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Published on: May 28, 2019
Impact of lactate dehydrogenase on prognosis of patients undergoing cardiac surgery
Yu Zeng1, Yuhe Zhao1, Shuren Dai1
1Department of Cardiology, Chongqing the Seventh People's Hospital, Chongqing, China.
Insights
Elevated preoperative lactate dehydrogenase (LDH) levels predict adverse outcomes in cardiac surgery patients. High LDH is a superior predictor of mortality and other complications compared to other common indicators.
Area of Science:
- Cardiology
- Biochemistry
- Medical Informatics
Background:
- Lactate dehydrogenase (LDH) is implicated in various heart conditions.
- The prognostic value of preoperative LDH in cardiac surgery is not fully understood.
Purpose of the Study:
- To investigate the predictive effect of preoperative lactate dehydrogenase (LDH) on adverse outcomes in patients undergoing cardiac surgery.
Main Methods:
- Retrospective analysis of data from the MIMIC III and MIMIC IV databases.
- Primary outcome: in-hospital mortality. Secondary outcomes: 1-year mortality, renal replacement therapy, prolonged ventilation, and extended ICU/hospital stay.
Main Results:
- Higher preoperative LDH levels correlated significantly with adverse outcomes (p < 0.001).
- Elevated LDH independently predicted increased risk for primary and secondary endpoints.
- LDH demonstrated the highest area under the curve (0.768) for predicting the primary endpoint compared to other markers.
Conclusions:
- Preoperative LDH is a robust predictor of poor prognosis in cardiac surgery.
- LDH's predictive power surpasses that of neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), lactate, and SAPS II.
Background:
Lactate dehydrogenase (LDH) has been reported in multiple heart diseases. Herein, we explored the prognostic effects of preoperative LDH on adverse outcomes in cardiac surgery patients.
Methods:
Retrospective data analysis was conducted from two large medical databases: Medical Information Mart for Intensive Care (MIMIC) III and MIMIC IV databases. The primary outcome was in-hospital mortality, whereas the secondary outcomes were 1-year mortality, continuous renal replacement therapy, prolonged ventilation, and prolonged length of intensive care unit and hospital stay.
Results:
Patients with a primary endpoint had significantly higher levels of LDH (p < 0.001). Multivariate regression analysis presented that elevated LDH was independently correlated with increased risk of primary and secondary endpoints (all p < 0.001). Subgroup analyses showed that high LDH was consistently associated with primary endpoint. Moreover, LDH exhibited the highest area under the curve (0.768) for the prediction of primary endpoint compared to the other indicators, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), lactate, and simplified acute physiology score (SAPS) II. The above results were further confirmed in the MIMIC IV dataset.
Conclusions:
Elevated preoperative LDH may be a robust predictor of poor prognosis in cardiac surgery patients, and its predictive ability is superior to NLR, LMR, PLR, lactate, and SAPS II.
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