Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
High serum lactate dehydrogenase and dyspnea: Positive predictors of adverse outcome in critical COVID-19 patients in Yichang
Xiao-Ting Lv, Yong-Ping Zhu, Ai-Guo Cheng, Yong-Xu Jin, Hai-Bo Ding, Cai-Yun Wang, Shu-Yu Zhang, Gong-Ping Chen, Qing-Quan Chen, Qi-Cai Liu
Xiao-Ting Lv, Yong-Xu Jin, Hai-Bo Ding, Cai-Yun Wang, Gong-Ping Chen, Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Xiao-Ting Lv, Institute of Respiratory Disease, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Yong-Ping Zhu, Department of Cardiovascular Surgery, Fujian Medical University Attached Union Hospital, Fuzhou 350001, Fujian Province, China
Ai-Guo Cheng, Department of Critical Medicine, the Third People's Hospital of Yichang, Yichang 443000, Hubei Province, China
Shu-Yu Zhang, Qing-Quan Chen, Department of Laboratory Medicine, Fujian Medical University, Fuzhou 350004, Fujian Province, China
Qi-Cai Liu, Department of Reproductive Medicine Centre, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Author contributions: Lv XT, Zhu YP, Chen GP and Liu QC contributed equally to this work; Chen GP, Chen QQ, and Liu QC designed the research study; Cheng AG, Jin YX, Ding HB, Wang CY and Zhang SY performed the research; Cheng AG, Jin YX, Ding HB and Lv XT contributed reagents and analytic tools; Lv XT and Zhu YP analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Supported by National Natural Science Foundation of China, No. 81800070; Development Fund Program of Fujian Provincial Health and Family Planning Commission, China, No. 2017-1-43.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University [(No. (2020) 153)].
Informed consent statement: Patients were not required to give informed consent to the study as the analysis used anonymous clinical data that were obtained after each patient gave their informed verbal consent prior to study inclusion.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qi-Cai Liu, MD, Chief Technician, Doctor, Teacher, Department of Reproductive Medicine Centre, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou 350005, Fujian Province, China. lqc673673673@163.com
Received: April 26, 2020
Peer-review started: April 26, 2020
First decision: August 23, 2020
Revised: September 4, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: November 26, 2020
ARTICLE HIGHLIGHTS
Research background
Millions of new coronavirus disease pneumonia (coronavirus disease 2019, COVID-19) cases have been reported worldwide. Moreover, the prognosis of critically ill and severe COVID-19 patients is extremely poor.
Research motivation
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.
Research objectives
To describe the clinical characteristics and examine the clinical changes in LDH in the alveolitis and fibrosis stages according to computed tomography findings in critically ill COVID-19 patients and their predictive value for clinical prognosis.
Research methods
We 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 and divided them into non-survivors and survivors. Clinical data including symptoms, detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), chest computed tomography images, changes in serum LDH in different clinical phases, and prognosis were collected.
Research results
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. Both first and lowest LDH values in the alveolitis and fibrosis stage were more pronounced in non-survivors than in survivors. Importantly, patients with high LDH had a significantly shorter median survival time in the alveolitis and fibrosis phase.
Research conclusions
High serum LDH and dyspnea symptoms in the early stages of infection were positive predictors of severity and poor prognosis in patients with critical COVID-19. The rapid progressive fibrosis stage was more perilous than the alveolitis stage, even if SARS-CoV-2 is undetectable.
Research perspectives
The immunologic mechanism of elevated serum LDH during SARS-COV-2 infection requires further investigation.
