Prognostic value of lactate dehydrogenase for in-hospital mortality in severe and critically ill patients with COVID-19

Dong, Xingtong; Sun, Lu; Li, Yan

doi:10.7150/ijms.47604

“…Dong et al reported that LDH levels in COVID-19 patients who died were significantly higher than those who survived [20]. Our study findings endorsed Dong's findings, as we found LDH on admission and its trend as a useful prognostic marker.…”

Section: Discussionsupporting

confidence: 90%

Coronavirus Disease Clinical and Laboratory Parameters: Dismembering the Values Reveals Outcomes

Zehra¹,

Siddique²,

Aamir³

et al. 2021

Cureus

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Background The medical community's understanding of the novel coronavirus disease (COVID-19) was limited initially, and many laboratory investigations were performed to observe effects of the virus on the body, its complications, and outcomes. We observed that some laboratory investigations provided redundant information regarding outcomes, and, therefore, were not necessary. Therefore, the extent of laboratory investigations may need to be pared down to not only avoid issues related to repeated blood sampling but also to minimize the financial burdens in poor socioeconomic countries. Objective This study aimed to observe trends of clinical and laboratory values in COVID-19 patients and their relationship to outcomes, including disease severity, length of hospital stay, and mortality. Methods We conducted an observational cohort study of COVID-19 patients treated as inpatients at the Shifa International Hospital (SIH) in Islamabad in April 2020. Patients were included if they were nonsurgical, adult inpatients of SIH diagnosed with COVID-19 via positive polymerase chain reaction test. We monitored study participants' clinical and laboratory values (including hypoxia) on admission and throughout the study period. We used IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA) for data entry and analysis. Descriptive statistics were calculated for qualitative and quantitative data. We determined the effect of all variables on outcomes through chi-squared or Fisher's exact test, and p-values <0.05 with 95% confidence interval were considered statistically significant. Results A total of 51 patients with COVID-19 were enrolled. Most of the study participants were men older than age 50 with multiple comorbidities and resided in Khyber Pakhtunkhwa. Length of hospital stay ranged from eight to 14 days, and most patients had severe disease and survived. Factors such as patient age, gender, comorbid conditions, residence, and medication did not significantly affect outcomes. Hypotension during the height of symptoms and oxygen saturations <80% on admission was associated with prolonged hospital stays. Two complete blood count (CBC) parameters (platelet counts and mean corpuscular volume, MCV) were strongly associated with mortality and severity in our patients. Four non-CBC parameters (alanine transaminase, ALT; D-dimer; C-reactive protein, CRP; and lactate dehydrogenase, LDH) had strong statistical impact on disease severity, length of hospital stay, and mortality in our patients. Conclusion In a resource-limited country, laboratory testing must be chosen wisely and used appropriately. Patient age, gender, comorbid conditions, drugs, residence, and ferritin levels did not affect COVID-19 outcomes. Hemoglobin, platelet count, MCV, CRP, D-dimer, ALT, LDH, hypoxia, and hypotension were all correlated to disease outcomes. Therefore, these factors are useful laboratory examinations for COVID-19 patients, especially in poor countries. Categories: Internal Medicine, Infectious Disease Keywords: covid-19, tren...

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“…Two studies were conducted in Turkey [ 34 , 58 ], 1 in the USA [ 57 ], 1 in Korea [ 52 ], and the remaining 51 in China [ 14 , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [53] , [54] , [55] , [56] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] ]. Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ...…”

Section: Resultsmentioning

confidence: 99%

“…Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , [52] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , 67 , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , 87 ], whereas the remaining 5 did not report information regarding the study design [ 14 , 49 , 66 , 71 , 86 ]. Clinical endpoints included disease severity based on current clinical guidelines in 21 studies [ 38 , 43 , 45 , [48] , [49] , [50] , [51] , [52] , 54 ...…”

Section: Resultsmentioning

confidence: 99%

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

Zinellu

¹

,

Sotgia

²

,

Fois

³

et al. 2021

Advances in Medical Sciences

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Objectives We conducted a systematic review and meta-analysis with meta-regression of creatine kinase-MB (CK-MB), a biomarker of myocardial injury, in COVID-19 patients. Methods We searched PubMed, Web of Science and Scopus, for studies published between January 2020 and January 2021 that reported CK-MB, COVID-19 severity and mortality (PROSPERO registration number: CRD42021239657). Results Fifty-five studies in 11,791 COVID-19 patients were included in the meta-analysis. The pooled results showed that CK-MB concentrations were significantly higher in patients with high disease severity or non-survivor status than patients with low severity or survivor status (standardized mean difference, SMD, 0.81, 95% CI 0.61 to 1.01, p<0.001). The rate of patients with CK-MB values above the normal range was also significantly higher in the former than the latter (60/350 vs 98/1,780; RR=2.84, 95%CI 1.89 to 4.27, p<0.001; I 2 =19.9, p=0.254). Extreme between-study heterogeneity was observed (I 2 =93.4%, p<0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified (effect size range, 0.77 to 0.84). Begg's (p=0.50) and Egger's (p=0.86) t-tests did not show publication bias. In meta-regression analysis, the SMD was significantly and positively associated with the white blood count, aspartate aminotransferase, myoglobin, troponin, brain natriuretic peptide, lactate dehydrogenase, and D-dimer. Conclusions Higher CK-MB concentrations were significantly associated with severe disease and mortality in COVID-19 patients. This biomarker of myocardial injury might be useful for risk stratification in this group.

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“…The high LDH level was a risk factor for the progression of diseases in mild COVID-19 patients [ 28 ]. It has been reported that LDH may be a predictor of respiratory failure in patients with COVID [ 29 ], as well as a predictive factor for early recognition of severe COVID-19 cases [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting Severity and Intrahospital Mortality in COVID‐19: The Place and Role of Oxidative Stress

Čekerevac

¹

,

Turnic

²

,

Draginić

³

et al. 2021

Oxidative Medicine and Cellular Longevity

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SARS-CoV-2 virus causes infection which led to a global pandemic in 2020 with the development of severe acute respiratory syndrome. Therefore, this study was aimed at examining its possible role in predicting severity and intrahospital mortality of COVID-19, alongside with other laboratory and biochemical procedures, clinical signs, symptoms, and comorbidity. This study, approved by the Ethical Committee of Clinical Center Kragujevac, was designed as an observational prospective cross-sectional clinical study which was conducted on 127 patients with diagnosed respiratory COVID-19 viral infection from April to August 2020. The primary goals were to determine the predictors of COVID-19 severity and to determine the predictors of the negative outcome of COVID-19 infection. All patients were divided into three categories: patients with a mild form, moderate form, and severe form of COVID-19 infection. All biochemical and laboratory procedures were done on the first day of the hospital admission. Respiratory ( p < 0.001 ) and heart ( p = 0.002 ) rates at admission were significantly higher in patients with a severe form of COVID-19. From all observed hematological and inflammatory markers, only white blood cell count ( 9.43 ± 4.62 , p = 0.001 ) and LDH ( 643.13 ± 313.3 , p = 0.002 ) were significantly higher in the severe COVID-19 group. We have observed that in the severe form of SARS-CoV-2, the levels of superoxide anion radicals were substantially higher than those in two other groups ( 11.3 ± 5.66 , p < 0.001 ) and the nitric oxide level was significantly lower in patients with the severe disease ( 2.66 ± 0.45 , p < 0.001 ). Using a linear regression model, TA, anosmia, ageusia, O2−, and the duration at the ICU are estimated as predictors of severity of SARS-CoV-2 disease. The presence of dyspnea and a higher heart rate were confirmed as predictors of a negative, fatal outcome. Results from our study show that presence of hypertension, anosmia, and ageusia, as well as the duration of ICU stay, and serum levels of O2− are predictors of COVID-19 severity, while the presence of dyspnea and an increased heart rate on admission were predictors of COVID-19 mortality.

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Prognostic value of lactate dehydrogenase for in-hospital mortality in severe and critically ill patients with COVID-19

Cited by 35 publications

References 26 publications

Coronavirus Disease Clinical and Laboratory Parameters: Dismembering the Values Reveals Outcomes

Coronavirus Disease Clinical and Laboratory Parameters: Dismembering the Values Reveals Outcomes

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

Predicting Severity and Intrahospital Mortality in COVID‐19: The Place and Role of Oxidative Stress

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