Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

Zheng, Shu-Fa; Wang, Haojie; Chen, Guorong; Shang-Guan, Huang-Cheng; Yu, Long; Zhang, Lin; Lin, Yuanxiang; Yao, Pei-Sen; Kang, Dezhi

doi:10.3389/fneur.2021.720574

Cited by 10 publications

(13 citation statements)

References 39 publications

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“…Hunt-Hess grade is used to classify the clinical status of patients with aSAH to select the timing of surgery and determine the prognosis. Related literature has reported that the higher the Hunt-Hess grade of patients at admission, the worse the prognosis ( 26 – 28 ). Frontera et al showed that in the severe group (Hunt-Hess > 3), patients with aSAH were more prone to ischemic brain injury in the early stage, with higher mortality and disability rates, confirming our findings ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Zhang

Wang

et al. 2022

Front. Neurol.

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ObjectiveTo investigate the relationship between CLR and disease severity and clinical prognosis of aSAH.MethodsThe authors retrospectively analyzed the clinical data of 221 patients with aSAH, who were admitted to the intensive care unit from January 2017 to December 2020. The indicators of inflammatory factors in the first blood routine examination within 48 h of bleeding were obtained. The prognosis was evaluated by mRS score at discharge, mRS>2 was a poor outcome. Through the receiver operating characteristic (ROC) curve, the area under the curve was calculated and the predicted values of inflammatory factors (CLR, CRP, WBC, and neutrophils) were compared. Univariate and multivariable logistic regression analyses were used to evaluate the relationship between CLR and the clinical prognosis of patients. ROC curve analysis was performed to determine the optimal cut-off threshold, sensitivity, and specificity of CLR in predicting prognosis at admission.ResultsAccording to the mRS score at discharge, 139 (62.90%) patients were classified with poor outcomes (mRS>2). The inflammatory factor with the best predictive value was CLR, which had an optimal cut-off threshold of 10.81 and an area under the ROC curve of 0.840 (95%CI.788–0.892, P < 0.001). Multivariable Logistic regression analysis showed that the Modified Fisher grade, Hunt-Hess grade, and CLR at admission were independent risk factors for poor outcomes of patients with aSAH (P < 0.05). According to Hunt-Hess grade, patients were divided into a mild group (Hunt-Hess ≤ 3) and a severe group (Hunt-Hess > 3), and the CLR value was significantly higher in severe patients with aSAH than in mild patients. The optimal cut-off threshold of CLR in the severe group was 6.87, and the area under the ROC curve was 0.838 (95% CI.752–0.925, P < 0.001).ConclusionsThe CLR value at the admission of patients with aSAH was significantly associated with Hunt-Hess grade, The higher Hunt-Hess grade, the higher the CL R-value, and the worse the prognosis. Early CLR value can be considered as a feasible biomarker to predict the clinical prognosis of patients with aSAH.

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Section: Discussionmentioning

confidence: 99%

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Zhang

Wang

et al. 2022

Front. Neurol.

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“…Our findings are still significant after including other important biomarkers which were not included in previous studies: troponin T, 16,17,23 neutrophil count, 17,23 C-reactive-protein, 16,17 blood glucose, 17 and procalcitonin. 16,17,23 Third, the mortality data are accurate and complete, since death records were extracted from household registration data. 19,20 Fourth, this study also obtained continuous LDH levels for a month after admission, and thus, this study further assessed the impact of trajectory, median, and max LDH levels.…”

Section: Discussionmentioning

confidence: 50%

“…They found that LDH may be a useful biomarker in predicting postoperative pneumonia in patients with aSAH. More recently, in a retrospective cohort of 874 patients who underwent microsurgical clipping, Zheng et al 17 found an association between preoperative serum levels of LDH and mRS outcome at 3 months. The findings showed that a higher preoperative serum LDH level was associated with functional neurological outcomes at 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…9 Serum LDH levels are considered a marker of inflammation and reflect the degree of brain tissue injury. [10][11][12][13][14][15] Recent studies indicate that LDH is associated with postoperative pneumonia 16 and functional outcome 17 in patients with aSAH after surgery. However, it is unclear if LDH level is an important predictor for mortality, in addition to other factors (C-reactive protein and glycemia) and across all aSAH treatments, and if adding LDH to the SAHIT model can improve outcome prediction.…”

Section: Introductionmentioning

confidence: 99%

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Lactate dehydrogenase predicting mortality in patients with aneurysmal subarachnoid hemorrhage

Zan

Deng

Zhang

et al. 2022

Ann Clin Transl Neurol

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Objective Lactate dehydrogenase (LDH) has been reported to be associated with outcomes after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH), but it is unclear if this is independent from other biomarkers and across all aSAH treatments. This study aims to assess whether LDH is an independent predictor of mortality in patients with aSAH and test whether the inclusion of LDH in a well‐established prediction model can improve discrimination and reclassification. Methods This was a retrospective observational study at a tertiary academic medical center. This study measured baseline LDH levels taken at admission and longitudinal LDH levels (up to a month postadmission) to assess median, max, and trajectory LDH levels. The primary outcome was mortality at 90 days. Multivariable regression analyses were used to evaluate associations between LDH and outcomes. The full original Subarachnoid Hemorrhage International Trialists' (SAHIT) model was used as the reference model. Results In total, 3524 patients with aSAH were included. LDH at admission was independently associated with mortality at 90 days (quartile 4 vs. 1: odds ratio 1.60; 95% CI 1.08–2.37) and mortality at the longest follow‐up (quartile 4 vs. 1: hazard ratio1.72; 95% CI 1.34–2.20). Compared with the SAHIT model, the addition of three LDH (admission, max, and median) levels to the SAHIT model significantly improved the area under the curve and categorical net reclassification improvement for prediction mortality. Interpretation In patients with aSAH, LDH level is an independent predictor of all‐cause mortality. The incorporation of LDH into a well‐established prediction model improved the ability to predict the risk of death in patients with aSAH.

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“…Lactate dehydrogenase (LDH) is a glycolytic enzyme in brain tissue and can be released from the damaged neuronal cells when the cell membrane is destroyed, which is nonspecific and exists in other human organs, including the liver, heart, skeletal muscle, kidney, and lung. It was reported that LDH could predict the unfavorable outcome of traumatic brain injury [ 12 , 13 , 14 ], intracerebral hemorrhage [ 15 ], and aneurysmal subarachnoid hemorrhage [ 16 ], but few studies assessed the relationship between LDH and the outcome of rIA. Brain tissue hypoxia could be induced by hypophosphatemia because it can promote an adverse increase in hemoglobin oxygen affinity and reduce the oxygen release to the brain [ 17 ], resulting in secondary cerebral hypoxia and brain tissue injury.…”

Section: Introductionmentioning

confidence: 99%

Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Propensity-Score Matching Analysis

et al. 2022

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Objective: In this study, we assessed the correlation between the lactate dehydrogenase (LDH) to phosphate ratio and the prognosis of microsurgical clippings for ruptured intracranial aneurysm (rIA) to test the hypothesis that the serum LDH to phosphate ratio could be a predictor of the outcome of microsurgical clipping for rIA. Methods: Records of rIA patients between 2012 and 2018 were retrospectively collected. Age, sex, Hunt-Hess grade, Fisher grade, medical history, aneurysm location, hydrocephalus, laboratory data including serum LDH, phosphate, and LDH to phosphate ratio, related complications, and the outcomes in 3 months were recorded. Results: A total of 1608 rIA patients in our institution were collected, and 856 patients treated by microsurgical clipping were enrolled. On admission, a significantly higher LDH-phosphate ratio was observed in patients with poor outcomes at 3 months (median ±SD, 200.175 ± 107.290 for mRS 0–2 vs. 323.826 ± 219.075 for mRS score 3–6; p =0.000). An LDH to phosphate ratio of 226.25 in the receiver operating characteristic (ROC) curve was the optimal cutoff value to discriminate between good and poor outcomes at 3 months. The LDH to phosphate ratio ≥ 226.25 on admission was independently correlated with poor outcomes in rIA patients. In addition, Hunt and Hess grade, Fisher grade, pneumonia, and DIND were also independently correlated with poor outcomes. After removing the bias in essential clinical variables between patients with LDH to phosphate, ratio ≥ 226.25 versus <226.25 by PSM, the number of patients with poor outcomes at 3 months increased in patients with an LDH to phosphate ratio of ≥ 226.25 (p = 0.005). Conclusions: The LDH to phosphate ratio was a potential biomarker and could predict the unfavorable outcome of microsurgical clipping for rIA in 3 months, related to neuronal damage, cerebral hypoxia, and early brain injury after aneurysm ruptures.

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Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

Cited by 10 publications

References 39 publications

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Clinical Value and Prognosis of C Reactive Protein to Lymphocyte Ratio in Severe Aneurysmal Subarachnoid Hemorrhage

Lactate dehydrogenase predicting mortality in patients with aneurysmal subarachnoid hemorrhage

Serum Lactate Dehydrogenase to Phosphate Ratio as an Independent Predictor for Adverse Outcome of Microsurgical Clipping for Ruptured Intracranial Aneurysm: A Propensity-Score Matching Analysis

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