Prognostic value of lactate dehydrogenase for in-hospital mortality in severe and critically ill patients with COVID-19
Prognostic value of lactate dehydrogenase for in-hospital mortality in severe and critically ill patients with COVID-19
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DOI：
10.7150/ijms.47604
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发表时间：
2020-01-01
影响因子：
3.6
通讯作者：
Li, Yan
中科院分区：
文献类型：
--
作者：
Dong, Xingtong;Sun, Lu;Li, Yan
背景：乳酸脱氢酶（LDH）已被证明是2019冠状病毒病（COVID-19）严重程度和不良结局的预后因素。在大多数研究中，对不同程度的COVID-19严重程度的患者进行了汇总和分析，这可能无法准确评估LDH与疾病进展和院内死亡之间的关系。在这项研究中，我们旨在评估LDH与COVID-19重症和危重症患者住院死亡率的关系。方法：本研究为单中心回顾性研究，纳入119例患者。生存曲线采用Kaplan-Meier法绘制，log-rank检验比较。采用多变量Cox回归模型确定住院死亡率的独立危险因素。构建受体-操作者曲线（roc）来评估LDH和其他预后生物标志物的预测准确性。结果：与存活组相比，死亡组LDH水平显著升高[559.5 (172,7575)U/L vs 228 (117,490) U/L, P < 0.001]。在多因素Cox回归中，它仍然是院内死亡的独立危险因素（危险比5.985,95.0%CI: 1.498 ~ 23.905； P=0.011）。截断值353.5 U/L预测院内死亡率，敏感性为94.4%，特异性为89.2%。结论：LDH是预测COVID-19重症、危重症患者住院死亡率的良好预后生物标志物，准确性高。这可能会指导世界各地的医生有效地优先考虑高死亡风险患者的资源，并在早期实施更积极的治疗，以挽救患者的生命。
Background: Lactate dehydrogenase (LDH) has been proved to be a prognostic factor for the severity and poor outcomes of coronavirus disease 2019 (COVID-19). In most studies, patients with various levels of COVID-19 severity were pooled and analyzed which may prevent accurate evaluation of the relationship between LDH and disease progression and in-hospital death. In this study, we aimed to evaluate the association of LDH with in-hospital mortality in severe and critically ill patients with COVID-19.Methods: This single-center retrospective study enrolled 119 patients. Survival curves were plotted using Kaplan-Meier method and compared by log-rank test. Multivariate Cox regression models were used to determine the independent risk factors for in-hospital mortality. Receiver-operator curves (ROCs) were constructed to evaluate the predictive accuracy of LDH and other prognostic biomarkers.Results: Compared to the survival group, LDH levels in the dead group were significantly higher [559.5 (172, 7575) U/L vs 228 (117, 490) U/L, (P < 0.001)]. In Multivariate Cox regression, it remained an independent risk factor for in-hospital mortality (Hazard ratio 5.985, 95.0%CI: 1.498-23.905; P=0.011). A cutoff value of 353.5 U/L predicted the in-hospital mortality with a sensitivity of 94.4% and a specificity of 89.2% respectively.Conclusion: LDH is a favorable prognostic biomarker with high accuracy for predicting in-hospital mortality in severe and critically ill patients with COVID-19. This may direct physicians worldwide to effectively prioritize resources for patients at high risk of death and to implement more aggressive treatments at an earlier phase to save patients' lives.