurnal Respirasi Vol. 11 No. 3 (2025): September 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.3.2025.208-215

Introduction: Distinguishing between malignant and non-malignant pleural effusions is often challenging due to overlapping biochemical profiles. Conventional diagnostic methods, including cytology and biopsy, are limited by their invasive nature, high costs, and potential complications. Emerging biomarkers, such as tissue inhibitor of metalloproteinase-1 (TIMP-1) and pleural fluid glucose levels, show promise as alternative diagnostic tools, but their clinical utility requires further validation. This study investigated the diagnostic value of TIMP-1 and pleural fluid glucose levels in differentiating malignant from non-malignant pleural effusions and explored their correlation in malignant cases. Methods: This cross-sectional analytical study included patients with exudative pleural effusion, categorized as malignant or non-malignant based on cytology and/or biopsy results. Biomarker levels of TIMP-1 and pleural fluid glucose were measured using enzyme-linked immunosorbent assay (ELISA) and biochemical analysis. Diagnostic thresholds for both biomarkers were determined using receiver operating characteristic (ROC) curve analysis. Results: Among 88 patients studied (33 malignant, 55 non-malignant), pleural fluid glucose levels were significantly lower in malignant cases (55.97 vs. 93.71 mg/dL; p=0.001), while TIMP-1 levels were notably higher (13.88 vs. 13.34 pg/mL; p<0.001). Tissue inhibitor of metalloproteinase-1 demonstrated superior diagnostic accuracy (86.5%) compared to glucose (70.6%) and the combined biomarker model (76.5%), with the sensitivity and specificity of 84.8% and 83.6%, respectively. Conclusion: Elevated TIMP-1 levels and reduced pleural fluid glucose levels are promising diagnostic biomarkers for malignant pleural effusion (MPE). Tissue inhibitor of metalloproteinase-1 exhibited the highest diagnostic accuracy, highlighting its potential as a non-invasive diagnostic tool in clinical practice.

Foreign Body Extraction of a Push-pin nail with Granulation Tissue Complication on a Thirteen Years Old Male octavia, umi fatma; Putra, Ngakan Putu Parsama
Malang Respiratory Journal Vol. 3 No. 1 (2021): Vol. 3 No. 1
Publisher : Universitaas Brawijaya

Background : Foreign body aspiration is common in children (80% in children under 5 years old) and elderly. The ratio in men is higher than in women. Flexible bronchoscopy is often used as a primary procedure in such cases because of its high sensitivity and specificity. However, in some cases, rigid bronchoscopy might be superior. This is a case report about a patient who came with complaints of bloody cough and chest pain after the ingestion of a push-pin nail. The patient underwent both bronchoscopic procedures.Case : A 13-year-old male presented with complaints of sudden bloody coughing accompanied by chest pain in the middle area. Physical examinations were unremarkable, but images of spikes suggestive of a foreign object on the left hilus were found at the chest x-ray. A flexible fiberoptic bronchoscopy was performed immediately. A push-pin nail, located the left main bronchus with a sharp tip embedded in the mucosa and covered by granulation tissue, was identified. Evacuation attempts were unsuccessful. Rigid bronchoscopy was then performed and evacuation was carried out successfully. The patient was then discharged after forty-eight hours of close monitoring.Conclusion: There are two types of bronchoscopy, flexible and rigid. Both have their respective advantages in the handling of patients with foreign bodies. Â Acquiring skills in operating both types of bronchoscopy are important for a bronchologist.Keywords: Foreign body, Aspiration, Granulation tissue, Bronchoscopy

The Case Report : Challenges in the Management of Pneumothorax for COVID-19 Patient Permatasari, Adinda Pramitra; Rakhma, Sastia; Putra, Ngakan Putu Parsama
Malang Respiratory Journal Vol. 5 No. 1 (2023): Volume 5 No 1, March 2023
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2023.005.01.1

INTRODUCTION : Pneumothorax has been reported in minority of COVID-19 cases. Spontaneus Pneumothorax is an uncommon complication of COVID-19. The incidence and risk factors are still unknown. Here we will review where there are challenges with case of Pneumothorax in COVID-19 patients. CASE ILLUSTRATION : We report one case at Dr. Saiful Anwar hospital, a 42 years old man was diagnosed with Spontaneous Pneumothorax and tested positive for COVID-19 via nasopharyngeal swab. Management in this case requires consideration from emergency treatment, risk of virus transmission and the aerolization of the procedure. Invasive procedure such as insertion chest tube and pharmacologic therapy be the treatment in this case. After 2 weeks of treatment, there was improvement on clinical and radiological imaging. DISCUSSION : Various strategies to reduce the risk of exposure to COVID-19 infection on Spontaneus Pneumothorax. This literature discusses about the risk factor that lead to Pneumothorax with COVID-19 and the management of Pneumothorax cases in COVID-19 patients. CONCLUSION: Spontaneous Pneumothorax is a rare complication of COVID-19. Management in this case requires consideration from emergency treatment, risk of virus transmission and the aerolization of the procedure. Key words : Pneumothorax; COVID-19; Chest Tube

Idiopathic Massive Bilateral Chylothorax : A Case Report Ananda, Ilham Revan; Listyoko, Aditya Sri; Putra, Ngakan Putu Parsama; Aslam, Achmad Bayhaqi Nasir
Malang Respiratory Journal Vol. 5 No. 2 (2023): September Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2023.005.02.03

Abstract Introduction : Chylothorax is an uncommon medical condition caused by the accumulation of chylous fluid in the pleural space. Chylothorax has no predilection for sex or age. The prevalence after various cardiothoracic surgeries is 0.2% to 1%. Mortality and morbidity rates are around 10%. Respiratory distress may occur due to compression of the lung by the accumulated fluid. Management and approaches to treating the condition require multidisciplinary therapy, starting from non- pharmacological, pharmacological, to interventional management. Case Report : A 57-year-old Man patient was referred to the emergency room with chief complaint of shortness of breath. Reduced breathing sound on both lung fields. No previous history of cancer or thoracic surgery were found. X-ray examination had found bilateral pleural effusion. Thoracocentesis and pleural fluid analysis was performed with total of 6800 cc serosanguinous, whitish fluid was extracted from both of the lung. The patient was diagnosed with chylothorax. Lymphangiography and embolization was performed on the leak on left thoracic duct (T10) from right lymph node. Antibiotic was also given to treat the community acquired pneumonia that could be one of the possible etiology on this patient. Dietary modification with low fat diet and Ocreotide was also given to this patient as one of the treatment modalities. Discussion : The diagnosis of Chylothorax on this patient was established based on pleural fluid analysis and evidenced by lymphangiography examination by the presence of a leak in the thoracic lymphatic duct. Various modalities to diagnose this condition have been carried out with inconclusive results. Non-pharmacological, pharmacological and radiological interventions with embolization through lymphangiography are proven to be able to stop leaks and reduce symptoms in this patient. Conclusion : Chyle leak to the pleural space may compress the lung and cause respiratory distress. Combinaton of thoracocentesis, embolization of the leakage, dietary intake modification and administration of ocreotide may help prevent further chylous fluid accumulation. Keywords : chylothorax, embolization, lymphangiography, thoracocentesis.

aO2, SaO2, dan Rasio PaO2/FiO2 Sebagai Prediktor Derajat Keparahan Pasien COVID-19 Rawat Inap Putra, Ngakan Putu Parsama; Listyoko, Aditya Sri; Christanto, Anthony
Majalah Kedokteran Indonesia Vol 70 No 12 (2020): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, V
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.70.12-2020-326

Introduction: Currently COVID-19 continues to show an increase in prevalence and mortality. Fever, dry cough, fatique and progression to dyspnea even respiratory failure and ARDS are the symptoms of COVID-19. “Happy hypoxia” is an indication that certain patients do not express breathlessness but have impaired oxygenation. It is important to determine the degree of oxygenation an all COVID-19 patients that will predict the severity of the disease and provide an outline of further management plans.Objective: This study aimed to describe the parameters of blood gas analysis in hospitalized patients and analyze its correlation with degree of severity of the diseaseMethods: We conducted observational analysis, cross sectional, single-center study including 71 laboratory-confirmed patients in Dr. Saiful Anwar General Hospital, Malang, Indonesia from April-Juni 2020. Statistical analysis was performed to determine the determine the relation of blood gas analysis with disease severity. Result: Subjects were divided to 25 patients (35,21%) in the mild-moderate group and 46 patients (64,79%) in severe group. Analysis of demographic and clinical characteristic showed that age, history of smoking, dyspnea and oxygen delivery were associated with disease severity (p less than 0,005). Statistical analysis of blood gas analysis showed associated degree of oxygenation with disease severity which is assessed by PaO2, SaO2 BGA, PaO2/FiO2 and original PaO2 (p less than 0,005). Conclusion: In our cross sectional study we found that degree of oxygenation was associated with disease severity in hospitalized COVID-19 patients.

Risk Factors Analysis for Rapid In-Hospital Mortality among Covid-19 Patients in a Tertiary Care Hospital in Indonesia Febriawati, Juwita; Putra, Ngakan Putu Parsama; Listyoko, Aditya Sri; Djajalaksana, Susanthy
Jurnal Kedokteran Brawijaya Vol. 33 No. 2 (2024)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2024.033.02.15

Systemic inflammation plays an important role in pathogenesis of Covid-19, especially in development of ARDS which is characterized by decrease of PaO2/FiO2 ratio. CRP and procalcitonin are inflammatory markers that are closely associated with severity and mortality of Covid-19. Although several studies have addressed benefit of CRP and procalcitonin as markers on Covid-19 severity, the benefit of these inflammatory markers for in-hospital mortality remain inadequately understood. The aim of this study was to analyze PaO2/FiO2 ratio,comorbidity,CRP,and procalcitonin as risk factors that affect time of in-hospital mortality Covid-19 patient. This was a retrospective observational cohort study of 250 Covid-19 patients who died during hospitalization and data was retrieved from medical record. Laboratory data was collected from three different times, including at time of admission,third day of hospital care,and before patient’s death. Data were analyzed using Chi square test,Mann Whitney test,Wilcoxon test, Friedman test, and binary logistic regresion. There were significant differences between CRP and procalcitonin at admission and time of in-hospital mortality (p<0.001; p=0.007). Binary logistic regression analysis revealed significant relationship between CRP and time of in-hospital mortality with p=0.007. ROC curve showed optimal threshold of 11.75mg/L with sensitivity 72.3%; specificity 59.6%, RR 3.24(95% CI: 1.84-5.70). Significant changes were observed regarding PaO2/FiO2 ratio,CRP,and procalcitonin at admission as compared to before patient’s death with p<0.001;p=0.017;p<0.001 respectively. This study showed significant decrease of PaO2/FiO2 ratio, elevated CRP and procalcitonin at admission as compared to before patient’s death. The increase of CRP could serve as predictor for time of in-hospital mortality for Covid-19 patient.

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