Lactate dehydrogenase as a predictor of in-hospital mortality in patients with acute aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Changluo ¹ , LONG Yong ¹ , YUAN Feng ¹ ,  YANG Guifang ² ,  SHENG Lijuan ³

1. Department of Emergency Medicine, Changsha Central Hospital, Changsha, 410000, P.R.China;
2. Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011, P.R.China;
3. Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, 410011, P.R.China;

Corresponding author：

SHENG Lijuan, Email: shenglijuannice@csu.edu.cn

Keywords：

Lactate dehydrogenase; acute aortic dissection; in-hospital mortality

DOI：

10.7507/1007-4848.201904020

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Objective To evaluate the significance of lactate dehydrogenase (LDH) as a predictor of in-hospital mortality in patients with acute aortic dissection(AAD). Methods We conducted a retrospective analysis of the clinical data of 445 AAD patients who were admitted to the Second Xiangya Hospital of Central South University and the Changsha Central Hospital from January 2014 to December 2017 within a time interval of ≤14 days from the onset of symptoms to hospital admission, including 353 males and 92 females with the age of 45-61 years. LDH levels were measured on admission and the endpoint was the all-cause mortality during hospitalization. Results During hospitalization, 86 patients died and 359 patients survived. Increased level of LDH was found in non-survivors compared with that in the survived [269.50 (220.57, 362.58) U/L vs. 238.00 (191.25, 289.15) U/L, P<0.001]. A nonlinear relationship between LDH levels and in-hospital mortality was observed. Using multivariable logistic analysis, we found that LDH was an independent predictor of in-hospital mortality in the patients with AAD [OR=1.002, 95% CI (1.001 to 1.014), P=0.006]. Furthermore, using receiver operating characteristic (ROC) analysis, we observed that the best threshold of LDH level was 280.70 U/L, and the area under the curve was 0.624 (95% CI 0.556 to 0.689). Conclusion LDH level on admission is an independent predictor of in-hospital mortality in patients with AAD.

Citation： LI Changluo, LONG Yong, YUAN Feng, YANG Guifang, SHENG Lijuan. Lactate dehydrogenase as a predictor of in-hospital mortality in patients with acute aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1213-1218. doi: 10.7507/1007-4848.201904020 Copy

1.	Yang GF, Sheng LJ, Peng W, et al. Comorbidity: A novel insight to aortic dissection. Int J Cardiol, 2016, 207: 53-54.
2.	Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
3.	中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
4.	Milewicz DM, Ramirez F. Therapies for thoracic aortic aneurysms and acute aortic dissections. Arterioscl Throm Vas, 2019, 39(2): 126-136.
5.	Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
6.	Mori K, Tamune H, Tanaka H, et al. Admission values of d-dimer and c-reactive protein (CRP) predict the long-term outcomes in acute aortic dissection. Internal Med, 2016, 55(14): 1837-1843.
7.	Shah P, Mehta VM, Cowger JA, et al. Diagnosis of hemolysis and device thrombosis with lactate dehydrogenase during left ventricular assist device support. J Heart Lung Transpl, 2014, 33(1): 102-104.
8.	Nielsen C, Pedersen LT, Lindholt JS, et al. An automated plasma D-lactate assay with a new sample preparation method to prevent interference from L-lactate and L-lactate dehydrogenase. Scand J Clin Lab Inv, 2011, 71(6): 507-514.
9.	Hu EC, He JG, Liu ZH, et al. High levels of serum lactate dehydrogenase correlate with the severity and mortality of idiopathic pulmonary arterial hypertension. Exp Ther Med, 2015, 9(6): 2109-2113.
10.	Lu J, Wei Z, Jiang H, et al. Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: A retrospective observational study. J Surg Res, 2018, 228: 314-321.
11.	Dave A, Maru L, Jain A. LDH (Lactate dehydrogenase): A biochemical marker for the prediction of adverse outcomes in pre-eclampsia and eclampsia. J Obstet Gynaecol India, 2016, 66(1): 23-29.
12.	Erbel R, Aboyans V, Boileau C, et al. Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J, 2015, 36(41): 2779.
13.	Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
14.	Yousaf MN, Powell MD. The effects of heart and skeletal muscle inflammation and cardiomyopathy syndrome on creatine kinase and lactate dehydrogenase levels in Atlantic salmon (Salmo salar L.). ScientificWorldJournal, 2012, 2012: 741302.
15.	Storey KB. Comparative enzymology-new insights from studies of an "old" enzyme, lactate dehydrogenase. Comp Biochem Physiol B Biochem Mol Biol, 2016, 199: 13-20.
16.	Rho JM. Inhibition of lactate dehydrogenase to treat epilepsy. N Engl J Med, 2015, 373(2): 187-189.
17.	Colgan SM, Mukherjee S, Major P. Hypoxia-induced lactate dehydrogenase expression and tumor angiogenesis. Clin Colorectal Cancer, 2007, 6(6): 442-446.
18.	Gaisl T, Bratton DJ, Kohler M. The impact of obstructive sleep apnoea on the aorta. Eur Respir J, 2015, 46(2): 532-544.
19.	Drent M, Cobben NA, Henderson RF, et al. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. Eur Respir J, 1996, 9(8): 1736-1742.
20.	Duan XZ, Xu ZY, Lu FL, et al. Inflammation is related to preoperative hypoxemia in patients with acute Stanford type a aortic dissection. J Thorac Dis, 2018, 10(3): 1628-163421.
21.	Liao YT, Chen CJ, Li WF, et al. Elevated lactate dehydrogenase activity and increased cardiovascular mortality in the arsenic-endemic areas of southwestern Taiwan. Toxicol Appl Pharm, 2012, 262(3): 232-237.

1. Yang GF, Sheng LJ, Peng W, et al. Comorbidity: A novel insight to aortic dissection. Int J Cardiol, 2016, 207: 53-54.
2. Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: Diagnosis and management, an update. Eur Heart J, 2018, 39(9): 739-749.
3. 中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
4. Milewicz DM, Ramirez F. Therapies for thoracic aortic aneurysms and acute aortic dissections. Arterioscl Throm Vas, 2019, 39(2): 126-136.
5. Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
6. Mori K, Tamune H, Tanaka H, et al. Admission values of d-dimer and c-reactive protein (CRP) predict the long-term outcomes in acute aortic dissection. Internal Med, 2016, 55(14): 1837-1843.
7. Shah P, Mehta VM, Cowger JA, et al. Diagnosis of hemolysis and device thrombosis with lactate dehydrogenase during left ventricular assist device support. J Heart Lung Transpl, 2014, 33(1): 102-104.
8. Nielsen C, Pedersen LT, Lindholt JS, et al. An automated plasma D-lactate assay with a new sample preparation method to prevent interference from L-lactate and L-lactate dehydrogenase. Scand J Clin Lab Inv, 2011, 71(6): 507-514.
9. Hu EC, He JG, Liu ZH, et al. High levels of serum lactate dehydrogenase correlate with the severity and mortality of idiopathic pulmonary arterial hypertension. Exp Ther Med, 2015, 9(6): 2109-2113.
10. Lu J, Wei Z, Jiang H, et al. Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: A retrospective observational study. J Surg Res, 2018, 228: 314-321.
11. Dave A, Maru L, Jain A. LDH (Lactate dehydrogenase): A biochemical marker for the prediction of adverse outcomes in pre-eclampsia and eclampsia. J Obstet Gynaecol India, 2016, 66(1): 23-29.
12. Erbel R, Aboyans V, Boileau C, et al. Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J, 2015, 36(41): 2779.
13. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
14. Yousaf MN, Powell MD. The effects of heart and skeletal muscle inflammation and cardiomyopathy syndrome on creatine kinase and lactate dehydrogenase levels in Atlantic salmon (Salmo salar L.). ScientificWorldJournal, 2012, 2012: 741302.
15. Storey KB. Comparative enzymology-new insights from studies of an "old" enzyme, lactate dehydrogenase. Comp Biochem Physiol B Biochem Mol Biol, 2016, 199: 13-20.
16. Rho JM. Inhibition of lactate dehydrogenase to treat epilepsy. N Engl J Med, 2015, 373(2): 187-189.
17. Colgan SM, Mukherjee S, Major P. Hypoxia-induced lactate dehydrogenase expression and tumor angiogenesis. Clin Colorectal Cancer, 2007, 6(6): 442-446.
18. Gaisl T, Bratton DJ, Kohler M. The impact of obstructive sleep apnoea on the aorta. Eur Respir J, 2015, 46(2): 532-544.
19. Drent M, Cobben NA, Henderson RF, et al. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. Eur Respir J, 1996, 9(8): 1736-1742.
20. Duan XZ, Xu ZY, Lu FL, et al. Inflammation is related to preoperative hypoxemia in patients with acute Stanford type a aortic dissection. J Thorac Dis, 2018, 10(3): 1628-163421.
21. Liao YT, Chen CJ, Li WF, et al. Elevated lactate dehydrogenase activity and increased cardiovascular mortality in the arsenic-endemic areas of southwestern Taiwan. Toxicol Appl Pharm, 2012, 262(3): 232-237.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Lactate dehydrogenase as a predictor of in-hospital mortality in patients with acute aortic dissection

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