Pengaruh Gangguan Fungsi Hepar terhadap Prognosis Pasien COVID-19

Sakinah Rahma Sari, Juferdy Kurniawan

Abstract

Meskipun cukup banyak ditemukan peningkatan enzim hati pada pasien COVID-19, namun pengaruh peningkatan penanda fungsi hepar yang abnormal terhadap prognosis pasien COVID-19 masih belum diketahui dengan pasti. Laporan kasus berbasis bukti ini disusun untuk mengetahui pengaruh fungsi hati abnormal pada pasien COVID-19 melalui penelusuran literatur pada tiga database, yaitu PubMed, Scopus, dan Proquest pada tanggal 16-17 Agustus 2021. Hasil penelusuran kemudian diseleksi melalui skrining judul dan abstrak, eliminasi duplikasi, dan penerapan kriteria eligibilitas. Artikel yang terpilih kemudian ditelaah menggunakan Centre of Evidence Based Medicine (CEBM), University of Oxford. Meskipun beberapa studi melaporkan tidak ada perbedaan signifikan antara fungsi hati abnormal dan fungsi hati normal dalam prognosis pasien COVID-19, mayoritas studi menyatakan fungsi hati abnormal meningkatkan risiko prognosis buruk pada pasien COVID-19. Berdasarkan studi dengan tingkat kepercayaan tertinggi, didapatkan pasien dengan peningkatan kadar serum glutamic oxaloacetic transaminase (SGOT) dan serum glutamic pyruvic transaminase (SGPT) berisiko terjadinya prognosis yang lebih buruk dibandingkan pasien dengan kadar SGOT dan SGPT normal [OR 2,98 (IK 95% 2,35-3,77); p<0,001) dan OR 1,73 (IK 95% 1,32-2,27; p<0,001)]. Berdasarkan 34 studi yang telah ditelaah, dapat disimpulkan bahwa fungsi hati abnormal dapat menyebabkan prognosis yang lebih buruk pada pasien COVID-19 sehingga pasien COVID-19 dengan fungsi hati abnormal memerlukan pengawasan yang lebih ketat.
Kata Kunci: COVID-19, fungsi hati abnormal, prognosis

Abnormal Liver Function in Predicting COVID-19 Patients’ Prognosis

Despite of the high prevalence of liver enzyme elevation in COVID-19 patients, its effect on predicting COVID-19 patients’ prognosis was still debatable. This evidence-based case report aims to evaluate the effect of abnormal liver function in the prognosis of COVID-19 patients. Literature searching was performed on August 16-17 2021 using 3 databases: PubMed, Scopus, and Proquest. The articles selected by title/abstract screening, duplication elimination, and applying eligibility criteria were then appraised using Centre of Evidence Based Medicine (CEBM), University of Oxford. Some of the studies reported there were no significant difference in the prognosis of COVID-19 patient with and without abnormal liver function. However, most of the studies reported abnormal liver function as an independent poor prognosis predictor in COVID-19 patients. Based on the study with the highest level of evidence, the elevation of AST and ALT increase the risk of poor prognosis in COVID-19 patients [OR 2.98 (95% CI 2.35-3.77), p<0.0001) and OR 1.73 (95% CI 1.32-2.27, p<0.001)]. Based on the 34 studies appraised, we conclude that abnormal liver function will increase the risk of poor prognosis in COVID-19 patients. Thus, careful monitoring must be done in COVID-19 patients with abnormal liver function.

Keywords

Abnormal liver function, COVID-19, prognosis

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