Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis

Henry, Brandon Michael; Aggarwal, Gaurav; Wong, Johnny; Benoit, Stefanie; Vikse, Jens; Plebani, Mario; Lippi, Giuseppe

doi:10.1016/j.ajem.2020.05.073

Cited by 510 publications

(569 citation statements)

References 21 publications

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“…The LDH is a predictor of severity and mortality in hospitalized patients. 21 In our study, the LDH levels in both groups were high on admission, but the LDH level was found to be lower in the patients in the bromhexine arm as compared to the standard group at the end of the therapy, however it was not statistically significant (P=0.056). The low levels of LDH in the bromhexine group are indicative of the less cell damage and therefore, better outcomes during COVID-19 pneumonia.…”

Section: Research Highlightscontrasting

confidence: 58%

Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial

et al. 2020

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Introduction: Bromhexine is a potential therapeutic option in COVID-19, but no data from a randomized clinical trial has been available. The present study aimed to evaluate the efficacy of bromhexine in intensive care unit (ICU) admission, mechanical ventilation, and mortality in patients with COVID-19. Methods: An open-label randomized clinical trial study was performed in Tabriz, North-West of Iran. They were randomized to either the treatment with the bromhexine group or the control group, in a 1:1 ratio with 39 patients in each arm. Standard therapy was used in both groups and those patients in the treatment group received oral bromhexine 8 mg three times a day additionally. The primary outcome was a decrease in the rate of ICU admissions, intubation/mechanical ventilation, and mortality. Results: A total of 78 patients with similar demographic and disease characteristics were enrolled. There was a significant reduction in ICU admissions (2 out of 39 vs. 11 out of 39, P = 0.006), intubation (1 out of 39 vs. 9 out of 39, P = 0.007) and death (0 vs. 5, P = 0.027) in the bromhexine treated group compared to the standard group. No patients were withdrawn from the study because of adverse effects. Conclusion: The early administration of oral bromhexine reduces the ICU transfer, intubation, and the mortality rate in patients with COVID-19. This affordable medication can easily be administered everywhere with a huge positive impact(s) on public health and the world economy. Altogether, the verification of our results on a larger scale and different medical centers is strongly recommended. Trial Registration: IRCT202003117046797N4; https://irct.ir/trial/46969.

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Section: Research Highlightscontrasting

confidence: 58%

Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial

et al. 2020

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“…Regarding laboratory data, a marked reduction in lymphocytes and elevation of the concentrations of CRP, LDH and hepatic enzyme are often observed in COVID-19 patients. Recently, a few laboratory features were reported to be associated with severe disease in COVID-19 patients [1,9,18,19]. In a study of more than 1000 patients, Guan et al [9] showed that among the laboratory parameters that assessed inflammation and cell damage, CRP and LDH were significantly higher in patients with a severe disease than in patients with a non-severe disease and thus appeared to have a prognostic impact.…”

Section: Discussionmentioning

confidence: 99%

Baseline chest X-ray in coronavirus disease 19 (COVID-19) patients: association with clinical and laboratory data

et al. 2020

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Purpose To assess the reliability of CXR and to describe CXR findings and clinical and laboratory characteristics associated with positive and negative CXR. Methods Retrospective two-center study on consecutive patients admitted to the emergency department of two north-western Italian hospitals in March 2020 with clinical suspicion of COVID-19 confirmed by RT-PCR and who underwent CXR within 24 h of the swab execution. 260 patients (61% male, 62.8 ± 15.8 year) were enrolled. CXRs were rated as positive (CXR+) or negative (CXR−), and features reported included presence and distribution of airspace opacities, pleural effusion and reduction in lung volumes. Clinical and laboratory data were collected. Statistical analysis was performed with nonparametric tests, binary logistic regression (BLR) and ROC curve analysis. Results Sensitivity of CXR was 61.1% (95%CI 55–67%) with a typical presence of bilateral (62.3%) airspace opacification, more often with a lower zone (88.7%) and peripheral (43.4%) distribution. At univariate analysis, several factors were found to differ significantly between CXR+ and CXR−. The BLR confirmed as significant predictors only lactate dehydrogenase (LDH), C-reactive protein (CRP) and interval between the onset of symptoms and the execution of CXR. The ROC curve procedure determined that CRX+ was associated with LDH > 500 UI/L (AUC = 0.878), CRP > 30 mg/L (AUC = 0.830) and interval between the onset of symptoms and the execution of CXR > 4 days (AUC = 0.75). The presence of two out of three of the above-mentioned predictors resulted in CXR+ in 92.5% of cases, whereas their absence in 7.4%. Conclusion CXR has a low sensitivity. LDH, CRP and interval between the onset of symptoms and the execution of CXR are major predictors for a positive CXR.

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“…Clinical features of patients with Covid-19 have revealed a number of potential biochemical markers associated with in-hospital mortality. In particular, the blood levels of D-dimer, ferritin, C-reactive protein (CRP), troponin I, lactate dehydrogenase (LDH), and procalcitonin have been extensively studied due to their apparently good accuracy to discriminate patients with the most severe courses of the disease [ 8 , 9 , 10 , 11 , 12 , 13 ]. In parallel, numerous studies have also proposed the use of hematological markers such as lymphocyte, monocyte, and neutrophil counts that seem to associate with increased severity and mortality in patients with Covid-19 [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at Admission Predict In-Hospital Mortality in Mexican Patients with Severe SARS-CoV-2 Infection (Covid-19)

et al. 2020

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There is a deep need for mortality predictors that allow clinicians to quickly triage patients with severe coronavirus disease 2019 (Covid-19) into intensive care units at the time of hospital admission. Thus, we examined the efficacy of the lymphocyte-to-neutrophil ratio (LNR) and neutrophil-to-monocyte ratio (NMR) as predictors of in-hospital death at admission in patients with severe Covid-19. A total of 54 Mexican adult patients with Covid-19 that met hospitalization criteria were retrospectively enrolled, followed-up daily until hospital discharge or death, and then assigned to survival or non-survival groups. Clinical, demographic, and laboratory parameters were recorded at admission. A total of 20 patients with severe Covid-19 died, and 75% of them were men older than 62.90 ± 14.18 years on average. Type 2 diabetes, hypertension, and coronary heart disease were more prevalent in non-survivors. As compared to survivors, LNR was significantly fourfold decreased while NMR was twofold increased. LNR ≤ 0.088 predicted in-hospital mortality with a sensitivity of 85.00% and a specificity of 74.19%. NMR ≥ 17.75 was a better independent risk factor for mortality with a sensitivity of 89.47% and a specificity of 80.00%. This study demonstrates for the first time that NMR and LNR are accurate predictors of in-hospital mortality at admission in patients with severe Covid-19.

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Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis

Cited by 510 publications

References 21 publications

Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial

Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial

Baseline chest X-ray in coronavirus disease 19 (COVID-19) patients: association with clinical and laboratory data

The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at Admission Predict In-Hospital Mortality in Mexican Patients with Severe SARS-CoV-2 Infection (Covid-19)

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