Factors Associated with All-Cause 30-Day Mortality in Indonesian Inpatient COVID-19 Patients at Cipto Mangunkusumo National General Hospital

Author:

Rinaldi Ikhwan1ORCID,Yulianti Mira2,Yunihastuti Evy3ORCID,Rajabto Wulyo1,Irawan Cosphiadi1ORCID,Sukrisman Lugyanti1,Rachman Andhika1ORCID,Mulansari Nadia Ayu1,Lubis Anna Mira1,Prasetyawaty Findy1,Cahyanur Rahmat1,Priantono Dimas1,Ahani Ardhi Rahman1,Muthalib Abdul1,Sudoyo Aru1,Atmakusuma Tubagus Djumhana1,Reksodiputro Arry Harryanto1,Djoerban Zubairi1,Tambunan Karmel1,Winston Kevin4,Shufiyani Yuli Maulidiya4,Wiyono Lowilius4ORCID,Pratama Samuel4ORCID,Edina Brenda Cristie4

Affiliation:

1. Hematology and Medical Oncology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia

2. Respirology and Critical Care, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia

3. Allergy and Immunology, Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia

4. Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia

Abstract

Introduction: Indonesia, as a developing country, has limited data on the factors associated with 30-day mortality in COVID-19 patients in Indonesia. As a matter of fact, study analyzing factors associated with 30-day mortality of COVID-19 infection in Indonesia has never been conducted. This study aims to fill this gap in the literature by conducting a large-scale analysis of factors associated with 30-day mortality in COVID-19 patients in Indonesia. Method: This study employed a single-center retrospective cohort observational design, and was conducted at Cipto Mangunkusumo National General Hospital between the years 2022 and 2023. Sampling was conducted using the consecutive sampling method. The study included patients aged 18 years and above who had been confirmed to have COVID-19 infection. Survival analysis was conducted using Kaplan–Meier and multivariate Cox regression analysis. Result: Our study included a total of 644 patients, with 120 patients (18.6%) expiring within 30 days. In the multivariate analysis using the backward Wald method, severe COVID-19 (HR: 7.024; 95% CI: 3.971–12.744; p value: <0.0001), moderate COVID-19 infection (HR: 1.660; 95% CI: 1.048–2.629; p value: 0.031), liver cirrhosis (HR: 3.422; 95% CI: 1.208–9.691; p value: 0.021), female sex (HR: 1.738; 95% CI: 1.187–2.545; p value: 0.004), old age (HR: 2.139; 95% CI: 1.279–3.577; p value: 0.004), high leukocyte (HR: 11.502; 95% CI: 1.523–86.874; p value: 0.018), high NLR (HR: 1.720; 95% CI: 1.049–2.819; p value: 0.032), high CRP (HR: 1.906; 95% CI: 1.092–3.329; p value: 0.023), high procalcitonin (HR: 3.281; 95% CI: 1.780–6.049; p value: 0.001), and high creatinine (HR: 1.863; 95% CI: 1.240–2.800; p value: 0.003) were associated with 30-day mortality from COVID-19 infection. Subgroup analysis excluding cancer patients showed that age, D-Dimer, CRP, and PCT were associated with 30-day mortality in COVID-19 patients, while steroid therapy is protective. Conclusions: This study finds that COVID-19 severity, liver cirrhosis, sex, age, leukocyte, NLR, CRP, creatinine, and procalcitonin were associated with COVID-19 mortality within 30 days. These findings underscore the multifactorial nature of COVID-19 infection mortality. It is important, therefore, that patients which exhibit these factors should be treated more aggressively to prevent mortality.

Publisher

MDPI AG

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