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Updated: Dec 11, 2025
Mapping Metabolism: Monitoring Lactate Dehydrogenase Activity Directly in Tissue
Published on: June 21, 2018
Lactate dehydrogenase: an old enzyme reborn as a COVID-19 marker (and not only)
1Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
Insights
Lactate dehydrogenase (LDH) testing, once limited, now shows significant prognostic value in cancer and COVID-19 severity. Improved standardization and traceability are crucial for its renewed clinical utility.
Area of Science:
- Clinical Biochemistry
- Diagnostic Medicine
- Biomarker Discovery
Background:
- Lactate dehydrogenase (LDH) was initially part of a cardiac enzyme triad for myocardial infarction diagnosis.
- Its use later narrowed to anemia evaluation and general tumor prognostication.
- Recent years have seen a resurgence in LDH's clinical applications.
Purpose of the Study:
- To highlight the evolving and expanding clinical significance of lactate dehydrogenase (LDH) measurements.
- To underscore the need for improved standardization and traceability of LDH assays.
Main Methods:
- Review of historical and recent clinical applications of LDH testing.
- Analysis of LDH's role in neoplastic conditions and infectious diseases like COVID-19.
- Examination of its inclusion in updated staging systems (e.g., Revised International Staging System).
Main Results:
- LDH is a confirmed predictor of poor outcomes in various cancers.
- LDH is integral to staging multiple myeloma in the Revised International Staging System.
- LDH has demonstrated significant utility in assessing COVID-19 severity.
Conclusions:
- The expanded clinical utility of LDH necessitates enhanced assay standardization.
- Traceability of clinical LDH results to reference measurement systems is essential for reliable clinical decision-making.
Abstract:
Background Historically, the lactate dehydrogenase (LDH) measurement was introduced into Laboratory Medicine as component (together with creatine kinase (CK) and aspartate aminotransferase) of the classical enzyme triad employed for the diagnosis of myocardial infarction, which was subsequently replaced by CK-MB, and more recently by cardiac troponins. Afterwards, for many years, the clinical application of serum LDH measurement has been limited to the evaluation of anemias and to as a rough prognostic tool for certain tumors. Content In the last few years, significant changes have happened. First, the test has been confirmed as a robust predictor of poor outcomes in many neoplastic conditions. Furthermore, in the Revised International Staging System adopted in the 2015 by the International Myeloma Working Group, LDH acts as determinant of disease biology in differentiating myeloma stages. Finally, in the last few months, LDH is definitively reborn given its proven significant contribution in defining the COVID-19 severity. Conclusions This increased clinical role calls for an improvement of LDH assay standardization through the implementation of traceability of results of clinical samples to the available reference measurement system.
