https://doi.org/10.4081/monaldi.2023.2543

Serum lactate dehydrogenase and its isoenzymes as predictors of clinical outcomes in acute exacerbation of chronic obstructive pulmonary disease: a retrospective analysis of a hospitalized cohort

Vol. 94 No. 2 (2024)
Submitted: February 6, 2023
Accepted: May 25, 2023
Published: June 7, 2023
Lactate dehydrogenase, LDH isoenzymes, COPD acute exacerbation, COPD outcomes
Abstract Views: 839
PDF: 256
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Authors

Dimitrios Papadopoulos
d.g.papadopoulos@gmail.com
https://orcid.org/0000-0002-5547-6474
2nd Pulmonary Medicine Department, “Sismanogleion” General Hospital of Attica, Marousi, Greece.
Vlasios Skopas
2nd Pulmonary Medicine Department, “Sismanogleion” General Hospital of Attica, Marousi; Respiratory Medicine Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Greece.
Nikolaos Trakas
Clinical Chemistry Department, “Sismanogleion” General Hospital of Attica, Marousi, Greece.
Eleni Papaefstathiou
Clinical Chemistry Department, “Sismanogleion” General Hospital of Attica, Marousi, Greece.
Nikolaos Tzogas
3rd Pulmonary Medicine Department, Henry Dunant Hospital Center, Athens, Greece.
Demosthenes Makris
Critical Care Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Greece.
Zoe Daniil
Respiratory Medicine Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Greece.
Konstantinos Gourgoulianis
Respiratory Medicine Department, School of Medicine, University of Thessaly, University Hospital of Larissa, Greece.

We aimed to test the relationship between serum lactate dehydrogenase (LDH) and its isoenzymes and treatment outcomes during hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Thirty-eight AECOPD patients were recruited from a tertiary hospital from December 2017 to June 2018. Serum LDH and LDH isoenzymes were measured on venous blood collected at admission. Treatment outcomes included duration of hospital stay, initiation of mechanical or non-invasive ventilation (NIV), initiation of antipseudomonal antibiotics, change in empirical antibiotic treatment, need for intravenous corticosteroids or methylxanthines, and percentage of change in C-reactive protein from admission to the third day. Multivariate linear and binary logistic regression analyses were used to test the study’s objectives. We found that, after adjusting for age, gender, comorbidities, COPD severity, level of hypoxemia, and inflammation markers, each 10 U/L increase in serum LDH was associated with prolongation of the hospital stay by 0.25 (0.03, 0.46) days, 42% higher odds [odds ratio (OR) 1.42 (1.00, 2.03)] for need of NIV, and 25% higher odds [OR 1.25 (1.04, 1.49)] for initiation of antipseudomonal treatment. LDH1 and LDH2 were the LDH isoenzymes that mainly drove these relationships. LDH release in the context of an AECOPD could originate from lung, muscle, or heart tissue damage due to airway inflammation, respiratory muscle recruitment, and myocardial stress. Myocardial injury and aerobic adaptation in respiratory muscles may explain the predominance of LDH1 and LDH2 isoenzymes in these associations.

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Europe PMC
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;9:1736-42.
Faruqi S, Wilmot R, Wright C, Morice AH. Serum LDH in chronic cough: a potential marker of airway inflammation. Clin Respir J 2012;6:81-7.
Thomeer M, Grutters JC, Wuyts WA, et al. Clinical use of biomarkers of survival in pulmonary fibrosis. Respir Res 2010;11:89.
Cobben NAM, Drent M, Schols AMWJ, et al. Serum lactate dehydrogenase and its isoenzyme pattern in ex-coalminers. Respir Med 1997;91:616-23.
Terpstra ML, Aman J, van Nieuw Amerongen GP, Groeneveld ABJ. Plasma biomarkers for acute respiratory distress syndrome: a systematic review and meta-analysis*. Crit Care Med 2014;42:691-700.
Hoffman RM, Rogers RM. Serum and lavage lactate dehydrogenase isoenzymes in pulmonary alveolar proteinosis. Am Rev Respir Dis 1991;143:42-6.
Emad A, Rezaian GR. Lactate dehydrogenase in bronchoalveolar lavage fluid of patients with active pulmonary tuberculosis. Respiration 1999;66:41-5.
Hagadorn JE, Bloor CM, Yang MS. Elevated plasma activity of lactate dehydrogenase isoenzyme-3 (LDH 3) in experimentally induced immunologic lung injury. Am J Pathol 1971;64:575-81.
Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med 2017;195:557-82.
Cepelak I, Dodig S, Romic D, et al. Enzyme catalytic activities in chronic obstructive pulmonary disease. Arch Med Res 2006;37:624-9.
Mujaddadi A, Moiz JA, Singla D, et al. Effect of eccentric exercise on markers of muscle damage in patients with chronic obstructive pulmonary disease. Physiother Theory Pract 2021;37:801-7.
Nillawar AN, Bardapurkar JS, Bardapurkar SJ. High sensitive C-reactive protein as a systemic inflammatory marker and LDH-3 isoenzyme in chronic obstructive pulmonary disease. Lung India 2012;29:24-9.
Skopas V, Papadopoulos D, Trakas N, et al. Lactate dehydrogenase isoenzymes in patients with acute exacerbation of chronic obstructive pulmonary disease: an exploratory cross-sectional study. Respir Physiol Neurobiol 2021;283:103562.
Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196-204.
Rubin DB. Multiple imputation for nonresponse in surveys. New York: Wiley; 1987.
Saey D, Michaud A, Couillard A, et al. Contractile fatigue, muscle morphometry, and blood lactate in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;171:1109-15.
Spruit MA, Pennings HJ, Does JD, et al. Serum LDH and exercise capacity in COPD. Thorax 2008;63:472.
Patel ARC, Kowlessar BS, Donaldson GC, et al. Cardiovascular risk, myocardial injury, and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013;188:1091-9.
Reddy RM, Guntupalli KK. Review of ventilatory techniques to optimize mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2007;2:441-52.
Ozben B, Eryuksel E, Tanrikulu AM, et al. Acute exacerbation impairs right ventricular function in COPD patients. Hellenic J Cardiol 2015;56:324-31.
Mesquita R, Donária L, Genz ICH, et al. Respiratory muscle strength during and after hospitalization for COPD exacerbation. Respir Care 2013;58:2142-9.
Gea J, Agustí A, Roca J. Pathophysiology of muscle dysfunction in COPD. J Appl Physiol 2013;114:1222-34.
Torres SH, Montes de Oca M, Loeb E, et al. Isoenzimas de lactatodeshidrogenasa en el músculo esquelético de pacientes con EPOC. Arch Bronconeumol 2009;45:75-80. [Article in Spanish].

Ethics Approval

The study protocol was approved by the Research Committee of the University of Thessaly (protocol number 2800/2017).

How to Cite

Papadopoulos, Dimitrios, Vlasios Skopas, Nikolaos Trakas, Eleni Papaefstathiou, Nikolaos Tzogas, Demosthenes Makris, Zoe Daniil, and Konstantinos Gourgoulianis. 2023. “Serum Lactate Dehydrogenase and Its Isoenzymes As Predictors of Clinical Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Analysis of a Hospitalized Cohort”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2543.
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