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All Journal Jurnal Respirologi Indonesia Jurnal Respirasi (JR) Respiratory Science Cermin Dunia Kedokteran
Aphridasari, Jatu
Department Of Pulmonology And Respiratory Medicine, Faculty Of Medicine, Sebelas Maret University
Health Professions Medicine & Pharmacology Public Health

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Interleukin-6 and Neutrophil–Lymphocyte Ratio in Predicting Outcome of Confirmed COVID-19 Patients Harsini Harsini; Jatu Aphridasari; Artrien Adhiputri; Agung Prasetyo; Hie Sukiyanto; Aditya Sri Listyoko
Jurnal Respirasi Vol. 9 No. 2 (2023): May 2023
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v9-I.2.2023.108-116

Abstract

Introduction: COVID-19 emerged as a pandemic about 2 years ago. Severe and critical COVID-19 has been associated with increased interleukin 6 (IL-6) level and neutrophil–lymphocyte ratio (NLR). This study aimed to test whether IL-6 and/or NLR are associated with COVID-19 mortality. Methods: Subjects were COVID-19 patients with suspected Omicron variant infection that were hospitalized at Dr. Moewardi Hospital from October 2021 to March 2022. According to their medical records, subjects were divided into survivor and non-survivor groups. Serum level of IL-6 and NLR at admission were recorded, compared, and analyzed for association with mortality. Results: Seventy-four respondents, average age 53.07 ± 16.2 years, joined the research. The area under curve (AUC) value of IL-6 was 0.740, with a cut-off value of 42.00 mg/dL (73.9% sensitivity; 70.6% specificity). The AUC value of NLR was 0.721, with a cut-off value of 5.51 (73.9% sensitivity; 60.8% specificity). IL-6 had a higher odds ratio than NLR as a risk factor for mortality (6.80 [95% CI 2.24–20.61; p < 0.001]; 4.39 [95% CI 1.48–13.03; p < 0.001], respectively). The correlation between IL-6 and NLR had an r-value of 0.164 (p = 0.164). Conclusion: There was no difference in sensitivity between IL-6 level and NLR as mortality predictors of COVID-19, but serum IL-6 level was more specific. IL-6 level correlated positively with NLR, but there was no significance.
Is Vaccination Related to The Cure Rate of COVID-19 Patients with Comorbidities? Mia Herdiyani Achmad; Reviono Reviono; Yusup Subagio Sutanto; Jatu Aphridasari; Windu Prasetyo
Jurnal Respirologi Indonesia Vol 43, No 3 (2023)
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.v43i3.324

Abstract

Background: Prior vaccination can prevent a COVID-19 patient from falling into moderate, severe, and critical conditions. The effect of vaccination on COVID-19 patients’ recovery has been widely studied. However, its correlation in critically severe COVID-19 patients with comorbidity has not been fully understood yet. This study aims to determine the correlation of vaccination in critically severe COVID-19 patients with comorbidity of hypertension and/or Diabetes Mellitus (DM).Methods: A retrospective cohort study was conducted in critically severe COVID-19 patients with hypertension and/or DM treated in Dr. Moewardi Hospital, Surakarta, Indonesia from March 2021 to September 2021. The data were taken from patients’ medical records. We analyzed all data statistically with Chi-Square and fisher's exact test, and a p-value of < 0.05 was considered significant.Results: There were 489 patients included in our study, 247 patients with hypertension and DM, and 242 patients without comorbidities. Vaccination status was significantly associated with the cure rate of critically severe COVID- 19 patients with hypertension (p=0.018), but not with DM (p=0.606). There was no significant association between age to the cure rate of critically severe COVID-19 patients with hypertension and DM (p=0.953). Vaccination status was related among patients with comorbidities and without comorbidities (p<0.001).Conclusion: Vaccination was significantly correlated the cure rate of moderate to critically severe COVID-19 patients with hypertension and without comorbidities.
The Effect of Inhaled Ipratropium Bromide as a Premedication For Bronchoscopy on Dyspnea, Cough, and Tracheobronchial Secretion Safina Mutmainnah; Yusup Subagio Sutanto; Jatu Aphridasari; A. Farih Raharjo
Jurnal Respirologi Indonesia Vol 43, No 4 (2023)
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.v43i4.256

Abstract

Background: Bronchoscopy is a minimally invasive procedure used for diagnostic examination and intervention of the airways. Patient comfort and cooperation during bronchoscopy are very important because they affect the success and outcome. The sympathetic anticholinergic effect of ipratropium bromide can improve procedure tolerance and airway visualization. This study was conducted to analyze the effect of inhaled ipratropium bromide as a bronchoscopy premedication for the assessment of dyspnea, cough, and tracheobronchial secretion.Methods: This was a clinical study with a quasi-experimental pretest-posttest control group design in pulmonary patients who underwent bronchoscopy at Dr. Moewardi General Hospital Surakarta in October 2021 using consecutive sampling. The subjects of the study were divided into an intervention group with inhaled ipratropium bromide and a control group without inhaled ipratropium bromide. The Borg scale of dyspnea and the visual analog scale (VAS) score of cough were assessed before and after bronchoscopy in both groups. The grading of tracheobronchial secretion was assessed during bronchoscopy.Results: Thirty-six pulmonary patients who underwent bronchoscopy were included in this study. The intervention group showed a lower Borg scale (0.28±0.57) and VAS score (3.22±8.54), lower tracheobronchial secretion grading, and there was a significant difference compared to the control (P≤0.05).Conclusion: There was a significant difference in the Borg scale of dyspnea, VAS score of cough, and the grading of tracheobronchial secretion in patients undergoing bronchoscopy as an effect of ipratropium bromide inhalation.
Comparison of NEWS, SIRS, and qSOFA Score as Predictors of Mortality and Length of Stay in Patients Pneumonia with Sepsis Harsini Harsini; Aditya Alfarizi; Jatu Aphridasari; A Farih Raharjo; Reviono Reviono
Jurnal Respirologi Indonesia Vol 44, No 1 (2024)
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.v44i1.505

Abstract

Background: Pneumonia is a major health problem in all age groups and often related with sepsis. In 2021, Surviving Sepsis Campaign Guidelines mentioned several clinical scoring systems to identify patients with potentials of developing sepsis, such as systemic inflammatory response syndrome (SIRS), national early warning score (NEWS), quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA). The guideline stated that there is no gold standard for diagnosing sepsis, contradicting The Sepsis-3 Guideline in 2016 that mentioned SOFA score as a gold standard for diagnosing sepsis.Methods: Subjects were all patients with pneumonia and sepsis who were treated in Dr.Moewardi Hospital within 1 January to 31 December 2022. Data from subjects’ medical records were collected to assess their NEWS, SIRS, qSOFA, and SOFA score on the day of admission. Since evaluation of SOFA score needs a number of components requiring laboratory results and takes longer time so they made a simpler tool called qSOFA to avoid delayed treatment of the patients.Results: NEWS is more consistent with SOFA compared to SIRS and qSOFA (Kappa value = 0.726 vs 0.320 vs 0.22; respectively). NEWS, SIRS, and qSOFA were all significantly correlated with mortality (P<0.001) with NEWS having the strongest correlation (r=0.482 vs 0.216 vs 0.175; respectively). Only NEWS showed significant correlation with the length of stay (r=0.129; P<0.001).Conclusion: NEWS was the most consistent score to SOFA compared to SIRS and qSOFA. NEWS was also the best predictor for mortality and was the only score correlated with length of hospital stay.
The Role of Omega-3 on the IL-6 Levels, Malondialdehyde, and Clinical Improvement in Adults with Community-Acquired Pneumonia Dewi Astarini; Jatu Aphridasari; Ana Rima Setijadi
Jurnal Respirologi Indonesia Vol 44, No 1 (2024)
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.v44i1.402

Abstract

Background: Acute lung parenchymal infection, known as pneumonia, can be carried on by multiple microorganisms, including bacteria, viruses, fungi, and parasites. Globally, community-acquired pneumonia is a major factor of morbidity, mortality, and health issues. Malondialdehyde (MDA) is a marker of oxidative stress in pneumonia patients, and interleukin 6 (IL-6) is a marker of inflammatory process. Effect of Omega-3 as an immunomodulator, anti-inflammatory, and antioxidant may be implemented as adjunctive therapy in patient with community-acquired pneumonia.Methods: Clinical trial research with a true experimental method and pretest-posttest design. The study involved 30 community-acquired pneumonia patients who were admitted at Moewardi Hospital in Surakarta and Dr. Soehadi Prijonegoro Hospital in Sragen from August to September 2022 by consecutive sampling. The control group (n=15) received standard therapy, and the treatment group (n=15) received standard therapy plus Omega-3 at a dose of 1600 mg/day. IL-6 and MDA levels were measured when the subject was admitted to the hospital and there was clinical improvement.Results: There was a significant difference in reduced IL-6 levels (P=0.001), decreased MDA levels (P=0.001), and the duration of clinical improvement (P=0.042) between the treatment group and the control group. There was a moderate correlation between the decrease in IL-6 (R=0.480) and MDA (R=0.459), while the duration of clinical improvement had a strong correlation (R=0.756) in the treatment group.Conclusion: Supplementation of Omega-3 was effective in reducing IL-6, MDA levels, and the duration of clinical improvement in community-acquired pneumonia patients.
The Agreement Level of Colorimetric Indicator Paper and pH Meter Examination Compared to Urine Analyzer in Measuring Exudative Pleural Effusion Fluid pH Muttaqin Huda; Yusup Subagio Sutanto; Jatu Aphridasari
Jurnal Respirologi Indonesia Vol 46 No 2 (2026)
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.v46i2.1086

Abstract

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural space, commonly associated with pulmonary infections and malignancies. Measurement of pleural fluid pH is necessary for diagnosis, therapeutic decision-making, and prognostic evaluation. Multiple methods are used, including pH meters, indicator papers, and urine analyzers, but their concordance has not been widely studied in Indonesia. This study aimed to assess the agreement of pleural fluid pH results measured using pH meters, indicator papers, and urine analyzers to support the appropriate selection of diagnostic methods. Methods: This observational analytic study with a cross-sectional design was conducted at dr. Moewardi General Hospital, Surakarta, from February to June 2025. The sample consisted of 55 patients with exudative pleural effusion who met the inclusion criteria. Pleural fluid pH was measured using three methods: colorimetric indicator paper, a pH meter, and a urine analyzer. Data were analyzed using the Kappa coefficient and the Intraclass Correlation Coefficient (ICC) to assess the agreement between methods. Results: The mean pH values of pleural fluid measured by the urine analyzer, pH meter, and colorimetric indicator paper were 8.18±0.47, 8.13±0.46, and 8.15±0.59, respectively. Agreement analysis showed a very strong and statistically significant correlation between the pH meter and urine analyzer (ICC=0.948; P<0.001), between the pH strip and urine analyzer (ICC=0.855; P<0.001), and between the pH meter and pH strip (ICC=0.916; P<0.001). A significant positive correlation was also observed between glucose levels and pH measured by both the urine analyzer and the pH meter. Conclusion: There is good agreement among pH measurements obtained using colorimetric indicator paper, urine analyzer, and pH meter in exudative pleural effusion fluid.
Comparative Analysis of Copeptin, IL-6, and TNF-α as Predictive Biomarkers for Clinical Outcome in Moderate to Severe COVID-19 Patients Harsini Harsini; Jatu Aphridasari; Sihsusetyaningtyas Tiominar Siregar
Jurnal Respirologi Indonesia Vol 46 No 1 (2026)
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.v46i1.1114

Abstract

Background: Cytokine release syndrome (CRS) plays a central role in disease progression, driven by pro-inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), as well as neuroendocrine stress markers such as copeptin. Perbandingan langsung biomarker copeptin, IL-6, dan TNF-α sangat penting untuk mengidentifikasi prediktor hasil COVID-19 yang paling andal, terutama pada kasus sedang hingga berat. This retrospective clinical study aimed to evaluate the correlation of copeptin, IL-6, and TNF-α levels with the clinical outcomes of patients with moderate to severe COVID-19. Methods: The study included patients who met the selection criteria and provided written informed consent. A sample size of 41 was determined via power analysis to achieve 80% power at a 0.05 significance level. Consecutive sampling was employed to select participants. The study utilized medical records of patients with moderate to severe COVID-19 who underwent copeptin, IL-6, and TNF-α testing. Correlation analyses and Bonferroni corrections were performed using SPSS® ver. 21. Results: Results revealed a moderate positive correlation between copeptin levels and patient outcomes (Bonferroni correlation=0.597; P<0.001). A weak positive correlation was observed between IL-6 levels and outcomes (Bonferroni correlation=0.239; P=0.055), while a negligible positive correlation was found for TNF-α levels (Bonferroni correlation=0.140; P=0.177), which was not statistically significant. Conclusion: Copeptin emerged as a more sensitive biomarker for predicting the outcomes of COVID-19 patients. Elevated copeptin levels were associated with a poorer prognosis. Furthermore, its stability in serum renders copeptin a more sensitive biomarker than IL-6 and TNF-α.
Co-Authors Aditya Alfarizi Aditya Sri Listyoko Agung Prasetyo Ana Rima Setijadi Angga M. Raharjo Anita Ramlie Ari Natalia Probandari Artrien Adhiputri Aslani Threestiana Sari ASTARI FEBYANE PUTRI Christian James Ibrahim Dewi Astarini Dicki Harnanda Dina Okfina Ria Dono Indarto Fakhruddin, Helmi Farih Raharjo Harsini Hastuti, Heni Hie Sukiyanto Jarot Subandono Kurniasih, Oktavera Tri LELI SAPTAWATI Linda Soebroto Lusiana Susilo Utami Maratus Sholihah Mia Herdiyani Achmad Muhammad Samhan Muttaqin Huda Prima Karita Sari Reviono Reviono Reviono Reviono Reviono Reviono Safina Mutmainnah Sihsusetyaningtyas Tiominar Siregar Sumardiyono Sumardiyono Suradi Suradi Suradi Suradi Suradi Suradi Suradi Suradi SURYAWATI, BETTY Windu Prasetyo Yusup Subagio Susanto Yusup Subagio Sutanto