The Application of Lactate Dehydrogenase in Coronavirus Disease 2019 As the Best Indicator for the Progression and Clinical Status: A Case-Control Study

Introduction Coronavirus disease 2019 (COVID-19) is now officially a pandemic. Current studies observed extensive abnormal indexes in COVID-19 patients and significant differences between mild and severe patients. However, which index would perform better as the indicator of disease progression merits further investigation.Methods We enrolled COVID-19 patients who were admitted to Shanghai Public Health Clinical center. We closely monitored the following candidate indictors: white blood cell, lymphocyte, platelet, CD4 T cell, CD8 T cell, alanine aminotransferase, estimated glomerular filtration rate (eGFR), fibrin degradation products (FDP), D-dimer, creatine kinase, myoglobin, troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactase dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin. The correlation with illness severity were assessed by Spearman analysis and the ability of differentiating the clinical statuses was quantified as the AUC value of the ROC curve. Results A total of 326 patients were enrolled, including 299 mild-ordinary and 27 severe-critical patients. At admission, D-dimer and CRP were elevated above normal range both in mild-ordinary and severe-critical patients. LDH, NT-proBNP, myoglobin, CD4 T cell, eGFR, FDP and PCT were beyond normal range in the mild-ordinary stages of severe-critical patients, but remained normal in the persistently mild-ordinary patients. Top 5 parameters with highest spearmen coefficient were LDH, procalcitonin, NT-proBNP, myoglobin and D-dimer (Spearman coefficient: 0.488, 0.453, 0.414, 0.412, 0.407). Comparing between mild-ordinary stage and severe/critical stage, LDH showed the highest receiver operating characteristics (ROC) area under the curve (AUC) of 0.951. PCT ranked second, with the ROC AUC of 0.905. Comparing between mild-ordinary and severe stages, only LDH had the ROC AUC of over 0.90 (0.927). Conclusions This study found LDH to be a superior indicator for COVID-19 status and had the potential to optimize the clinical management strategy.