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Mapping Metabolism: Monitoring Lactate Dehydrogenase Activity Directly in Tissue
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The role of changes in lactate dehydrogenase (LDH) levels in predicting COVID-19 severity and mortality: A biomarker

Seyed Hassan Saadat1, Behzad Einollahi1, Hadi Norouzi2

  • 1Nephrology and Urology Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Journal of Infection and Public Health
|February 10, 2026
PubMed

Insights

Dynamic changes in lactate dehydrogenase (LDH) predict COVID-19 severity. Both significant LDH reductions and elevations indicate higher risks for mortality and ICU admission in COVID-19 patients.

Area of Science:

  • Biomarkers in infectious diseases
  • Clinical chemistry and diagnostics
  • COVID-19 research

Background:

  • Lactate dehydrogenase (LDH) is a potential COVID-19 severity biomarker.
  • The predictive value of dynamic LDH changes (ΔLDH) for COVID-19 outcomes is not well-established.

Purpose of the Study:

  • To evaluate the predictive capability of ΔLDH for clinical outcomes in hospitalized COVID-19 patients.
  • To investigate the relationship between ΔLDH and COVID-19 severity, including mortality and ICU admission.

Main Methods:

  • Retrospective cohort study of 5635 adult COVID-19 patients.
  • Analysis of serial lactate dehydrogenase (LDH) measurements and calculation of ΔLDH.
  • Stratification by ΔLDH quartiles, multivariable logistic regression, and ROC analysis for outcome prediction.

Main Results:

  • A U-shaped relationship was observed between ΔLDH and adverse outcomes.
  • Both significant LDH reductions (Q1) and elevations (Q4) were associated with increased mortality and ICU admission risk.
  • ΔLDH demonstrated excellent discrimination for mortality (AUC=0.78) with an optimal cutoff of 181.5 U/L.

Conclusions:

  • Dynamic changes in LDH (ΔLDH) are a powerful, independent predictor of COVID-19 severity.
  • A novel U-shaped risk pattern for COVID-19 outcomes associated with ΔLDH was identified.
  • Serial LDH monitoring and the 181.5 U/L threshold can aid in COVID-19 risk stratification and management.
Abstract

Keywords:
COVID-19ICU AdmissionLactate dehydrogenase (LDH)Mortality

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