Profiling of Lactate Dehydrogenase Isoenzymes in COVID-19 Disease

Erika Dzsudzsák; Renáta Sütő; Marianna Pócsi; Miklós Fagyas; Zoltán Szentkereszty; Béla Nagy Jr

Profiling of Lactate Dehydrogenase Isoenzymes in COVID-19 Disease

EJIFCC. 2021 Dec 7;32(4):432-441. eCollection 2021 Dec.

Authors

Erika Dzsudzsák¹, Renáta Sütő^{2

3}, Marianna Pócsi^{1

3}, Miklós Fagyas^{3

4}, Zoltán Szentkereszty², Béla Nagy Jr^{1

3}

Affiliations

¹ Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
² Gyula Kenézy Campus, Intensive Care Unit, University of Debrecen, Debrecen, Hungary.
³ Doctoral School of Kálmán Laki, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
⁴ Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

PMID: 35046761
PMCID: PMC8751399

Abstract

Introduction: Serum total lactate dehydrogenase (LDH) activity was elevated and showed a positive correlation with disease severity and outcome in severe COVID-19 disease. However, it is still unknown whether the relative abundance or calculated activity of any LDH isoenzyme is predominately increased in COVID-19 subjects.

Methods: Twenty-two consecutive patients suffered from moderate or severe COVID-19 pneumonia were recruited into this study who showed enhanced total LDH activity. The ratio of LDH isoenzyme activities was further investigated using gel electrophoresis (Hydragel^®, Sebia) with densitometric evaluation. Calculated activity values of these isoenzymes were correlated with routine laboratory parameters, the degree of lung parenchymal affection based on chest CT and clinical outcome.

Results: Total LDH activity was raised in the range of 272-2141 U/L and significantly correlated with calculated LDH-3 and LDH-4 activities (r=0.765, P=0.0001; and r=0.783, P=0.0001, respectively). In contrast, the relative abundance of neither LDH isoenzyme was exclusively abnormal in COVID-19 patients. Calculated activity of LDH-3 and LDH-4 demonstrated a modest but statistically significant association with serum ferritin (r=0.437, P=0.042; r=0.505, P=0.016, respectively). When the relationship between the severity of pulmonary affection by SARS-CoV-2 infection and relative abundance of LDH isoenzymes was studied, a larger ratio of mid-zone fractions was observed in the presence of ≥ 50% lung parenchymal involvement. Finally, regardless of LDH isoenzyme pattern, abnormal relative ratio of LDH-4 and higher calculated LDH-3 and LDH-4 activity values were detected in subjects with unfavorable outcome.

Conclusion: No characteristic profile of LDH isoenzymes can be detected in COVID-19 pneumonia, however, elevated activities of LDH-3 and LDH-4 are associated with worse clinical outcomes.

Keywords: COVID-19; LDH; SARS-CoV-2; clinical outcome; electrophoresis; inflammation.