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Original research
Prognostic value of elevated lactate dehydrogenase in patients with COVID-19: a systematic review and meta-analysis
  1. Januar Wibawa Martha1,
  2. Arief Wibowo1,
  3. Raymond Pranata1,2
  1. 1 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Jawa Barat, Indonesia
  2. 2 Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia
  1. Correspondence to Dr Januar Wibawa Martha, Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Jawa Barat 45363, Indonesia; jwmartha{at}gmail.com

Abstract

Purpose This meta-analysis aimed to evaluate the prognostic performance of elevated lactate dehydrogenase (LDH) in patients with COVID-19.

Methods A systematic literature search was performed using PubMed, Embase and EuropePMC on 19 November 2020. The outcome of interest was composite poor outcome, defined as a combined endpoint of mortality, severity, need for invasive mechanical ventilation and need for intensive care unit care. Severity followed the included studies’ criteria.

Results There are 10 399 patients from 21 studies. Elevated LDH was present in 44% (34%–53%) of the patients. Meta-regression analysis showed that diabetes was correlated with elevated LDH (OR 1.01 (95% CI 1.00 to 1.02), p=0.038), but not age (p=0.710), male (p=0.068) and hypertension (p=0.969). Meta-analysis showed that elevated LDH was associated with composite poor outcome (OR 5.33 (95% CI 3.90 to 7.31), p<0.001; I2: 77.5%). Subgroup analysis showed that elevated LDH increased mortality (OR 4.22 (95% CI 2.49 to 7.14), p<0.001; I2: 89%). Elevated LDH has a sensitivity of 0.74 (95% CI 0.60 to 0.85), specificity of 0.69 (95% CI 0.58 to 0.78), positive likelihood ratio of 2.4 (95% CI 1.9 to 2.9), negative likelihood ratio of 0.38 (95% CI 0.26 to 0.55), diagnostic OR of 6 (95% CI 4 to 9) and area under curve of 0.77 (95% CI 0.73 to 0.80). Elevated LDH would indicate a 44% posterior probability and non-elevated LDH would in indicate 11% posterior probability for poor prognosis. Meta-regression analysis showed that age, male, hypertension and diabetes did not contribute to the heterogeneity of the analyses.

Conclusion LDH was associated with poor prognosis in patients with COVID-19.

PROSPERO registration number CRD42020221594.

  • COVID-19
  • adult intensive & critical care
  • adult intensive & critical care
  • intensive & critical care

Data availability statement

Data are available on reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

http://dx.doi.org/10.1136/postgradmedj-2020-139542

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors JWM and RP were involved in the conceptualisation and design of the manuscript. JWM, AW and RP participated in data curation and investigation. RP performed data analysis, formal analysis and statistical analysis. AW and RP drafted the manuscript. JWM reviewed and edited the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.