An Interplay between Oxidative Stress (Lactate Dehydrogenase) and Inflammation (Anisocytosis) Mediates COVID-19 Severity Defined by Routine Clinical Markers

Abstract

Viral infections activate the innate immune response and the secretion of inflammatory cytokines. They also alter oxidative stress markers, which potentially can have an involvement in the pathogenesis of the disease. The aim of this research was to study the role of the oxidative stress process assessed through lactate dehydrogenase (LDH) on the severity of COVID-19 measured by oxygen saturation (SaO2) and the putative interaction with inflammation. The investigation enrolled 1808 patients (mean age of 68 and 60% male) with COVID-19 from the HM Hospitals database. To explore interactions, a regression model and mediation analyses were performed. The patients with lower SaO2 presented lymphopenia and higher values of neutrophils-to-lymphocytes ratio and on the anisocytosis coefficient. The regression model showed an interaction between LDH and anisocytosis, suggesting that high levels of LDH (>544 U/L) and an anisocytosis coefficient higher than 10% can impact SaO2 in COVID-19 patients. Moreover, analysis revealed that LDH mediated 41% (p value = 0.001) of the effect of anisocytosis on SaO2 in this cohort. This investigation revealed that the oxidative stress marker LDH and the interaction with anisocytosis have an important role in the severity of COVID-19 infection and should be considered for the management and treatment of the oxidative phenomena concerning this within a precision medicine strategy.

The Relationship between the Laboratory Biomarkers of SARS-CoV-2 Patients with Type 2 Diabetes at Discharge and the Severity of the Viral Pathology

“…The increase in LDH as a nonspecific enzyme, starting from the eighth day of SARS-CoV-2 infection, has been reported in studies in the literature, and it has been the most important risk factor for mortality in COVID-19 patients [ 24 ]. Furthermore, in COVID-19 infection, LDH levels as a marker of oxidative stress have been shown to correlate with ambient oxygen saturation, anisocytosis, and disease severity [ 25 ]. Another acute-phase protein is fibrinogen, the precursor of fibrin, which consists of two subunits with three polypeptide chains of Aalpha, Bbeta, and γ.…”

Lactate dehydrogenase predicts disease progression outcome in COVID-19 patients treated with Azvudine

“…However, the association between inflammatory biomarkers and prognosis in COVID-19 patients undergoing Azvudine treatment remains unclear.Lactate dehydrogenase (LDH), a cytoplasmic glycolytic enzyme found in almost every tissue, is commonly used as an indicator of tissue damage ( Jurisic et al., 2015 ). Numerous studies have shown that elevated LDH levels are positively associated with the severity of COVID-19 ( Bartziokas and Kostikas, 2021 ; Szarpak et al., 2021 ; Alonso-Bernáldez et al., 2023 ; Ergenc et al., 2023 ). However, it is still uncertain whether LDH can predict the prognosis in COVID-19 patients receiving Azvudine treatment.…”