ABSTRACT
Background: COVID-19 is a health crisis that triggered the need to find a rapid and sensitive tool to screen populations with a high risk of complications. Lactate Dehydrogenase (LDH) is an enzyme found in almost all body cells, particularly pneumocytes, and appears to be associated with worst outcome. Pneumomediastinum (PM), which results from ruptured alveoli, can occur in non-ventilated patients. Acute pneumocytes injury induces the release of serum LDH. Objective: This study evaluates the role of baseline serum LDH levels in predicting COVID-19 lung necrosis. Methods: This retrospective study was conducted among 524 COVID-19 patients admitted to Hôtel-Dieu de France university hospital, Lebanon, between March 2020 and March 2021. Baseline serum LDH was retrieved from patients’ medical records. Radiological severity outcomes were assessed at admission and during follow-up by non-contrast computed tomography (NCCT) of the chest. Results: The mean age of participants was 63 ± 16 years, with 359 males (68.5%) and median (IQR) LDH levels upon admission of 328 (248-430). LDH was correlated with lobar involvement at both admission and NCCT follow-up (Spearman’s rho 0.527 and 0.264, respectively) and the development of a PM (p = 0.035) in 3% of the patients. Using ROC analysis, a baseline LDH value higher than 395 U/L was associated with the presence of a PM on admission and follow up chest CT, with a sensitivity of 75% and a specificity of 60.1%. Conclusion: Baseline LDH levels could serve as a tool for early diagnosis of severe pulmonary injury with poor radiological outcomes in hospitalized COVID-19 patients.
ABSTRACT
Background: COVID-19 is a health crisis that triggered the need to find a rapid and sensitive tool to screen populations with a high risk of complications. Lactate Dehydrogenase (LDH) is an enzyme found in almost all body cells, particularly pneumocytes, and appears to be associated with worst outcome. Pneumomediastinum (PM), which results from ruptured alveoli, can occur in non-ventilated patients. Acute pneumocytes injury induces the release of serum LDH. Objective: This study evaluates the role of baseline serum LDH levels in predicting COVID-19 lung necrosis. Methods: This retrospective study was conducted among 524 COVID-19 patients admitted to Hôtel-Dieu de France university hospital, Lebanon, between March 2020 and March 2021. Baseline serum LDH was retrieved from patients’ medical records. Radiological severity outcomes were assessed at admission and during follow-up by non-contrast computed tomography (NCCT) of the chest. Results: The mean age of participants was 63 ±16 years, with 359 males (68.5%) and median (IQR) LDH levels upon admission of 328 (248-430). LDH was correlated with lobar involvement at both admission and NCCT follow-up (Spearman’s rho 0.527 and 0.264, respectively) and the development of a PM (p=0.035) in 3% of the patients. Using ROC analysis, a baseline LDH value higher than 395 U/L was associated with the presence of a PM on admission and follow up chest CT, with a sensitivity of 75% and a specificity of 60.1%. Conclusion: Baseline LDH levels could serve as a tool for early diagnosis of severe pulmonary injury with poor radiological outcomes in hospitalized COVID-19 patients. o Fundamento: El COVID-19 es una crisis sanitaria que desencadenó la necesidad de encontrar una herramienta rápida y sensible para el cribado de poblaciones con alto riesgo de complicaciones. La lactato deshidrogenasa (LDH) es una enzima que se encuentra en casi todas las células del cuerpo, particularmente en los neumocitos, y parece estar asociada con el peor resultado. El neumomediastino (PM), que resulta de la ruptura de los alvéolos, puede ocurrir en pacientes no ventilados. La lesión aguda de neumocitos induce la liberación de LDH sérica. Objetivo: Este estudio evalúa el papel de los niveles séricos basales de LDH en la predicción de la necrosis pulmonar por COVID-19. Métodos: Este estudio retrospectivo se realizó entre 524 pacientes con COVID-19 ingresados en el hospital universitario Hôtel-Dieu de France, Líbano, entre marzo de 2020 y marzo de 2021. La LDH sérica basal se recuperó de los registros médicos de los pacientes. Los resultados de gravedad radiológica se evaluaron al ingreso y durante el seguimiento mediante tomografía computarizada (TCNC) sin contraste del tórax. Resultados: La edad media de los participantes fue de 63 ±16 años, con 359 varones (68,5%) y mediana (IQR) niveles de LDH al ingreso de 328 (248-430). La LDH se correlacionó con la afectación lobar tanto al ingreso como al seguimiento de la NCCT (rho de Spearman 0,527 y 0,264, respectivamente) y el desarrollo de un PM (p=0,035) en el 3% de los pacientes. Mediante el análisis ROC, se asoció un valor basal de LDH superior a 395 U/L con la presencia de un PM al ingreso y seguimiento de la TC de tórax, con una sensibilidad del 75% y una especificidad del 60,1%. Conclusión: Los niveles basales de LDH podrían servir como una herramienta para el diagnóstico precoz de lesión pulmonar grave con malos resultados radiológicos en pacientes hospitalizados con COVID-19.
ABSTRACT
Introduction: Post-COVID persistent dyspnea linked to a paradoxical vocal fold movement has rarely been described, and it has never been described as associated with dysfunctional dysphonia. Case study: We present a case of a 46-year-old patient with severe COVID-19 history who presented to our hospital for persistent cough, dysphonia, and intermittent episodes of dyspnea, getting worse when speaking. A chest computed tomography (CT) scan done was normal. The patient was treated by empiric bronchodilators with inhaled corticosteroids but without any improvement. A bronchoscopy was done and revealed spontaneous paradoxical vocal fold movement and dysfunctional dysphonia. The patient was referred to a speech therapist, and her problem was resolved. Conclusion: Resistant dyspnea to empiric treatment, after COVID-19, should suggest the diagnosis of paradoxical vocal fold movement. Laryngoscopy should be done to confirm the diagnosis, and the patient should be referred to a speech therapist.