Background
Enzyme biomarkers–such as creatine phosphokinase, aspartate aminotransferase, and
alanine aminotransferase–are associated with acute decompensated heart failure (ADHF)
severity and, therefore, have a prognostic value in ADHF. However, the prognostic
value of lactate dehydrogenase (LDH) is unclear. This study aimed to investigate the
prognostic value of LDH in ADHF.
Methods
This single-centre observational retrospective study enrolled 396 patients with ADHF
between June 2014 and July 2016. The patients were categorised into groups based on
the tertile values of serum LDH (LDH-low [<196 U/L], LDH-intermediate [196≤ LDH <239
U/L] and LDH-high [LDH ≥239 U/L]). Survival analysis for all-cause mortality was performed.
This study also examined the ability of adding log-transformed LDH (LogLDH) on Get
With The Guideline score, which is an established risk score to predict 90-day, 180-day
and 365-day mortality using time-dependent receiver operating characteristic curves.
Results
During the follow-up (median, 204 days), 100 (25%) patients died. The LDH-intermediate
and LDH-high groups had worse survival (LDH-low vs LDH-intermediate, log-rank p=0.019;
LDH-low vs LDH-high, log-rank p<0.001). Log LDH improved the ability to predict 90-day,
180-day and 365-day all-cause mortality, which was statistically significant (90 days,
area under curve [AUC] = 0.79, p=0.012; 180 days, AUC = 0.79, p=0.017; and 365 days,
AUC = 0.79, p=0.025).
Conclusions
Lactate dehydrogenase may be an important predictor of 90-day, 180-day and 365-day
all-cause mortality in ADHF patients; however, further studies are needed to confirm
these findings.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Understanding acute heart failure: pathophysiology and diagnosis.Eur Heart J Suppl. 2016; 18: G11-G18
- Biomarkers: hopes and challenges in the path from discovery to clinical practice.Transl Res. 2012; 159: 197-204
- Biochemical markers of myocardial injury.Br J Anaesth. 2004; 93: 63-73
- Biochemical markers of myocardial damage.EJIFCC. 2016; 27: 95-111
- Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure.Adv Ther. 2006; 23: 1060-1067
- Role of cardiac troponin levels in acute heart failure.Card Fail Rev. 2015; 1: 102-106
- Release of cardiac troponin I from viable cardiomyocytes is mediated by integrin stimulation.Pflug Arch Eur J Phy. 2008; 455: 979-986
- Stress (Takotsubo) cardiomyopathy - a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning.Nat Clin Pract Card. 2008; 5: 22-29
- Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF.Eur J Heart Fail. 2016; 18: 424-432
- Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study.Eur J Heart Fail. 2016; 18: 830-839
- Regulation of pyruvate metabolism and human disease.Cell Mol Life Sci. 2014; 71: 2577-2604
- Serum lactic dehydrogenase; a diagnostic aid in myocardial infarction.J Am Med Assoc. 1957; 165: 35-40
- Serum lactate dehydrogenase isoenzyme and total lactate dehydrogenase values in health and disease, and clinical evaluation of these tests by means of discriminant analysis.Am J Clin Pathol. 1969; 52: 320-328
- Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure.J Am Coll Cardiol. 2007; 49: 1943-1950
- The natural history of congestive heart failure: the Framingham study.N Engl J Med. 1971; 285: 1441-1446
- A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program.Circ Cardiovasc Qual Outcomes. 2010; 3: 25-32
- Validation of the Get With The Guideline-Heart Failure risk score in Japanese patients and the potential improvement of its discrimination ability by the inclusion of B-type natriuretic peptide level.Am Heart J. 2016; 171: 33-39
- Missing data exploration: highlighting graphical presentation of missing pattern.Ann Transl Med. 2015; 3: 356
- Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics.Bone Marrow Transpl. 2013; 48: 452-458
- Time-dependent ROC curves for censored survival data and a diagnostic marker.Biometrics. 2000; 56: 337-344
- Atypical patterns of lactate dehydrogenase isoenzymes in acute myocardial infarction.Clin Chem. 1988; 34: 1096-1098
- Myocardial lactate dehydrogenase patterns in volume or pressure overloaded left ventricles.Eur J Heart Fail. 2002; 4: 587-591
- Patterns of lactate dehydrogenase isoenzymes in serum of patients with acute pulmonary edema.Clin Chem. 1988; 34: 1882-1884
- Liver abnormalities in cardiac diseases and heart failure.Int J Angiol. 2011; 20: 135-142
- Validation of lactate level as a predictor of early mortality in acute decompensated heart failure patients who entered intensive care unit.J Cardiol. 2015; 65: 164-170
- Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine.Heart. 2006; 92: 843-849
- Principles of Medical Biochemistry.3rd Edition. Saunders, Philadelphia, PA2011
Article info
Publication history
Published online: December 03, 2019
Accepted:
November 10,
2019
Received in revised form:
October 8,
2019
Received:
June 1,
2019
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
