Lactate dehydrogenase, a Risk Factor of Severe COVID-19 Patients: A Retrospective and Observational Study

Abstract

BACKGROUNDThe World Health Organization (WHO) has recently declared coronavirus disease 2019 (COVID-19) a public health emergency of global concern. Updated analysis of cases might help identify the characteristic and risk factors of the illness severity. METHODSWe extracted data regarding 47 patients with confirmed COVID-19 from Renmin Hospital of Wuhan University between February 1 and February 18, 2020. The degree of severity of COVID-19 patients (severe vs. non-severe) was defined at the time of admission according to American Thoracic Society (ATS) guidelines for communityacquired pneumonia (CAP). RESULTSThe median age was 64.91 years, 26 cases (55.31%) were male of which, and 70.83% were severe cases. Severe patients had higher APACHE II (9.92 vs 4.74) and SOFA (3.0 vs 1.0) scores on admission, as well as the higher PSI (86.13 vs 61.39), Curb-65 (1.14 vs 0.48) and CT semiquantitative scores (5.0 vs 2.0) when compared with nonsevere patients. Among all univariable parameters, APACHE II, SOFA, lymphocytes, CRP, LDH, AST, cTnI, BNP, et al were significantly independent risk factors of COVID-19 severity. Among which, LDH was most positively related both with APACHE II (R = 0.682) and SOFA (R = 0.790) scores, as well as PSI (R = 0.465) andCT (R = 0.837) scores. To assess the diagnostic value of these selected parameters, LDH (0.9727) had maximum sensitivity (100.00%) and specificity (86.67%), with the cutoff value of 283. As a protective factor, lymphocyte counts less than 1.045 x 10 9 /L showed a good accuracy for identification of severe patients with AUC = 0.9845 (95%CI 0.959-1.01), the maximum specificity (91.30%) and sensitivity (95.24%). In addition, LDH was positively correlated with CRP, AST, BNP and cTnI, while negatively correlated with lymphocyte cells and its subsets, including CD3 + , CD4 + and CD8 + T cells (P < 0.01).

Development and validation of prognosis model of mortality risk in patients with COVID-19

“…According to our multivariate regression coefficients (Table 2), it is found that when the levels of LDH or CRP is high, the mortality is high. These results were consistent in the literature [29,30]. Here we derived the rate of change of mortality with respect to each variable as follows:…”

Clinical features and disease severity in an Iranian population of COVID-19 patients

“…Another important nding of our study was the markedly higher level of CRP in patients with severe and critical COVID-19 disease. This factor is reported to be independently related to disease severity; CRP levels >37.3 mg/L have been reportedly associated with poorer outcomes (20). In our study, the serum level of CRP showed an incremental increase with the rise in disease severity from mild/moderate to critical.…”

“…However, the direct invasion of the virus to hepatocytes can also be proposed as an etiologic factor, which was reported by some studies (19). Han et al reported that AST could be an independent risk factor for COVID-19 infection severity (20), which was not the case in our multivariate assessments.…”

“…A recent study on 548 patients from Wuhan indicated older age, comorbid hypertension, high LDH, and D-dimer were signi cantly associated with higher severity in cases with COVID-19 (29). LDH was also identi ed as a risk factor for severe disease in another retrospective study of 47 patients from Wuhan, which also indicated lymphocyte count, especially CD3, CD4, and CD8 cells, as a predictive factor for higher severity (30). Although age was signi cantly related to disease severity, inconsistent with the mentioned studies, our multivariate analyses did not nd signi cant associations between disease severity and age, comorbid conditions, LDH, and lymphocyte count.…”

CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

“…Higher level of neutrophil-to-lymphocyte ratio (NLR), indicating lower lymphocyte, combined with older age could be utilized as an e cient tool to recognize potential severe to critical patients who requires intensive monitoring and supportive care [34]. The decrease of peripheral lymphocyte is mainly attributable to the decreased T cells, especially CD3 + , CD4 + , and CD8 + T cells [35]. Decreased CD4 + and CD8 + T cells with excessive activation of themselves could cause the immunocompromise and disease progression in COVID-19 patients [25].…”