Latar Belakang. COVID-19 merupakan penyakit infeksi dengan manifestasi klinis utama di saluran pernapasan. Selain mempunyai manifestasi klinis pada saluran pernapasan, manifestasi COVID-19 juga ditemukan di saluran gastrointestinal, terutama pada organ hati. Gangguan fungsi hati pada pasien COVID-19 ditandai dengan peningkatan enzim alanine aminotransferase (ALT), peningkatan aspartate aminotransferase (AST), dan peningkatan serum bilirubin. Penelitian ini bertujuan mengetahui perbandingan kesintasan pasien konfirmasi positif COVID-19 yang mengalami gangguan fungsi hati dan mengetahui hubungan gangguan fungsi hati terhadap kesintasan pasien konfirmasi positif COVID-19 di RS Cipto Mangunkusumo.Metode. Penelitian ini menggunakan desain kohort retrospektif. Populasi dalam penelitian ini adalah pasien rawat inap dewasa dengan konfirmasi positif COVID-19 pada periode Oktober 2020 hingga Januari 2021. Analisis untuk mengetahui perbandingan kesintasan pasien konfirmasi positif COVID-19 yang mengalami gangguan fungsi hati. Analisis Cox Regresi Extended digunakan untuk mengetahui hubungan kausal gangguan fungsi hati terhadap kesintasan pasien COVID-19. Hasil dilaporkan dalam bentuk Hazard Rasio dengan Interval Kepercayaan 95%.Hasil. Sebanyak 354 pasien konfirmasi positif COVID-19 masuk dalam penelitian ini. Hasil penelitian menunjukan probabilitas kesintasan kumulatif 30 hari pada pasien COVID-19 lebih rendah pada kelompok pasien dengan adanya gangguan fungsi hati dibandingkan dengan kelompok pasien tanpa adanya gangguan fungsi hati, yaitu sebesar 31,1% vs. 69,4%, nilai p <0,001. Pada 14 hari masa awal pengamatan, terdapat hubungan gangguan fungsi hati yang signifikan terhadap kesintasan pasien konfirmasi positif COVID-19 setelah dikontrol dengan variabel confounder berupa ARDS, D-dimer, dan ventilator. HR adjusted 2,81 (IK 95%: 1,43-5,53, nilai p 0,003). Sementara pada > 14 hari pengamatan, tidak ditemukan adanya perbedaan risiko kematian pada kelompok pasien yang mengalami gangguan fungsi hati dan tidak mengalami gangguan hati. HR adjusted 0,33 (IK 95%: 0,06-1,75), nilai p 0,195.Kesimpulan. Kesintasan pasien COVID-19 lebih rendah pada pasien yang mengalami gangguan fungsi hati. Adanya gangguan fungsi hati yang ditemukan di 14 hari masa awal pengamatan merupakan faktor risiko yang berkontribusi terhadap kesintasan pasien COVID-19.

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Background. COVID-19 is an infectious disease with the main clinical manifestations in the respiratory tract. In addition, manifestations of COVID-19 are also found in the gastrointestinal tract, especially in the liver. Abnormal liver function in COVID-19 patients is characterized by an increasing enzyme alanine aminotransferase (ALT), an increase in aspartate aminotransferase (AST), and an increase in serum bilirubin. This study aims to compare the survival rates of COVID-19 patients with abnormal liver function and to evaluate the association between abnormal liver function with the survival of COVID-19 confirmation positive in Cipto Mangunkusumo Hospital.

Method. This study was a retrospective cohort. The population in this study were inpatients adult with positive confirmation of COVID-19 in the period October 2020 to January 2021. Survival analysis with Kaplan Meier was used to compare the survival of patients with positive confirmation of COVID-19 whose had abnormal liver function. Extended Regression Cox analysis was used to determine the causal relationship of abnormal liver function with the survival of COVID-19 patients. Results were reported in Hazard Ratio with 95% Confidence Interval.

Result. A total of 354 confirmed positive COVID-19 patients were included in this study. The results showed that the cumulative 30-day survival rate in COVID-19 patients was lower in the group of patients with abnormal liver function compared to the group of patients without abnormal liver function (31.1% vs. 69.4%, p value < 0.001). In the early 14 days of observation, there was a significant association of abnormal liver function with the survival of confirmed positive COVID-19 patients after controlling for confounder variables ARDS, D-dimer, and ventilator. HR adjusted 2.81 (95% CI: 1.43-5.53, p value 0.003). While at > 14 days observations, there was no difference in the risk of death in the group of patients with abnormal liver function and without abnormal liver function. HR adjusted 0.33 (95% CI: 0.06-1.75), p value 0.195.

Conclusion. The survival rate of COVID-19 patients was lower in patients with abnormal liver function. The presence of abnormal liver function in the initial 14 days of observation was a risk factor that contributed to the survival of COVID-19 patients.