The Application of Lactate Dehydrogenase in Coronavirus Disease 2019 as the Best Indicator for the Progression and Clinical Status: A Case-Control Study (preprint)

Introduction Coronavirus disease 2019 (COVID-19) is now officially a pandemic. Current studies observed extensive abnormal indexes in COVID-19 patients and significant differences between mild and severe patients. However, which index would perform better as the indicator of disease progression merits further investigation.Methods We enrolled COVID-19 patients who were admitted to Shanghai Public Health Clinical center. We closely monitored the following candidate indictors: white blood cell, lymphocyte, platelet, CD4 T cell, CD8 T cell, alanine aminotransferase, estimated glomerular filtration rate (eGFR), fibrin degradation products (FDP), D-dimer, creatine kinase, myoglobin, troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactase dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin. The correlation with illness severity were assessed by Spearman analysis and the ability of differentiating the clinical statuses was quantified as the AUC value of the ROC curve. Results A total of 326 patients were enrolled, including 299 mild-ordinary and 27 severe-critical patients. At admission, D-dimer and CRP were elevated above normal range both in mild-ordinary and severe-critical patients. LDH, NT-proBNP, myoglobin, CD4 T cell, eGFR, FDP and PCT were beyond normal range in the mild-ordinary stages of severe-critical patients, but remained normal in the persistently mild-ordinary patients. Top 5 parameters with highest spearmen coefficient were LDH, procalcitonin, NT-proBNP, myoglobin and D-dimer (Spearman coefficient: 0.488, 0.453, 0.414, 0.412, 0.407). Comparing between mild-ordinary stage and severe/critical stage, LDH showed the highest receiver operating characteristics (ROC) area under the curve (AUC) of 0.951. PCT ranked second, with the ROC AUC of 0.905. Comparing between mild-ordinary and severe stages, only LDH had the ROC AUC of over 0.90 (0.927). Conclusions This study found LDH to be a superior indicator for COVID-19 status and had the potential to optimize the clinical management strategy.

Optimizing diagnostic strategy for novel coronavirus pneumonia, a multi-center study in Eastern China (preprint)

COVID-19 caused by a novel coronavirus SARS-CoV-2 emerged in Wuhan, Hubei province since December 2019, and caused a rapid outbreak throughout China and globally. Cities outside Hubei are also facing great challenge and require implementing of effective and feasible strategy in precision diagnosing novel coronavirus pneumonia (NCP). We described a multicenter prospective study on diagnostic strategy of suspected NCP patients from January 22nd to February 9th, 2020 in Eastern China cities. Nasopharyngeal swabs were collected from the patients. The epidemiological characteristics, clinical symptoms, laboratory assessments, and computed tomographic (CT) scans were obtained. Pathogen screen were performed including RT-PCR, multiplex PCR, rapid flu antigen tests and mNGS. We enrolled 53 suspected NCP patients, among whom 20 were laboratory-confirmed. Fourteen (70%) and 3 (15%) patients were positive for the first and second SARS-CoV-2 RT-PCR test, respectively. All NCP patients were positive for mNGS. Chest CT images and the symptoms of early stage NCP patients were similar to other viral pneumonia patients. We identified 11 of 20 co-infections in NCP cases, including regular respiratory virus, fungi and bacteria synchronously. Genomic analysis showed that 8 of 10 cases had no mutation in virus genome, while 2 cases had only one single mutation in N gene. Our study discovered that a combination of chest CT, SARS-CoV-2 RT-PCR and multi-plex PCR is recommended in regions outside Hubei province. Co-infection of other pathogens with SARS-CoV-2 exists and should be acknowledged. Repeated sampling, change of specimen type or metagenomics sequencing could further facilitate during critical clinical cases.