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High serum lactate dehydrogenase and dyspnea: Positive predictors of adverse outcome in critical COVID-19 patients in Yichang.
Lv, Xiao-Ting; Zhu, Yong-Ping; Cheng, Ai-Guo; Jin, Yong-Xu; Ding, Hai-Bo; Wang, Cai-Yun; Zhang, Shu-Yu; Chen, Gong-Ping; Chen, Qing-Quan; Liu, Qi-Cai.
  • Lv XT; Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China.
  • Zhu YP; Department of Cardiovascular Surgery, Fujian Medical University Attached Union Hospital, Fuzhou 350001, Fujian Province, China.
  • Cheng AG; Department of Critical Medicine, the Third People's Hospital of Yichang, Yichang 443000, Hubei Province, China.
  • Jin YX; Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China.
  • Ding HB; Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China.
  • Wang CY; Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China.
  • Zhang SY; Department of Laboratory Medicine, Fujian Medical University, Fuzhou 350004, Fujian Province, China.
  • Chen GP; Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China.
  • Chen QQ; Department of Laboratory Medicine, Fujian Medical University, Fuzhou 350004, Fujian Province, China.
  • Liu QC; Department of Reproductive Medicine Centre, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China. lqc673673673@163.com.
World J Clin Cases ; 8(22): 5535-5546, 2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-1049214
Semantic information from SemMedBD (by NLM)
1. Serum LOCATION_OF Lactate Dehydrogenase
Subject
Serum
Predicate
LOCATION_OF
Object
Lactate Dehydrogenase
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Dyspnea PROCESS_OF Patients
Subject
Dyspnea
Predicate
PROCESS_OF
Object
Patients
4. 2019 novel coronavirus CAUSES COVID-19
Subject
2019 novel coronavirus
Predicate
CAUSES
Object
COVID-19
5. Lactate Dehydrogenase ASSOCIATED_WITH Disease
Subject
Lactate Dehydrogenase
Predicate
ASSOCIATED_WITH
Object
Disease
6. Patients LOCATION_OF Lactate Dehydrogenase
Subject
Patients
Predicate
LOCATION_OF
Object
Lactate Dehydrogenase
7. intensive care unit LOCATION_OF Retrospective Studies
Subject
intensive care unit
Predicate
LOCATION_OF
Object
Retrospective Studies
8. Laboratory Procedures USES TNFRSF11A protei
Subject
Laboratory Procedures
Predicate
USES
Object
TNFRSF11A protei
9. Alveolitis PROCESS_OF Patients
Subject
Alveolitis
Predicate
PROCESS_OF
Object
Patients
10. Symptoms PROCESS_OF Survivors
Subject
Symptoms
Predicate
PROCESS_OF
Object
Survivors
11. Survivors LOCATION_OF Lactate Dehydrogenase
Subject
Survivors
Predicate
LOCATION_OF
Object
Lactate Dehydrogenase
12. Lactate Dehydrogenase PART_OF Patients
Subject
Lactate Dehydrogenase
Predicate
PART_OF
Object
Patients
13. 2019 novel coronavirus PROCESS_OF Survivors
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Survivors
14. Symptoms ASSOCIATED_WITH COVID-19
Subject
Symptoms
Predicate
ASSOCIATED_WITH
Object
COVID-19
15. Serum LOCATION_OF Lactate Dehydrogenase
Subject
Serum
Predicate
LOCATION_OF
Object
Lactate Dehydrogenase
16. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
17. Dyspnea PROCESS_OF Patients
Subject
Dyspnea
Predicate
PROCESS_OF
Object
Patients
18. 2019 novel coronavirus CAUSES COVID-19
Subject
2019 novel coronavirus
Predicate
CAUSES
Object
COVID-19
19. Lactate Dehydrogenase ASSOCIATED_WITH Disease
Subject
Lactate Dehydrogenase
Predicate
ASSOCIATED_WITH
Object
Disease
20. Patients LOCATION_OF Lactate Dehydrogenase
Subject
Patients
Predicate
LOCATION_OF
Object
Lactate Dehydrogenase
21. intensive care unit LOCATION_OF Retrospective Studies
Subject
intensive care unit
Predicate
LOCATION_OF
Object
Retrospective Studies
22. Laboratory Procedures USES TNFRSF11A protein, human|TNFRSF11A
Subject
Laboratory Procedures
Predicate
USES
Object
TNFRSF11A protein, human|TNFRSF11A
23. Alveolitis PROCESS_OF Patients
Subject
Alveolitis
Predicate
PROCESS_OF
Object
Patients
24. Symptoms PROCESS_OF Survivors
Subject
Symptoms
Predicate
PROCESS_OF
Object
Survivors
25. Survivors LOCATION_OF Lactate Dehydrogenase
Subject
Survivors
Predicate
LOCATION_OF
Object
Lactate Dehydrogenase
26. Lactate Dehydrogenase PART_OF Patients
Subject
Lactate Dehydrogenase
Predicate
PART_OF
Object
Patients
27. 2019 novel coronavirus PROCESS_OF Survivors
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Survivors
28. Symptoms ASSOCIATED_WITH COVID-19
Subject
Symptoms
Predicate
ASSOCIATED_WITH
Object
COVID-19
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in China, constitutes a Public Health Emergency of International Concern. It is well known that COVID-19 patients may have increased serum lactate dehydrogenase (LDH) levels in the early stage. The clinical changes in LDH may have predictive value in disease evolution and prognosis in critically ill COVID-19 patients.

AIM:

To examine serum LDH and clinical characteristics in patients with COVID-19 and their predictive value for prognosis.

METHODS:

This retrospective study analyzed the clinical data of forty-seven critical COVID-19 patients in the intensive care unit of the Third People's Hospital of Yichang City from January 27 to March 25, 2020 and divided them into survivors and non-survivors. The patients were diagnosed according to the World Health Organization interim guidance and critical cases met any one of the following criteria Respiratory failure and required mechanical ventilation, the occurrence of shock, and the combined failure of other organs that required intensive care unit monitoring and treatments, according to the diagnostic criteria of critical COVID-19. Clinical data including symptoms, detection of SARS-CoV-2, chest computed tomography (CT) images, changes in serum LDH in different clinical phases, and prognosis were collected. Statistical analysis of the data was performed. Continuous variables were expressed as median (interquartile range) and compared with the Mann-Whitney U test. Categorical variables were compared with the Chi-square test. Survival data were analyzed using Kaplan-Meier survival curves and log-rank tests.

RESULTS:

According to chest CT images, we observed the alveolitis and fibrosis stages in all critical patients in this study. Most non-survivors died in the fibrosis stage. Non-survivors had fewer days of hospitalization, shorter disease duration, shorter duration of alveolitis and fibrosis, and had dyspnea symptoms at disease onset (P = 0.05). Both first and lowest LDH values in the alveolitis stage were more pronounced in non-survivors than in survivors (449.0 U/L vs 288.0 U/L, P = 0.0243; 445.0 U/L vs 288.0 U/L, P = 0.0199, respectively), while the first, lowest and highest values of serum LDH in non-survivors were all significantly increased compared to survivors in the fibrosis phase (449.0 U/L vs 225.5 U/L, P = 0.0028; 432.0 U/L vs 191.0 U/L, P = 0.0007; 1303.0 U/L vs 263.5 U/L, P = 0.0001, respectively). The cut-off points of first LDH values in the alveolitis and fibrosis phase for distinction of non-survivors from survivors were 397.0 U/L and 263.0 U/L, respectively. In the fibrosis stage, non-survivors had more days with high LDH than survivors (7.0 d vs 0.0 d, P = 0.0002). Importantly, patients with high LDH had a significantly shorter median survival time than patients with low LDH in the alveolitis phase (22.0 d vs 36.5 d, P = 0.0002), while patients with high LDH also had a significantly shorter median survival time than patients with low LDH in the fibrosis phase (27.5 d vs 40.0 d, P = 0.0008). The proportion of non-survivors with detectable SARS-CoV-2 until death in the alveolitis stage was significantly increased compared with that in the fibrosis stage (100% vs 35.7%, P = 0.0220).

CONCLUSION:

High LDH and dyspnea symptoms were positive predictors of an adverse outcome in critical COVID-19. The rapid progressive fibrosis stage was more perilous than the alveolitis stage, even if SARS-CoV-2 is undetectable.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Clinical Practice Guide / Observational study / Prognostic study / Risk factors Language: English Journal: World J Clin Cases Year: 2020 Document Type: Article Affiliation country: WJCC.V8.I22.5535

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Clinical Practice Guide / Observational study / Prognostic study / Risk factors Language: English Journal: World J Clin Cases Year: 2020 Document Type: Article Affiliation country: WJCC.V8.I22.5535