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Changes in lactate dehydrogenase on admission throughout the COVID-19 pandemic and possible impacts on prognostic
Elba O Medina-Hernández1, Lucía M Pérez-Navarro1, Joselín Hernández-Ruiz2,3
1Nephrology Service, Hospital General de México 'Dr Eduardo Liceaga', Mexico.
Insights
Lactate dehydrogenase (LDH) levels, a marker for COVID-19 inflammation and mortality, decreased during the pandemic. This decline diminished LDH's ability to predict patient outcomes in clinical trials.
Area of Science:
- Biochemistry
- Clinical Medicine
- Epidemiology
Background:
- Lactate dehydrogenase (LDH) is a recognized biomarker for hyperinflammation and mortality in COVID-19 patients.
- LDH has been utilized in prognostic tools and as an inclusion criterion in clinical trials for COVID-19.
Purpose of the Study:
- To evaluate the impact of a progressive decrease in blood LDH levels on its prognostic value for COVID-19 mortality.
- To assess how changes in LDH levels during the pandemic affected its predictive capacity in a clinical randomized trial (CRT).
Main Methods:
- Analysis of LDH levels in 843 COVID-19 patients.
- Calculation of relative risk and standard error for LDH.
- Generation of receiver operating characteristic (ROC) curves using two cutoff values.
Main Results:
- The relative risk associated with LDH lost its validity over time.
- The area under the ROC curve (AUC) progressively narrowed by trimester during the pandemic.
- A significant decrease in mean LDH levels was observed throughout the pandemic period.
Conclusions:
- The observed decrease in LDH levels has negatively impacted its predictive capability for COVID-19 mortality.
- Further research is required to validate these findings and understand their clinical implications for patient stratification and treatment strategies.
Abstract:
Introduction: The enzyme lactate dehydrogenase (LDH) is a good marker of general hyperinflammation correlated with mortality for COVID-19, and is therefore used in prognosis tools. In a current COVID-19 clinical randomized trial (CRT), the blood level of LDH was selected as an inclusion criterion. However, LDH decreased during the pandemic; hence, the impact of this decrease on the prognostic value of LDH for mortality was evaluated. Methods: Data on LDH levels in 843 patients were obtained and analyzed. Relative risk, standard error and receiver operating characteristic curves were calculated for two cutoff values. Results: Relative risk lost validity and the area under the curve narrowed by trimester during the pandemic. Conclusion: The progressive decrease in LDH impacted the capacity to predict mortality in COVID-19. More studies are needed to validate this finding and its implications.
