Serum Lactate Dehydrogenase Levels andPneumocystis cariniiPneumonia: Diagnostic and Prognostic Significance

Abstract

The level of serum lactate dehydrogenase (LDH) has been reported to be useful as a marker of Pneumocystis carinii pneumonia (PCP) in patients infected with the human immunodeficiency virus (HIV). In this study, we evaluated the clinical role of measurements of LDH in determining diagnosis and prognosis in 84 patients infected with HIV who presented with pulmonary problems. The mean serum LDH level of the 54 patients with PCP was 361 IU, which was significantly higher than the mean of 224 IU found in the 30 patients with other causes of pulmonary disease (p less than 0.001). Overlap of individual values occurred between the 2 groups. Levels greater than 450 IU consistently predicted PCP in our population, however, and normal values were found in only 7% of the patients with PCP. LDH levels in a group of 8 patients who developed PCP from conventional causes of immunosuppression were similar to those seen in PCP associated with HIV. LDH determinations prior to the episode of PCP were available in 45 patients and 39 (87%) showed an increase of greater than 50 IU at the time of diagnosis. The mean LDH in those who survived PCP was 340 IU, which was significantly less than the mean of 447 IU found in those who died (p less than 0.05). Significant overlap between the groups precluded use of the LDH as a predictor of mortality in an individual patient. Serial determinations of LDH during treatment for PCP showed that 27 of 36 (75%) of the survivors had gradual decreases of LDH, whereas 9 of 12 (75%) nonsurvivors had rising values during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Recent advances in the diagnosis, treatment, and prevention of Pneumocystis carinii pneumonia

“…In addition, the severity of interstitial edema on transbronchial biopsy, the presence of an elevated AaPO2 at the time of diagnosis, and persistence of pneumocystis cysts after 3 weeks of therapy all correlate with decreased longterm survival in these patients. Some investigators have found that elevated lactate dehydrogenase levels correlate with the presence of P. carinii, the severity of clinical disease, and survival (15,46). The prognostic value of these findings in an individual episode is uncertain, however, and hence clinical monitoring of this factor in a given patient must be interpreted with caution.…”

Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia

“…Severe hypoxaemia defined as an P(A-a),O 2 >8 kPa (>60 mmHg) at presentation was observed in only a minority of cases (17% in the group without any prophylaxis, 0% in the early failure group, and 21% in the late failure group). Furthermore, other parameters known to bear prognostic significance for the outcome of PCP, such as haemoglobin [19], albumin [20], LDH [21] and percentage of neutrophils in BAL [22], did not reveal any difference between the groups. Table 2 summarizes the most important data with regard to general clinical performance, severity of immunodeficiency, and severity of PCP in the three groups.…”

Pneumocystis Pneumonia Associated with Human Immunodeficiency Virus

“…An elevated serum lactate dehydrogenase (LDH) level is highly suggestive of PCP in an HIV-infected patient with sub-acute respiratory symptoms [40]. However an elevated serum LDH is non-specific as it is also found in other pulmonary diseases, including pulmonary embolism, non-specific interstitial pneumonitis, fungal, bacterial and mycobacterial pneumonia, as well in extra-pulmonary disease, such as multicentric Castleman disease and lymphoma.…”