One of the serious complications that caused a high mortality rate during the COVID-19 pandemic was the occurrence of Acute Respiratory Distress Syndrome (ARDS), which has even reached a fatality rate of 50-60% in treated patients. Patients who experience progression of pneumonia with worsening and severe respiratory problems require intensive care and ventilators, causing a crisis in ICU capacity and limited ventilator facilities throughout the world (WHO, 2022; Irwandy, 2020). In this condition, the importance of early diagnosis of the risk of ARDS which requires ICU treatment is felt so that intervention can be carried out more quickly. The crisis of ICU rooms and ventilators also occurred in Indonesia, especially at the peak of the second wave of COVID-19 cases in 2021.
Experts estimate that the expansion of pneumonia in COVID-19 is associated with clinical worsening and ARDS status. Efforts to detect early and predict worsening of pneumonia using chest x-ray scoring were pioneered by Borghesi with the Brixia Score. Meanwhile, Utami Purbasari conducted research aimed at using chest x-ray scoring to predict the risk of ARDS requiring ICU treatment based on the Berlin criteria for ARDS. He outlined this research in a dissertation entitled “UTAMI Scoring Method as a Prediction of ARDS (Acute Respiratory Distress Syndrome) ICU Based on Chest Photos and Risk Factors for COVID-19 Pneumonia Patients: Comparative Study Against the Berlin Criteria” which was defended in the open session for the promotion of a doctorate in Epidemiology on Tuesday, January 16, 2023.
When using the UTAMI Method (Universal Thorax ARDS Measurement Index) it was found that the UTAMI scoring method can be a diagnostic tool for predicting ARDS conditions that require ICU treatment and has a sensitivity of 84%, and an Area Under the Curve (AUC) value of 0.825, replacing the PaO2FiO2 examination which is based on blood gas analysis.
Apart from that, this study also found a scoring model that can predict a high risk of ARDS requiring ICU based on predictor factors of comorbid CAD, Oxygen Saturation and C-Reactive Protein (CRP) values.
The results showed that the UTAMI method could be used to predict the level of ARDS in patients with an AUC value of O.796. Meanwhile, the model with the best AUC value was 0.8125 using the Berlin criteria PaO2FiO2 value with the predictor factors being neutrophil levels, CRP, D-dimer, saturation, and respiratory rate. When the two models are compared, the predictor factors for CRP are found, and oxygen saturation is an important factor in both models. “The final ARDS predictor model using the UTAMI scoring method can be an alternative for diagnosing and predicting ICU ARDS, especially in hospitals with limited facilities and infrastructure because it is easier and more efficient. “Apart from that, the test results on the application of the scoring model for both methods show that the sensitivity and specificity are not too different,” explained Utami.
This research makes an important contribution to the development of management strategies and rapid diagnosis of ARDS. Apart from that, it is very important, especially in facing conditions of limited health resources during the pandemic.
Based on the results of his dissertation, Utami Purbasari was successfully declared to have graduated as a Doctor in the field of Epidemiology. Utami is the second PhD graduate in Epidemiology in 2024, the 106th PhD graduate in Epidemiology and the 397th PhD graduate in IKM.
This doctoral promotion open session was chaired by Prof. Dr. Dr. Ratna Djuwita, M.P.H., as Chair of the Session, with Prof. Drg. Nurhayati Adnan Prihartono, M.P.H., M.Sc., Sc.D., as Promoter and dr. Budhi Antariksa, Ph.D., Pulmonology Specialist, Asthma COPD Consultant and Dr. Dr. Helda, M.Kes., as Co-Promoter. The examining team consists of Prof. Dr. Dr. Sudarto Ronoatmodjo, S.K.M., M.Sc.; Dr. Dr. Yohanes Wolter Hendrik George, ICU Consultant Anesthesia Specialist, Dr. Dr. Rusli Mulyadi, SpRad(K) Thorax; and Dr. Dr. Rahmad Mulyadi, SpRad(K) Intervention.