Survival Study of D-dimer, Lactic Acid and BGA on COVID-19 Patients 1 Gadjah Mada University Academic Hospital, Yogyakarta, Indonesia. E-mail: p_sujalmo@ugm.ac.id 2 Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia 3 Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia ABSTRACT The value of D-dimer value, lactic acid levels, and the results of blood gas analysis (PaO2, PCO2, PH, and PaO2/FiO2) are prognostic factors for COVID-19 patients, although there is no agreement on the optimum cut-off point for specificity and sensitivity. The aim of this study is to examine D-dimer value, lactic acid levels, and the results of blood gas analysis as a prognosis for patients with severe or critical COVID-19. This was a retrospective study of the medical records of the UGM Academic Hospital. Overall survival was assessed by the Kaplan-Meier curve. Determination of the cut-off for D-dimer, lactic acid, and BGA variables was carried out using the ROC followed by calculating the Youden index. Then the hazard ratio was determined by Cox regression. The cut-off value to determine the group of patients on the D-dimer and lactic acid variable was 881 ng/mL (sensitivity 77.23%, specificity 32.31%) (p=0.040) and 21 ng/mL, patients with lactic acid values above the cut-off had a higher risk of death (p=0.391). The cut-off of pH, PaO2, and PaCO2 were 7.43, 72.2 mmHg, and 33.9, respectively. D-dimer levels, lactic acid, and PaCO2 values in blood gas analysis above the cut-off value had a worse survival rate, while patients also had a worse survival rate if the PaO2 and PH values were below the cut-off value. Keywords: Blood gas analysis, COVID-19, D-dimer, lactic acid, prognostic factor PAGE 69 2022 November; 29(1): 69-73 p-ISSN 0854-4263 e-ISSN 2477-4685 Available at www.indonesianjournalofclinicalpathology.org Survival Study of D-dimer, Lactic Acid and BGA Sujalmo - , et al. INTRODUCTION COVID-19 caused by the SARS-CoV-2 virus is a terror for the whole world. It first appeared in the st form of a pneumonia cluster in December 31 , 2019 th in Wuhan, China. Then January 13 , 2020, officials confirmed the first case in Thailand, which was the 1,2 first case outside China. Based on the distribution th of WHO data dated February 17 , 223 countries were affected by the pandemic. A total of 108,822,960 cases in the world were confirmed COVID-19 and 1,403,641 people died. The most confirmed cases according to the region were 48,457,101 cases in America, Europe with 36,806,380 cases, and Southeast Asia with 13,225,290 cases. Meanwhile, the most confirmed cases according to the country were in the United States 27,309,503 cases, India 3 10,925,710 cases, and in Brazil 9,834,513 cases. Based on data from the Committee for Handling COVID-19 and the Indonesian National Economic th Recovery on February 17 , 2021, the total of confirmed patients was 1,233,959 people, 1,039,674 people recovered, 86,960 people were suspected, and 33,596 people dead. The highest number of confirmed cases were from DKI Jakarta 317,432 cases, West Java 175,950 cases, and Central Java 4 142,318 cases. Existing research states that D-dimer values, lactic acid levels, and Blood Gas Analysis (BGA) results (PaO2, PCO2, PH, and PaO2/FiO2) are prognostic factors in COVID-19 although there is no agreement on the best cut-off point value for specificity and 5,6 sensitivity. D-dimer describes the condition of hypercoagulability and lactic acid increases in severe sepsis. There has been no study evaluating these laboratory results as a determinant of the prognosis of COVID-19 in Indonesia. The aim of this study is needed to see the correlation between D-dimer values, lactic acid levels, BGA results (PaO2, PCO2, PH, and PaO2/FiO2), the prognosis of COVID-19, cases of sepsis, and hypercoagulability in ethnic groups in Indonesia. METHODS This study was a retrospective cohort analytic observational study. This research was conducted at the Academic Hospital of Gadjah Mada University from April 2021 to October 2021. This study's target population was patients diagnosed with PCR-confirmed COVID-19 with severe or critical severity. Retrospective data was taken using secondary data in the form of medical records of COVID-19 1 1 1 1,3 2 Purwadi Sujalmo , Rosita Purwanto , Clarista Rahardjo , Yanasta Yudo Pratama , Rochmi Rismawanti , 1 Wandira Lalitya