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A new parameter in COVID-19 pandemic: initial lactate dehydrogenase (LDH)/Lymphocyte ratio for diagnosis and
Istemi Serin1, Nagehan Didem Sari2, Mehmet Hilmi Dogu1
1University of Health Sciences, Istanbul Training and Research Hospital, Department of Hematology, Fatih, Turkey.
Insights
The Lactate Dehydrogenase (LDH)/Lymphocyte ratio shows promise as a sensitive biomarker for diagnosing COVID-19 and predicting patient mortality, especially when real-time polymerase chain reaction (RT-PCR) tests yield false negatives. This ratio offers a valuable tool for early detection and prognosis in pandemic situations.
Area of Science:
- Medical diagnostics
- Biomarker discovery
- Infectious disease epidemiology
Background:
- COVID-19 (Coronavirus Disease-2019) is a global pandemic with no specific treatment, making early diagnosis critical.
- Real-time polymerase chain reaction (RT-PCR) tests for COVID-19 can lack sufficient diagnostic sensitivity.
- Computed tomography (CT) scans show high sensitivity for detecting COVID-19 related lung involvement.
Purpose of the Study:
- To evaluate the diagnostic and prognostic utility of the Lactate Dehydrogenase (LDH)/Lymphocyte ratio in COVID-19 patients.
- To compare the sensitivity of the LDH/Lymphocyte ratio against CT findings as a gold standard.
Main Methods:
- Retrospective analysis of data from 2217 COVID-19 patients.
- Collected demographic data, comorbidities, PCR results, initial CT findings, laboratory values, LDH/Lymphocyte ratio, treatments, and patient outcomes.
- Statistical analysis to determine the diagnostic sensitivity and prognostic value of the LDH/Lymphocyte ratio.
Main Results:
- The LDH/Lymphocyte ratio demonstrated an Area Under the Curve (AUC) of 0.706 for diagnosis (cut-off > 0.06), with 76.4% sensitivity and 59.60% specificity when compared to CT scans.
- For predicting survival, the LDH/Lymphocyte ratio showed an AUC of 0.749 (cut-off > 0.21), with 70.59% sensitivity and 73.88% specificity.
- CT involvement was confirmed as a highly sensitive method for COVID-19 diagnosis.
Conclusions:
- The LDH/Lymphocyte ratio is a sensitive biomarker for COVID-19 diagnosis, particularly useful in cases of RT-PCR false negativity.
- The ratio also serves as a valuable predictor of mortality in COVID-19 patients.
- Established cut-off values of 0.06 for diagnosis and 0.21 for mortality provide clinical guidance.
Background:
COVID-19 (Coronavirus Disease-2019) is a pandemic disease, infecting more than 26.5 million people. Since there is no specific and effective treatment; early diagnosis and optimal isolation of the patient are of vital importance. Real-time polymerase chain reaction-based (RT-PCR) analyses do not achieve sufficient sensitivity in the diagnosis of the disease.
Methods:
The data from 2217 patients diagnosed as COVID-19 between March 2020 and June 2020 and hospitalized or discharged with home isolation were retrospectively analyzed. Demographic data, comorbidities, PCR results, initial computed tomography (CT), laboratory values, Lactate Dehydrogenase (LDH)/Lymphocyte ratio, initial treatments and last status were recorded. The diagnostic sensitivity of LDH/Lymphocyte ratio, which is the main purpose of the study, was analyzed statistically.
Results:
In order to test the effectiveness of LDH/Lymphocyte ratio for COVID-19 for diagnostic purposes, CT results were considered as gold standard. The area under the curve (AUC) was found to be 0.706 (p < 0.001; cut-off > 0.06) (Sensitivity: 76.4, specificity: 59.60). For the evaluation of LDH/Lymphocyte ratio in terms of survival, AUC was found to be 0.749 (p < 0.001; cut-off > 0.21) (Sensitivity: 70.59, specificity: 73.88).
Conclusion:
Studies based on radiological findings have demonstrated that CT involvement has higher sensitivity. LDH/Lymphocyte ratio was analyzed in terms of diagnosis and mortality with using specific CT involvement as gold standard method which was found to be a more sensitive due to PCR false negativity; 0.06 and 0.21 were obtained as cut off values for diagnosis and mortality.
