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"Coronavirus Disease-2019 atau COVID-19 merupakan penyakit yang disebabkan oleh Virus SARS-CoV-2. Program vaksinasi dan pengecekan dengan alat RT-PCR terus dijalankan demi mengetahui dan mencegah penyebaran penyakit. Dalam hal ini cycle threshold (Ct) value digunakan untuk mendiagnosa atau memprediksi infeksi COVID-19. Penelitian dilakukan dengan desain cross sectional menggunakan data retrospektif yang diperoleh dari sumber data sekunder. Data diperoleh dari Laboratorium Helix Depok dan Dinas Kesehatan Kota Depok periode Januari hingga Desember 2021. Dari 1060 data sampel Ct value serta faktor-faktor yang mungkin memengaruhinya, dilihat hubungannya dengan variabel usia, jenis kelamin, serta riwayat vaksinasi (jenis vaksin dan waktu pemberian vaksin). Hasil yang didapatkan dari profil Ct value Januari hingga Desember 2021 menunjukkan adanya penurunan Ct value di bulan Juni – Juli 2021. Jenis kelamin (Gen N, p=0,509; ORF1AB, p=0,447) dan usia (Gen N, p=0,482; ORF1AB p=0,764) tidak signifikan memengaruhi nilai Ct value. Sedangkan jenis vaksin non-Coronavac (Gen N, p=0,001; ORF1AB, p=0,001) dan waktu vaksinasi kurang dari 30 hari sebelum terjadinya infeksi (Gen N, p=0,002; ORF1AB, p< 0,001) secara signifikan berhubungan dengan nilai Ct value yang lebih tinggi (di atas median). Berdasarkan hasil penelitian ini, diketahui bahwa terjadi peningkatan jumlah kasus sejalan dengan penurunan rerata Ct value pada bulan Juni dan Juli 2021. Nilai Ct value tidak dipengaruhi usia dan jenis kelamin, namun jenis vaksin non-Coronavac serta waktu pemberian vaksin kurang dari 30 hari sebelum terjadinya infeksi berhubungan dengan nilai Ct value yang lebih tinggi, menunjukkan efektivitasnya dalam menurunkan keparahan penyakit.

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Coronavirus Disease-2019 or COVID-19 is a disease caused by the SARS-CoV-2 Virus. Vaccination programs and checking with RT-PCR tools continue to be carried out in order to find out and prevent the spread of the disease. In this case, the cycle threshold (Ct) value is used to diagnose or predict COVID-19 infection. The study was conducted with a cross sectional design using retrospective data obtained from secondary data sources. Data were obtained from Helix Depok Laboratory and Depok City Health Office from January to December 2021. From 1060 sample data, the Ct value and factors that might affect it were examined in relation to the variables of age, gender, and vaccination history (type of vaccine and time of vaccine administration). The results obtained from the Ct value profile from January to December 2021 showed a decrease in Ct value in June - July 2021. Gender (Gene N, p=0.509; ORF1AB, p=0.447) and age (Gene N, p=0.482; ORF1AB p=0.764) did not significantly affect the Ct value. Non-Coronavac vaccine type (Gen N, p=0.001; ORF1AB, p=0.001) and vaccination time less than 30 days before infection (Gen N, p=0.002; ORF1AB, p<0.001) were significantly associated with higher Ct values (above median). Based on the results of this study, it is known that there was an increase in the number of cases in line with the decrease in the average Ct value in June and July 2021. Ct value was not influenced by age and gender, but non-Coronavac vaccine type and vaccine administration time less than 30 days prior to infection were associated with higher Ct value, indicating its effectiveness in reducing disease severity."

"Latar Belakang: Infeksi severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pada pasien lansia sering berkembang menjadi berat dengan tingkat kematian yang tinggi. Tes laboratorium yang dapat digunakan sebagai prediktor keparahan dan kematian COVID-19 tidak spesifik dan sering dijumpai pada kondisi lainnya. Penelitian tentang hubungan antara nilai cycle threshold (CT) awal uji polymerase chain reaction (PCR) dengan kejadian gagal nafas dan kematian saat perawatan pada pasien lansia yang terinfeksi SARS-CoV-2 belum ada. Penelitian yang melaporkan cut-off nilai CT yang dapat digunakan untuk interpretasi atau stratifikasi risiko pada pasien lansia juga belum ada.Tujuan: Membuktikan peran nilai CT awal uji PCR untuk memprediksi kejadian gagal nafas dan kematian saat perawatan pada pasien lansia terkonfirmasi COVID-19.Metode: Penelitian ini merupakan suatu kohort retrospektif yang melibatkan pasien lansia terkonfirmasi COVID-19 yang dirawat di Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo (RSCM) Jakarta periode Juni 2020 sampai Desember 2021. Kriteria inklusi adalah pasien berusia ≥ 60 yang tahun memiliki diagnosis COVID-19 kasus konfirmasi dan terdapat hasil nilai CT awal uji PCR di dalam rekam medis. Kriteria eksklusi adalah rekam medis tidak ditemukan atau data tidak lengkap, pasien sudah gagal nafas atau meninggal saat datang, pasien pulang paksa atau pindah rumah sakit.Hasil: Penelitian ini melibatkan 543 subyek dengan median usia 67,59 tahun (rentang interkuartil [RIK] 63,12-73,35), sebanyak 55,6% subyek berjenis kelamin laki-laki dan 50,6% subyek memiliki dua atau lebih komorbiditas. Komorbiditas yang paling sering ditemui adalah hipertensi (55,1%), DM (39,6%), penyakit ginjal kronis (15,3%), penyakit jantung koroner (15,1%) dan kanker (10,3%). Median nilai CT awal uji PCR pada kelompok yang mengalami gagal nafas lebih rendah (23,76 vs. 28,07), p<0,001. Cut-off terbaik dari nilai CT awal uji PCR untuk memprediksi gagal nafas adalah 23,8 (sensitivitas 51,0% dan spesifisitas 76,4%). Median nilai CT awal uji PCR pada kelompok yang meninggal lebih rendah (23,55 vs. 28,14), p<0,001. Cut-off terbaik dari nilai CT awal uji PCR untuk memprediksi kematian adalah 25 (sensitivitas 60,3% dan spesifisitas 70,0%).Simpulan: Nilai CT awal uji PCR yang rendah merupakan prediktor tingginya kejadian gagal nafas dan kematian saat perawatan pada pasien lansia terkonfirmasi COVID-19 dengan nilai cut-off 23,8 dan 25 secara berturut-turut.

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Background: Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in elderly is often severe with a high mortality rate. Laboratory tests are not specific for predicting severity and mortality of COVID-19 and are common in other conditions. There is no study on the relationship between polymerase chain reaction (PCR) cycle threshold (CT) value with respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19. CT value-based risk stratification or interpretation in elderly is also limited by the absence of CT cut-off values.

Objective: This sudy aims to determine the role of initial PCR CT value to predict respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19.

Methods: This retrospective cohort study utilised data of elderly inpatients with confirmed COVID-19 in Cipto Mangunkusumo Hospital, Indonesia’s national general hospital from June 2020 to December 2021. The inclusion criterion was complete data of initial PCR CT value in medical records from elderly inpatients aged 60 years and older with confirmed COVID-19. Exclusion criteria were incomplete data or no medical records found, those who had respiratory failure or deceased on arrival, those who was forced dicharged or moved to another hospital.

Results: A total of 543 elderly patients were enrolled in this study. Among all, the median age was 67.59 years (interquartile range (IQR) 63.12-73.35); 55.6% patients were men and 50.6% patients had two or more comorbidities. The common comorbidities were hypertension (55,1%), diabetes mellitus (39,6%), chronic kidney disease (15,3%), coronary heart disease (15,1%) and cancer (10,3%) The median CT value of group with acute respiratory distress syndrome (ARDS) was lower (23.76 vs. 28.07), p<0.001. The best cut-off for predicting ARDS was 23.8 (sensitivity of 51.0% and specificity of 76.4%). The median CT value of non-survivor group was lower (23.55 vs. 28.14), p<0.001. The best cut-off for predicting ARDS was 25 (sensitivity of 60.3% and specificity of 70.0%).

Conclusions: A low PCR CT value is a predictor of high respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19, the best cut-off was 23.8 and 25 respectively. "

"Pendahuluan: COVID-19 telah dilaporkan menyebabkan berbagai gejala, termasuk gejala pernapasan dan gejala gastrointestinal seperti mual, muntah, dan diare. Standar emas untuk pengujian COVID-19 adalah RT-PCR menggunakan koleksi swab nasofaring. Namun, beberapa penelitian menunjukkan bahwa pengambilan swab nasofaring memiliki beberapa keterbatasan, terutama untuk mendeteksi gejala gastrointestinal. Salah satu variabel dalam pengujian RT-PCR adalah Nilai CT yang diketahui dapat meningkatkan spesifisitas pengujian. Namun, belum ada penelitian yang menghubungkan Nilai CT pasien dengan pengambilan sampel swab anal dengan gejala gastrointestinal terkait COVID-19. Metode: Penelitian ini menggunakan desain penelitian analitik, khususnya penelitian potong lintang. Data sekunder diperoleh dan diolah yang berisi data pribadi, pekerjaan, dan hasil CT Value. Analisis lebih lanjut dilakukan pada hubungan antara gejala gastrointestinal dan tingkat Nilai CT pada swab anal. Hasil: Distribusi tingkat Nilai CT responden berdasarkan cut off >25 untuk tinggi, dan <25 untuk rendah dan sedang. Dari 37 subjek, 1 orang (2,7%) memiliki Nilai CT rendah dan 36 pasien memiliki Nilai CT tinggi. Distribusi gejala subjek didapatkan 15 pasien (40,5%) tidak mengalami gejala gastrointestinal dan sebanyak 22 pasien (59,5%) mengalami gejala gastrointestinal. Gejala gastrointestinal umum yang dilaporkan pada pasien meliputi: mual (54,1%), muntah (18,9%), sakit perut (16,2%) dan diare (13,5%). Namun, tidak ada hubungan yang signifikan (p>0,05) antara Nilai CT pada pengambilan anal swab dengan gejala gastrointestinal pada pasien COVID-19. Kesimpulan: Hubungan antara Nilai CT pada pengambilan anal swab dengan gejala gastrointestinal pada pasien COVID-19 tidak menunjukkan hubungan yang signifikan. Penelitian lebih lanjut tentang faktor risiko yang mempengaruhi hasil nilai CT direkomendasikan.

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Introduction: COVID-19 has been reported to cause a range of symptoms, including respiratory symptoms and gastrointestinal symptoms such as nausea, vomiting, and diarrhea. The gold standard for COVID-19 testing is RT-PCR using nasopharyngeal swab collection. However, several studies have shown that taking nasopharyngeal swabs have some limitation, particularly to detect gastrointestinal symptoms. One of the variables in RT-PCR testing is CT Value, which known can increase specifity of the test. However, there has been no study linking the CT Value of patients with anal swab sampling with COVID-19 related gastrointestinal symptoms. Methods: This study used an analytical research design, particularly a cross-sectional study. Secondary data were obtained and processed which contained personal data, work, and CT Value results. Further analysis was conducted on the relationship between gastrointestinal symptoms and the level of CT Value on anal swabs. Result: The distribution of respondents' CT Value levels were based on a cut off of >25 for high, and <25 for low and moderate. From 37 subjects, 1 person (2.7%) had a low CT Value and 36 patients had a high CT Value. The distribution of the subject's symptoms found 15 patients (40.5%) had no gastrointestinal symptoms and as many as 22 patients (59.5%) had gastrointestinal symptoms. Common gastrointestinal symptoms reported in patients include: nausea (54.1%), vomiting (18.9%), abdominal pain (16.2%) and diarrhea (13.5%). However, there was no significant relationship (p>0.05) between CT Value in anal swab taking and gastrointestinal symptoms in COVID-19 patients. Conclusion: The association between CT Value in anal swab taking and gastrointestinal symptoms in COVID-19 patients did not show a significant relationship. Further research on risk factors affecting the CT value results are recommended"

"Pasien kritis di ICU rentan terkena kandidiasis invasif dengan insiden 10–15%. Kultur darah merupakan diagnostik baku emas memiliki keterbatasan membutuhkan waktu 4-5 hari keluar hasil, sensitivitasnya hanya 50%. RT-PCR memiliki keunggulan dapat langsung menetukan jenis candida, relatif cepat, dan memiliki sensitifitas tinggi. Studi ini bertujuan menganalisis nilai diagnostik dari titik potong CT Value RT-PCR terhadap hasil kultur darah dalam menegakkan diagnosis kandidiasis invasif. Penelitian uji diagnostik pada 67 pasien diduga Kandidiasis Invasif di ICU. Kriteria inklusi pasien dengan skor candida ≥ 3. Spesimen sampel darah diambil pada tempat dan waktu yang sama kemudian dilakukan kultur darah dalam media Saboroud Agar dan pemeriksaan RT-PCR. Primer RT-PCR dapat deteksi C.albicans, C.parapsilosis, C.tropikalis, dan C.Glabrata. Pengambilan sampel dilakukan secara consecutive sampling. Dari 67 sampel penelitian didapatkan sampel yang positif RT-PCR 6 sampel, positif kultur darah 6 sampel, dan sampel yang positif RT-PCR dan kultur darah ada 3 sampel. Spesies candida yang didapatkan pada RT-PCR semua sampel adalah C.parapsilosis. Nilai titik potong CT Value yang didapat adalah 36.185 dengan nilai area AUC 66,7%. Nilai diagnostik CT-Value dengan metode RT-PCR memiliki nilai diagnostik yang tidak berbeda terhadap hasil kultur darah dalam mendiagnosis kandidiasis invasif, namun dengan tingkat kepercayaan yang rendah. Nilai titik potong CT-Value pemeriksaan RT-PCR adalah 36.185. Nilai ini memiliki sensitifitas 33.33%, spesifisitas 96,87%, PPV 33.33%, NPV 96,87%.

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Critical patients in the ICU are susceptible to invasive candidiasis with an incidence of 10–15%. Blood culture is a gold standard diagnostic that has limitations that it takes 4-5 days to get results, the sensitivity is only 50%. RT-PCR has the advantage of being able to directly determine the type of candida, relatively fast, and has high sensitivity. This study aims to analyze the diagnostic value of the CT Value RT-PCR cut-off point on the results of blood culture in establishing the diagnosis of invasive candidiasis. Diagnostic test study on 67 patients suspected of Invasive Candidiasis in the ICU. Inclusion criteria for patients with candida scores ≥ 3. Blood sample specimens were taken at the same place and time, then blood culture was carried out in Saboroud Agar media and RT-PCR examination. RT-PCR primers can detect C. albicans, C. parapsilosis, C. tropicals, and C. Glabrata. Sampling was carried out by consecutive sampling. Of the 67 research samples, 6 samples were positive for RT-PCR, 6 samples were positive for blood culture, and 3 samples were positive for RT-PCR and blood culture. The candida species obtained in RT-PCR of all samples was C. parapsilosis. The cut-off point value of the CT Value obtained was 36,185 with an AUC area value of 66.7%. The diagnostic value of CT-Value with the RT-PCR method has a diagnostic value that is not different from the results of blood culture in diagnosing invasive candidiasis, but with a low level of confidence. The CT-Value cut-off point value of the RT-PCR examination is 36.185. This value has a sensitivity of 33.33%, specificity of 96.87%, PPV of 33.33%, NPV of 96.87%."