Clinical Outcome in Patients with COVID-19 and Comparison to Serum LDH and D-dimer Levels

  • Archana R Patil Associate Professor, Department of Biochemistry, DY Patil Medical College and Hospital, Kasaba Bawada, Kolhapur, Maharashtra, India.
  • Rupesh P Dahilkar Assistant Professor, Department of Physiology, BJ Government Medical College and Hospital, Pune, Maharashtra, India.
  • Supriya Sardar Assistant Professor, Department of Physiology, ESI-PGIMSR, ESIC Medical College and ESI Hospital and ODC (EZ), Joka, Kolkata, India.
Keywords: COPD, COVID-19, D-dimer, Diabetes Mellitus, HFNO, Hypertension, LDH

Abstract

Background: D-dimer and LDH are crucial biomarkers, particularly in view of the fact that they have been strongly linked to COVID-19 infection and have been linked to worse consequences in people who have severe viral infections.

Objectives: To determine how D-dimer and LDH correlated with clinical effects in COVID-19 patients who were hospitalised and how they forecasted the severity of COVID-19 patients.

Material and Methods: This was cross-sectional research conducted relatively early in the second wave of the pandemic. A total of 110 patients diagnosed with COVID-19 and admitted to the ICU from January 2021 to June 2021, were included in the study. The clinical outcome was evaluated in terms of discharge and death among patients requiring various forms of assisted ventilation.

Results: The average age of patients was 53.16 years (± 18.47 years). 35.5% of the patients were with comorbidities of which diabetes, hypertension, and COPD were around 80%. D-dimer was deranged in 2.7% of the subjects and LDH was deranged in 60% of the study subjects at the time of admission. Coming on to the outcome, all patients were put on assisted ventilation with 71.8% on NIV, 20% on HFNO, 1% on CPAP, and 7.2% on MV. During their hospital stays, 6 (5.45%) patients died and the remaining patients were discharged. A higher D-dimer value (> 1.5 μg/ml) during the hospital stay was found to be statistically significant with assisted ventilation and deaths of the admitted study subjects.

Conclusion: In our investigation, the biomarker D-dimer value was more associated than LDH with mortality in patients with COVID-19 infection.

How to cite this article:
Patil AR, Dahilkar RP, Sardar S. Clinical Outcome in Patients with COVID-19 and Comparison to Serum LDH and D-dimer Levels. J Commun Dis. 2023;55(1):17-23.

DOI: https://doi.org/10.24321/0019.5138.202303

Author Biographies

Rupesh P Dahilkar, Assistant Professor, Department of Physiology, BJ Government Medical College and Hospital, Pune, Maharashtra, India.

MBBS MD Physiology, Assistant Professor, Department of Physiology

Supriya Sardar, Assistant Professor, Department of Physiology, ESI-PGIMSR, ESIC Medical College and ESI Hospital and ODC (EZ), Joka, Kolkata, India.

MBBS MD Physiology, Assistant Professor, Department of Physiology

References

Fauci AS, Lane HC, Redfield RR. Covid-19—navigating the uncharted. N Engl J Med. 2020;382(13):1268-9.

[PubMed] [Google Scholar]

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in

patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. [PubMed] [Google Scholar]

Wool GD, Miller JL. The impact of COVID-19 disease on platelets and coagulation. Pathobiology. 2021;88(1):15-

[PubMed] [Google Scholar]

Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-dimer. J Am Coll Cardiol. 2017 Nov

;70(19):2411-20. [PubMed] [Google Scholar]

Querol-Ribelles JM, Tenias JM, Grau E, Querol-Borras JM, Climent JL, Gomez E, Martinez I. Plasma

d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest. 2004

Oct;126(4):1087-92. [PubMed] [Google Scholar]

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang

Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan,

China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62. [PubMed] [Google Scholar]

Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, Chen X, Chen S, Yu K, Huang Z, Hu B. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020;8:49. [PubMed]

[Google Scholar]

Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, Zhang Z. D-dimer levels on admission to predict in-hospital

mortality in patients with Covid-19. J Thromb Haemost. 2020 Jun;18(6):1324-9. [PubMed] [Google Scholar]

Soni P, Solu MG, Garg V, Pathria A, Shah S, Mundra A. Organophosphate poisoning predicting the need

for mechanical ventilator support. Int J Sci Stud. 2016;4(6):5. [Google Scholar]

Chen Y, Tong X, Wang J, Huang W, Yin S, Huang R, Yang H, Chen Y, Huang A, Liu Y, Chen Y, Yuan L, Yan X, Shen

H, Wu C. High SARS-CoV-2 antibody prevalence among healthcare workers exposed to COVID-19 patients.

J Infect. 2020 Sep;81(3):420-6. [PubMed] [Google Scholar]

Tao RJ, Luo XL, Xu W, Mao B, Dai RX, Li CW, Yu L, Gu F, Liang S, Lu HW, Chen KB, Bai JW, Ji XB, Gu SY, Sun

XL, Dai FH, Jiang P, Cao WJ, Xu JF. Viral infection in community-acquired pneumonia patients with fever:

a prospective observational study. J Thorac Dis. 2018 Jul;10(7):4387-95. [PubMed] [Google Scholar]

Chiang CH, Shih JF, Su WJ, Perng RP. Eight-month prospective study of 14 patients with hospital-acquired

severe acute respiratory syndrome. Mayo Clin Proc. 2004 Nov;79(11):1372-9. [PubMed] [Google Scholar]

Henry BM, de Oliveira MH, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker

abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19):

a meta-analysis. Clin Chem Lab Med. 2020 Jun 25;58(7):1021-8. [PubMed] [Google Scholar]

Kuang ZS, Yang YL, Wei W, Wang JL, Long XY, Li KY, Tong CY, Sun Z, Song ZJ. Clinical characteristics and

prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised

host: a retrospective observational study. World J Emerg Med. 2020;11(3):145-51. [PubMed] [Google Scholar]

Ding J, Karp JE, Emadi A. Elevated lactate dehydrogenase (LDH) can be a marker of immune suppression in cancer: interplay between hematologic and solid neoplastic clones and their microenvironments. Cancer Biomark. 2017 Jul 4;19(4):353-63. [PubMed] [Google Scholar]

Mangalmurti N, Hunter CA. Cytokine storms: understanding COVID-19. Immunity. 2020 Jul

;53(1):19-25. [PubMed] [Google Scholar]

Erez A, Shental O, Tchebiner JZ, Laufer-Perl M, Wasserman A, Sella T, Guzner-Gur H. Diagnostic

and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med

Assoc J. 2014 Jul;16(7):439-43. [PubMed] [Google Scholar]

Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, Flemban H, Al-Nassir WN,

Balkhy HH, Al-Hakeem RF, Makhdoom HQ, Zumla AI, Memish ZA. Epidemiological, demographic, and clinical

characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a

descriptive study. Lancet Infect Dis. 2013 Sep;13(9):752-61. [PubMed] [Google Scholar]

Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou

T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID-19. Am J Hematol.

;95(7):834-47. [PubMed] [Google Scholar]

Arifputra J, Haroen H, Rotty LW, Lasut PF, Hendratta C. Coagulopathy of Coronavirus Disease 2019: a case

series. Open Access Macedon J Med Sci [Internet]. 2021 Jun 7 [cited 2022 Oct 7]. Available from: https://

doi.org/10.3889/oamjms.2021.6026 [Google Scholar]

Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, Maharjan A, Gautam R. D-dimer as a

biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predictingdisease outcome in hospitalized patients with COVID-19. PLoS One. 2021 Aug 26;16(8):e0256744. [PubMed]

[Google Scholar]

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B, Li LJ, Zeng G, Yuen KY,

Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng

P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment

Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020

Apr 30;382(18):1708-20. [PubMed] [Google Scholar]

Soni M, Gopalakrishnan R, Vaishya R, Prabu P. D-dimer level is a useful predictor for mortality in patients with

COVID-19: analysis of 483 cases. Diabetes Metab Syndr. 2020;14(6):2245-9. [PubMed] [Google Scholar]

Shah S, Shah K, Patel SB, Patel FS, Osman M, Velagapudi P, Turugam MK, Lakkireddy D, Garg J. Elevated D-dimer levels are associated with increased risk of mortality in Coronavirus Disease 2019: a systematic review

and meta-analysis. Cardiol Rev. 2020;28(6):295-302. [PubMed] [Google Scholar]

Naymagon L, Zubizarreta N, Feld J, van Gerwen M, Alsen M, Thibaud S, Kessler A, Venugopal S, Makki I, Qin

Q, Dharmapuri S, Jun T, Bhalla S, Berwick S, Christian K, Mascarenhas J, Dembitzer F, Moshier E, Tremblay

D. Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19. Thromb Res. 2020 Dec;196:99-

[PubMed] [Google Scholar]

Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert

Rev Hematol. 2020;13: 1265–1275. doi: 10.1080/17474086.2020.1831383 [PubMed] [Google

Scholar]

Gungor B, Atici A, Baycan OF, Alici G, Ozturk F, Tugrul S, et al. Elevated D-dimer levels on admission are

associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis. Am

J Emerg Med. 2021;39: 173–179. doi: 10.1016/j.ajem.2020.09.018 [PMC free article] [PubMed] [Google

Scholar]

Qeadan F, Tingey B, Gu LY, Packard AH, Erdei E, Saeed AI. Prognostic values of serum ferritin and D-dimer

trajectory in patients with COVID-19. Viruses. 2021 Mar 5;13(3):419. [PubMed] [Google Scholar]

Mohsin RH, Hussein DS, Abed AS. Evaluation of a few biomarkers among COVID-19 patients. J Commun Dis.

Mar 16;82-90. [Google Scholar]

Published
2023-05-04