Evaluation of serum lactate dehydrogenase and gamma glutamyl transferase in preeclamptic pregnancy and its comparison with normal pregnancy in third trimester

Abstract

INTRODUCTIONPreeclampsia is a clinical manifestation characterized by hypertension, proteinuria and edema that occurs after 20 th week of pregnancy. It is a multisystem disorder of pregnancy with potentially severe consequences for both mother and child.1 It affects about 5-8% of all pregnancies and is a major cause of maternal, fetal and neonatal mortality and morbidity. 2,3 The etiology of preeclampsia is unknown but thought to be related to hypoxia in the placenta and endothelial dysfunction. 4 The various causes that leads to these abnormalities ABSTRACT Background: Preeclampsia affects about 5-8% of all pregnancies and is a major cause of maternal, fetal and neonatal mortality and morbidity. Evidences prove that endothelial cell and altered endothelial cell function play an important role in the pathogenesis of preeclampsia. Therefore serum lactate dehydrogenase (LDH) and serum gamma glutamyl transferase (GGT) are the useful biochemical markers reflecting the severity of the occurrenc e of preeclampsia. The objective was to determine serum lactate dehydrogenase (LDH) and serum gamma glutamyl transferase (GGT) as biochemical markers in preeclamptic pregnant women and its comparison with normal pregnant women in third trimester. Methods: This is the case-control hospital based study carried in the Department of Biochemistry M.G.M. Medical College and associated M.Y. Hospital. Indore (M.P.). Normal pregnant women (n=48), women with preeclampsia (n=53) were included in the study. Both the groups were in their third trimester and of same age and same gestational age. Preeclamptic group was further divided into two subgroups mild (n=36) and severe (n=17) preeclampsia. Results: There were no significant differences among the three groups in age and body mass index but significantly higher differences in gestational age, systolic and diastolic blood pressure was observed. Higher values of serum lactate dehydrogenase (LDH) were found in mild and severe preeclamptic women than those of normal pregnant women in third trimester but the values of serum LDH was significantly elevated in severe preeclamptic women when comparison was done between mild and severe preeclamptic women. Serum GGT was significantly higher among all the groups. Conclusion: Elevated levels of serum LDH and serum GGT indicates the tissue damage related to endothelial vascular damage and are the main cause of the occurrence of preeclampsia.

Evaluation of Lactate Dehydrogenase- A Biochemical Marker of Preeclampsia

“…7,8,15,18,19 It is evident from present study that progressively increased LDH level in severe preeclampsia indicates progression of cellular injury with severity of this disorder as supported by Sarkar et al 8 Progressively raising LDH correlates with worsening of preeclampsia, maternal and foetal complications as supported by many studies. 7,8,[11][12][13][14][15]18 CONCLUSION From the present study, it can be concluded that elevated high serum LDH levels significantly correlate with the severity of preeclampsia. Hence, estimation of LDH in preeclampsia serves as a prognostic tool which is useful for early diagnosis and timely management to reduce maternal and foetal morbidity and mortality.…”

“…7 LDH is an intracellular enzyme that converts lactic acid to pyruvic acid and elevated levels indicate cellular death. 7,8 In our study, the levels of serum LDH was statistically significantly higher (p< 0.0001) in preeclamptic women as compared to normal pregnant women as shown in Table 2 and Table 3. These results are similar to many other studies.…”

“…Several potential biochemical markers have been proposed to predict the severity of preeclampsia. 8,10 According to Qublan et al, the multiorgan dysfunction in preeclampsia caused by vascular endothelial damage, including maternal liver, kidney, lungs, nervous system, coagulation system will lead to excessive LDH leakage and elevated levels in serum due to cellular dysfunction, which may cause the occurrence of preeclampsia. 7 LDH is an intracellular enzyme that converts lactic acid to pyruvic acid and elevated levels indicate cellular death.…”

Correlation of serum lactate dehydrogenase and pregnancy induced hypertension with its adverse outcomes

“…Increase in serum LDH level in preeclampsia was observed by Malvino et al, Qublan et al (p<0.001), Jaiswar et al (p< 0.0001) and Samarah et al 6,[10][11][12] Sarkar et al concluded in their study, the main cause of preeclampsia is due to elevated levels of serum LDH and serum GGT which indicates the tissue damage is related to endothelial vascular damage. 13 In the present study the LDH levels were significantly raised with the severity of the disease (P<0.0001) Jaiswar SP et al observed there was a significant increase in maternal morbidity with increasing serum LDH levels (P<0.001). Maternal mortality was 13.8% in patients with LDH levels >800 IU/l and this was a significant rise (P = 0.006), they concluded LDH levels have significant association with various maternal and fetal outcomes in patients of preeclampsia and eclampsia.…”

LDH as a prognostic marker in hypertensive pregnancy

“…These results are similar to other authors. [6][7][8] Literature review suggested that in the progressive endothelial dysfunction in maternal vascular system induced by toxins released from hypoxic placenta cause profound vasoconstriction affecting all organ system including liver. This hypoperfusion induced ischaemic injury to hepatic cells and other organs cause increased release of intracellular LDH to circulation.…”