Elevated lactate dehydrogenase predicts poor prognosis of acute ischemic stroke

Abstract

Background Lactate dehydrogenase (LDH) is associated with the prognosis of many diseases, but the relationship between LDH and the poor prognosis (recurrence and death) of acute ischemic stroke (AIS) has not been fully clarified. This study aimed to investigate the association between admission LDH level and poor prognosis in patients with AIS. Methods This retrospective study enrolled AIS patients treated in Taizhou Hospital of Zhejiang Province from July 2019 to December 2019. Poor prognosis included AIS recurrence and all-cause death at 3, 6, and 18 months. The correction between LDH and poor prognosis or all-cause death was assessed. Lasso Cox expression and multivariate Cox expression analyses were used to evaluate the association of LDH with the risk of poor prognosis and all-cause death, respectively. A nomogram was constructed to evaluate the predictive Values of LDH for the poor prognosis and all-cause death of AIS. Results 732 patients were included in the study. Multivariate analysis shows that admission LDH levels were significantly correlated with poor prognosis [odds ratio (OR),1.003; 95% confidence interval (95% CI), 1.001–1.005; P = 0.001] and all-cause death (OR, 1.005; 95% CI, 1.000–1.009; P = 0.031). The correlation analysis showed that admission LDH level was positively correlated with National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score. Time-dependent receiver operating characteristic (td-ROC) curves analysis showed that the AUC values of admission LDH level for predicting prognosis of AIS patients in 3-month, 6-month, 12-month and 18-month were 0.706 (95% CI, 0.604–0.810), 0.653 (95% CI, 0.583–0.723), 0.616 (95% CI, 0.556–60676) and 0.610 (95% CI, 0.552–0.680), respectively. And td-ROC also showed that the AUC values of admission LDH level for predicting all-cause death of AIS patients in 3-month, 6-month,12-month and 18-month were 0.861 (95% CI, 0.764–0.958), 0.824 (95% CI, 0.753–0.890), 0.726 (95% CI, 0.633–0.819) and 0.715 (95% CI, 0.622–0.807), respectively. The nomograms were constructed to create the predictive models of the poor prognosis and all-cause death of AIS. Conclusion Higher LDH levels are independently associated with poor prognosis and all-cause death of AIS.

Causal relationship between lactate dehydrogenase and risk of developing ischemic stroke: A Mendelian randomized study

“…However, the relationship between LDH and poor IS outcomes remains unclear. In the current studies, some studies suggested that high LDH was associated with poor IS outcomes (Jin et al., 2022 ), including hemorrhagic transformation (Chen et al., 2023 ) and cognitive impairment (Xu et al., 2022 ). Conversely, it has also been suggested that LDH was not associated with adverse IS outcomes (Sharma et al., 2021 ).…”

Integrated analysis of single cell‐RNA sequencing and Mendelian randomization identifies lactate dehydrogenase B as a target of melatonin in ischemic stroke

“…One report showed that LDH might be a risk predictor of poor prognosis and all-cause death of acute ischemic stroke, and the mortality rates at 3-month, 6-month, 12-month, and 18-month were 2.46%, 3.69%, 4.92%, and 5.33%, respectively. 16 It can also predict unfavorable outcomes after rt-PA thrombolysis is IS patients. 18 Regarding the clinical translation, removal of LDHB leads to an increase in symmetric neuronal terminal division.…”

“…LDHB is an enzyme involved in the conversion of lactate to pyruvate in the glycolytic pathway 14,15 . In the context of ischemic stroke, LDHB and lactate metabolism play a role in the response to the ischemic injury, and high LDH level indicates poor neurological outcome 16 . During ischemia, there is a reduction in oxygen and glucose supply to the affected area of the brain, which leads to a switch in cellular metabolism from aerobic metabolism (using oxygen) to anaerobic metabolism (without oxygen), resulting in an increase in lactate production.…”

“…Research suggests that LDHB, and the regulation of lactate metabolism may have implications for the severity of ischemic stroke and the subsequent damage to brain tissue. One report showed that LDH might be a risk predictor of poor prognosis and all‐cause death of acute ischemic stroke, and the mortality rates at 3‐month, 6‐month, 12‐month, and 18‐month were 2.46%, 3.69%, 4.92%, and 5.33%, respectively 16 . It can also predict unfavorable outcomes after rt‐PA thrombolysis is IS patients 18 .…”