Korelasi Systemic Immune-Inflammation Index (SII) dan Platelet Lymphocyte Ratio (PLR) dengan Tingkat Kecemasan pada Pasien COVID-19 di RSUP H. Adam Malik Medan

Abstract

Objective: To determine the correlation and association of systemic immune inflammation index (SII) and platelet lymphocyte ratio (PLR) with anxiety levels in COVID-19 patients Methods: This research is analytical-retrospective research with a cross-sectional design. The subjects of this study were 50 COVID-19 patients who were treated at HAM Hospital. The study used medical records as an instrument, where basic characteristic data of the patient along with laboratory data such as platelet counts, neutrophils, leukocytes, lymphocytes, and degrees of anxiety that was measured by the Beck anxiety inventory (BAI) questionnaire, were collected. The SII index was calculated by the equation: neutrophils × platelets/lymphocytes, while the PLR ratio is calculated employing a comparison of absolute platelet values and absolute values of lymphocytes. The correlation between the SII index, PLR ratio, and BAI score was analyzed using the Spearman Rho test to determine the relationship coefficient. Logistic regression tests were also conducted to find out the factors that had the biggest impact in causing severe anxiety in the study subjects. Results: Of the 50 study subjects, 28 (56%) were in the severe anxiety category, 15(30%) were in the moderate anxiety category, and 7(14%) were in the mild anxiety category. The average SII index of the overall subject was 29995.11 ± 4531.37 while the average overall PLR ratio was 309.75 ±253.85. Spearman correlation test showed the result of the correlation coefficient R = 0.518 with the value P = 0.0001 for the correlation of SII index and anxiety level, while for PLR ratio, the result of the correlation coefficient was R = 0.436 with the value P = 0.002. Logistic regression analysis showed the combination of SII index > 410 and PLR > 140 in COVID-19 sufferers increase the risk of severe anxiety by 9,754 times (P = 0.37; 95% CI 1,152 – 82,620) compared to patients without COVID-19. Conclusion: There is a linear relationship between the Systemic Inflammatory Index (SII) and platelet lymphocyte ratio (PLR) with a BAI score that indicates anxiety levels. The higher the SII index and PLR ratio, the higher the BAI score. The combination of SII> 410 and PLR >140 in COVID-19 patients increases the risk of severe anxiety by 9,754 times greater than patients who do not suffer from COVID-19.

Tujuan: Untuk mengetahui korelasi dan asosiasi systemic immune inflammation index (SII) dan platelet lymphocyte ratio (PLR) dengan tingkat kecemasan pada pasien COVID-19. Metode: Penelitian ini merupakan penelitian analitik-retrospektif dengan desain cross sectional. Subjek penelitian ini sebanyak 50 pasien COVID-19 yang dirawat di RSUP HAM. Penelitian ini menggunakan rekam medis sebagai alat instrumen dasar, dimana data dasar pasien beserta data laboratorium seperti jumlah trombosit, neutrofil, leukosit, limfosit, dan derajat kecemasan yang diukur dengan kuesioner Beck anxiety inventory (BAI) dikumpulkan. Indeks SII dihitung dengan cara neutrofil × trombosit / limfosit, sementara rasio PLR dihitung dengan cara perbandingan nilai absolut platelet dan nilai absolut limfosit. Korelasi antara indeks SII, rasio PLR, dan skor BAI akan dianalisis menggunakan uji Spearmann Rho untuk mengetahui koefisien relasi. Uji regresi logistik juga dilakukan untuk mengetahui faktor yang paling berperan dalam menimbulkan kecemasan berat pada subyek penelitian. Hasil: Dari 50 subyek penelitian, 28(56%) berada dalam kategori kecemasan berat, 15(30%) subyek berada dalam kategori kecemasan sedang, dan 7(14%) berada dalam kateogori kecemasan ringan. Rerata indeks SII dari keseluruhan subjek adalah 29995,11 ± 4531,37 sementara rerata rasio PLR secara keseluruhan adalah 309,75 ±253,85. Uji korelasi spearman menunjukkan hasil koefisien korelasi R = 0,518 dengan nilai P = 0,0001 untuk korelasi indeks SII dan tingkat kecemasan, sementara untuk rasio PLR didapatkan hasil hasil koefisien korelasi R = 0,436 dengan nilai P = 0,002. Analisis regresi logistik menunjukkan kombinasi antara indeks SII > 410 dan PLR > 140 pada penderita COVID- 19 meningkatkan resiko kecemasan berat hingga 9,754 kali (P = 0,37; 95% CI 1,152 – 82,620) lebih tinggi dibanding pasien yang tidak menderita COVID-19 Kesimpulan: Terdapat hubungan linear antara Systemic Inflammatory Index (SII) dan platelet lymphocyte ratio (PLR) dengan skor BAI yang menandakan tingkat kecemasan. Semakin tinggi indeks SII dan rasio PLR, maka akan semakin tinggi juga skor BAI. Kombinasi SII> 410 dan PLR >140 pada pasien COVID-19 meningkatkan resiko kecemasan berat sebesar 9,754 kali lebih besar dibandingkan pasien yang tidak menderita COVID-19.