COVID-19 Research Paper Volume 12, Issue 12 pp 11245—11258

Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study

Yi Han1, *, , Haidong Zhang2, *, , Sucheng Mu1, *, , Wei Wei1, , Chaoyuan Jin1, , Chaoyang Tong1, , Zhenju Song1, , Yunfei Zha2, , Yuan Xue1, , Guorong Gu1, ,

  • 1 Emergency Department, Zhongshan Hospital, Fudan University, Shanghai 20032, China
  • 2 Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
* Co-first authors

Received: April 10, 2020       Accepted: May 22, 2020       Published: June 24, 2020
How to Cite

Copyright © 2020 Han et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: The World Health Organization has declared coronavirus disease 2019 (COVID-19) a public health emergency of global concern. Updated analysis of cases might help identify the risk factors of illness severity.

Results: The median age was 63 years, and 44.9% were severe cases. Severe patients had higher APACHE II (8.5 vs. 4.0) and SOFA (2 vs. 1) scores on admission. Among all univariable parameters, lymphocytes, CRP, and LDH were significantly independent risk factors of COVID-19 severity. LDH was positively related both with APACHE II and SOFA scores, as well as P/F ratio and CT scores. LDH (AUC = 0.878) also had a maximum specificity (96.9%), with the cutoff value of 344.5. In addition, LDH was positively correlated with CRP, AST, BNP and cTnI, while negatively correlated with lymphocytes and its subsets.

Conclusions: This study showed that LDH could be identified as a powerful predictive factor for early recognition of lung injury and severe COVID-19 cases.

Methods: We extracted data regarding 107 patients with confirmed COVID-19 from Renmin Hospital of Wuhan University. The degree of severity of COVID-19 patients (severe vs. non-severe) was defined at the time of admission according to American Thoracic Society guidelines for community acquired pneumonia.


ACE2: angiotensin-converting enzyme 2; ALT: alanine transaminase; APACHEII: Acute Physiology and Chronic Health Evaluation II; APTT: activated partial thromboplastin time; AST: aspartate transaminase; ATS: American Thoracic Society; AUC: area under the ROC curve; BNP: B-type natriuretic peptide; CAP: community-acquired pneumonia; CKMB: creatine kinase-MB; COVID-19: coronavirus disease 2019; CRP: C-reactive protein; cTnI: troponin I; CT: computed tomography; CURB-65: Confusion/Urea/Respirotory rate/Blood pressure 65; EBV: Epstein-Barr virus; LDH: lactate dehydrogenase; OR: odds ratio; PcP: pneumocystis pneumonia; PSI: Pneumonia Severity Index; PT: prothrombin time; ROC curve: receiver operating characteristic curve; RT-PCR: real-time reverse-transcriptase-polymerase-chain-reaction; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SOFA: Sequential Organ Failure Assessment.