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Prognostic value of elevated lactate dehydrogenase in patients with COVID-19: a systematic review and meta-analysis
Januar Wibawa Martha1, Arief Wibowo2, Raymond Pranata2,3
1Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Jawa Barat, Indonesia jwmartha@gmail.com.
Insights
Elevated lactate dehydrogenase (LDH) is linked to poor prognosis in COVID-19 patients. This finding highlights LDH as a potential biomarker for predicting severe outcomes in coronavirus disease 2019.
Area of Science:
- Biochemistry and Molecular Biology
- Infectious Diseases
- Clinical Medicine
Background:
- Lactate dehydrogenase (LDH) is an enzyme released from damaged cells.
- Elevated LDH levels have been observed in various inflammatory conditions.
- The prognostic value of LDH in COVID-19 requires further investigation.
Purpose of the Study:
- To evaluate the prognostic performance of elevated lactate dehydrogenase (LDH) in patients diagnosed with COVID-19.
- To determine the association between LDH levels and composite poor outcomes in COVID-19 patients.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and EuropePMC.
- The primary outcome was a composite of mortality, severity, mechanical ventilation, and ICU admission.
- Meta-analysis and meta-regression were used to analyze data from 21 studies involving 10,399 patients.
Main Results:
- Elevated LDH was present in 44% of COVID-19 patients and significantly associated with a composite poor outcome (OR 5.33).
- Elevated LDH was also linked to increased mortality (OR 4.22) and demonstrated good diagnostic performance (AUC 0.77).
- Diabetes showed a correlation with elevated LDH, but age, sex, and hypertension did not significantly influence LDH levels or heterogeneity.
Conclusions:
- Elevated lactate dehydrogenase (LDH) is a significant indicator of poor prognosis in COVID-19 patients.
- LDH serves as a valuable biomarker for identifying patients at higher risk of severe disease and mortality.
- Further research can explore therapeutic strategies targeting LDH pathways.
Purpose:
This meta-analysis aimed to evaluate the prognostic performance of elevated lactate dehydrogenase (LDH) in patients with COVID-19.
Methods:
A systematic literature search was performed using PubMed, Embase and EuropePMC on 19 November 2020. The outcome of interest was composite poor outcome, defined as a combined endpoint of mortality, severity, need for invasive mechanical ventilation and need for intensive care unit care. Severity followed the included studies' criteria.
Results:
There are 10 399 patients from 21 studies. Elevated LDH was present in 44% (34%-53%) of the patients. Meta-regression analysis showed that diabetes was correlated with elevated LDH (OR 1.01 (95% CI 1.00 to 1.02), p=0.038), but not age (p=0.710), male (p=0.068) and hypertension (p=0.969). Meta-analysis showed that elevated LDH was associated with composite poor outcome (OR 5.33 (95% CI 3.90 to 7.31), p<0.001; I2: 77.5%). Subgroup analysis showed that elevated LDH increased mortality (OR 4.22 (95% CI 2.49 to 7.14), p<0.001; I2: 89%). Elevated LDH has a sensitivity of 0.74 (95% CI 0.60 to 0.85), specificity of 0.69 (95% CI 0.58 to 0.78), positive likelihood ratio of 2.4 (95% CI 1.9 to 2.9), negative likelihood ratio of 0.38 (95% CI 0.26 to 0.55), diagnostic OR of 6 (95% CI 4 to 9) and area under curve of 0.77 (95% CI 0.73 to 0.80). Elevated LDH would indicate a 44% posterior probability and non-elevated LDH would in indicate 11% posterior probability for poor prognosis. Meta-regression analysis showed that age, male, hypertension and diabetes did not contribute to the heterogeneity of the analyses.
Conclusion:
LDH was associated with poor prognosis in patients with COVID-19.
Prospero Registration Number:
CRD42020221594.
