Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study

Abstract

Background: The World Health Organization has declared coronavirus disease 2019 (COVID-19) a public health emergency of global concern. Updated analysis of cases might help identify the risk factors of illness severity. Results: The median age was 63 years, and 44.9% were severe cases. Severe patients had higher APACHE II (8.5 vs. 4.0) and SOFA (2 vs. 1) scores on admission. Among all univariable parameters, lymphocytes, CRP, and LDH were significantly independent risk factors of COVID-19 severity. LDH was positively related both with APACHE II and SOFA scores, as well as P/F ratio and CT scores. LDH (AUC = 0.878) also had a maximum specificity (96.9%), with the cutoff value of 344.5. In addition, LDH was positively correlated with CRP, AST, BNP and cTnI, while negatively correlated with lymphocytes and its subsets. Conclusions: This study showed that LDH could be identified as a powerful predictive factor for early recognition of lung injury and severe COVID-19 cases. Methods: We extracted data regarding 107 patients with confirmed COVID-19 from Renmin Hospital of Wuhan University. The degree of severity of COVID-19 patients (severe vs. non-severe) was defined at the time of admission according to American Thoracic Society guidelines for community acquired pneumonia.

Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19

“…Cardiac injury defined by the increase of hs-cTnI and D-dimer on admission and patients with high BNP is associated with a higher risk of mortality [50][51][52]. LDH, AST/ALT ratio, TBIL could be identified as powerful predictive factors for early recognition of liver injury and were positively correlated with death risk of COVID-19 patients [53][54][55]. Albumin, serum urea nitrogen and creatine were risk factor s for assessing kidney damage and disease progression [55,56].…”

Prognostic value of lactate dehydrogenase for in-hospital mortality in severe and critically ill patients with COVID-19

“…Poggiali et al [25] reported that LDH may be related to respiratory function (PaO2/FiO2) and be a predictor of respiratory failure in COVID-19 patients. Han et al [26] argued that LDH could be identified as a powerful predictive factor for early recognition of lung injury and severe COVID-19 cases. However, there have been few studies focusing on the specific patient population where the most deaths came from.…”

“…CRP and lymphocyte have been confirmed as prognostic biomarkers since the outbreak of COVID-19 and they were also recommended as the early warning indicators for severe and critically ill cases by Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th edition). Han et al [26] compared LDH with other prognostic biomarkers including CRP, lymphocyte and AST in predicting severe COVID-19 cases in patients with various levels of COVID-19 severity and demonstrated that LDH had higher accuracy than CRP and lymphocyte in predicting the severity. However, our study showed that LDH had a higher prognostic accuracy than lymphocyte and a similar accuracy as CRP for predicting the in-hospital mortality in severe and critically ill patients with COVID-19.…”

COVID-19 Metabolomic Profile: A Link Between Lung Dysfunction Markers and Altered Amino Acid Metabolism

“…Glutamine levels decrease in severe and mild COVID-19 patients and this change negatively correlated with lactate dehydrogenase (LDH), C reactive protein (CRP), and PO2 levels, and positively with PCO2; these markers have been associated with lung damage and altered oxygen homeostasis in COVID-19 patients 16,17 . In vitro experiments also have demonstrated that hypoxia increases glutamine transport into the cells through HIF2-alpha upregulation of SLC1A5 genes 18 .…”