Hubungan Rasio Neutrofil Limfosit, C-Reactive Protein, D-Dimer, Serum Feritin dengan Fungsi Kognitif pada Penderita Corona Virus Disease 2019

Abstract

Background : Corona virus disease 2019 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Leucocyte count, neutrophil to lymphocyte ratio (NLR,) C-reactive protein (CRP), D-dimer, and ferritin serum levels are very useful marker for systemic inflammation. Objective : This study was conducted to determine the association between NLR, CRP, Ddimer, ferritin serum, and cognitive function in patients with Covid-19. Methods : This study is a cross-sectional study that was selected using a consecutive sampling technique all of Covid-19 patients whom fulfill inclusion criteria and was conducted at H. Adam Malik General Hospital Medan. Cognitive function examination was performed using Forward and Backward Digit Span, Trail Making Test A&B. To analyze the association between NLR, CRP, D-dimer, ferritin serum and cognitive function using contingency coefficient test. Results : This study involved 40 Covid-19 patients consisting of 13 (32.5%) males and 27 (67.5%) females, the median age value of the patients was 39.5(19-65) with the highest age group are 50-64 years as many as 15 people (37.5%), the median value of NLR is 3.4 (1.4- 9.3), the median value of CRP is 12.6 mg/L(1.4-17.2), the median value of D-dimer 227 ng/mL(126-1600) and median ferritin serum value of 308.5 ng/mL(17.3-1789). From statistical analysis, it was found that there was a significant positive correlation between RNL(FDS (p=0,012) BDS (p=0,016) TMT-A (p=0,033) TMT-B (p=0,020), CRP(FDS (p=0,044) BDS (p=0,048) TMT-A (p=0,021) TMT-B (p=0,012), D-dimer (FDS (p=0,014) BDS (p=0,031) TMT-A (p=0,013) TMT-B (p=0,033), ferritin serum (FDS (p=0,026) BDS (p=0,012) TMT-A (p=0,003) TMT-B (p=0,010) and cognitive function on examination of the attention domain, working memory domain and executive function domain. Conclusion : There is a significant association between NLR, CRP, D-dimer, ferritin serum and impaired cognitive function in Covid-19 patients.

Latar Belakang: Penyakit Coronavirus 2019 (Covid-19) disebabkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Perhitungan leukosit, rasio neutrofil limfosit (RNL), C-reactive protein (CRP), D-dimer serta serum feritin adalah marker untuk inflamasi sistemik yang sangat berguna. Tujuan: Penelitian ini untuk mengetahui hubungan RNL, CRP, D-dimer, serum feritin, dengan fungsi kognitif pada penderita Covid-19. Metode: Penelitian ini merupakan penelitian cross sectional dengan teknik konsekutif sampling pada pasien Covid-19 yang memenuhi kriteria inklusi di RSUP H.Adam Malik Medan. Pemeriksaan fungsi kognitif dilakukan dengan menggunakan Forward and Backward Digit Span (FDS dan BDS) Trail Making Test A & B (TMT-A dan TMT-B) Untuk menganalisa hubungan RNL, CRP, Ddimer, serum feritin dengan fungsi kognitif digunakan uji koefisien kontingensi. Hasil: Penelitian ini melibatkan 40 pasien Covid-19, terdiri dari 13 orang (32,5%) laki-laki dan 27 orang (67,5%) perempuan, nilai median usia pasien adalah 39,5(19- 65) dengan kelompok usia terbanyak adalah 50-64 tahun sebanyak 15 orang(37,5%), nilai median RNL 3,4(1,4-9,3), nilai median CRP 12,6 mg/L(1,4- 17,2), nilai median D-dimer 227 ng/mL(126-1600) dan nilai median serum feritin 308,5 ng/mL(17,3-1789). Analisa statistik didapatkan adanya korelasi positif yang signifikan antara RNL dengan FDS (p=0,012) BDS (p=0,016) TMT-A (p=0,033) TMT-B (p=0,020), CRP dengan FDS (p=0,044) BDS (p=0,048) TMT-A (p=0,021) TMT-B (p=0,012), D-dimer dengan FDS (p=0,014) BDS (p=0,031) TMT-A (p=0,013) TMT-B (p=0,033), serum feritin dengan FDS (p=0,026) BDS (p=0,012) TMT-A (p=0,003) TMT-B (p=0,010). Kesimpulan : Terdapat hubungan yang signifikan antara RNL, CRP, D-dimer, serum feritin dengan gangguan fungsi kognitif pada pasien Covid-19