Lactate dehydrogenase and susceptibility to deterioration of mild COVID-19 patients: a multicenter nested case-control study

Abstract

Background: Coronavirus disease 2019 (COVID-19) has infected more than 4 million people within 4 months. There is an urgent need to properly identify high-risk cases that are more likely to deteriorate even if they present mild diseases on admission. Methods: A multicenter nested case-control study was conducted in four designated hospitals in China enrolling confirmed COVID-19 patients who were mild on admission. Baseline clinical characteristics were compared between patients with stable mild illness (stable mild group) and those who deteriorated from mild to severe illness (progression group). Results: From Jan 17, 2020, to Feb 1, 2020, 85 confirmed COVID-19 patients were enrolled, including 16 in the progression group and 69 in the stable mild group. Compared to stable mild group (n = 69), patients in the progression group (n = 16) were more likely to be older, male, presented with dyspnea, with hypertension, and with higher levels of lactase dehydrogenase and c-reactive protein. In multivariate logistic regression analysis, advanced age (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.020-1.166; P = 0.011) and the higher level of lactase dehydrogenase (OR, 1.012; 95% CI, 1.001-1.024; P = 0.038) were independently associated with exacerbation in mild COVID-19 patients. Conclusion: Advanced age and high LDH level are independent risk factors for exacerbation in mild COVID-19 patients. Among the mild patients, clinicians should pay more attention to the elderly patients or those with high LDH levels.

The Application of Lactate Dehydrogenase in Coronavirus Disease 2019 as the Best Indicator for the Progression and Clinical Status: A Case-Control Study

“…Therefore, we believe that even if LDH alone may slightly inferior to indicator combination in the predicting accuracy, it can greatly improve the convenience in clinical practice. What's more, the present indictor combination or work ow of COVID-19 [ 17,18 ] still lack large-scale clinical veri cation, while LDH has been widely proved to be an important marker to indicate the progress of the disease [3,4,5,6,17,18]. Our research further shows that LDH has outstanding practical predictive performance for disease progression from many aspects.…”

“…Third, predictors should show abnormalities earlier than the deterioration of the clinical condition manifested by the patient's symptoms and signs. The right way to nd those indicators is to compare the parameters of severe cases in their mild stage to the persistent mild patients [ 4 ]. It is common to compare admission ndings of the severe cases to the mild ones.…”

“…We collected variables with clinical signi cance based on our clinical experience and previous studies about COVID-19[ [2][3][4]. In SPHCC, the following candidate parameters were monitored closely, including white blood cell (WBC), lymphocyte, platelet, CD4 T cell, CD8 T cell, alanine aminotransferase (ALT), estimated glomerular ltration rate (eGFR), brin degradation products (FDP), D-dimer, creatine kinase (CK), myoglobin, troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactase dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin (PCT).…”

Corticosteroid prevents COVID-19 progression within its therapeutic window: a multicentre, proof-of-concept, observational study

“…Therefore, we thought that serum LDH level might be a valuable predicative marker for diseases progression [14], more importantly, could demonstrate the potential for depicting the spectrum of severity of diseases. Patients who with extremely high LDH levels, i.e.…”

Linking lactate dehydrogenase to the severity of COVID-19 cannot ignore the employed methodology

“…We read with interest the paper by Henry et al [ 1 ], who, through a pooled analysis of available studies, supports the evidence that lactate dehydrogenase (LDH) measurements in serum can be a significant predictor of severity and mortality in COVID-19 patients [ 2 ]. The link between LDH levels and the COVID-19 severity may reflect both the direct lung injury and more widespread tissue damage [ 3 , 4 ]. This association was analyzed in 9 published studies.…”