Serum lactate and lactate dehydrogenase as parameters for the prediction of dengue severity. Sirikutt Pugpen,Kalayanarooj Siripen Journal of the Medical Association of Thailand = Chotmaihet thangphaet BACKGROUND:Lactate and lactate dehydrogenase (LDH) have been found to be elevated in cardiopulmonary failure, sepsis, shock and hepatic injury. Severe dengue hemorrhagic fever (DHF) patients also develop shock and experience a certain degree of hepatic injury, implicating that serum lactate and LDH may be elevated in Dengue shock syndrome (DSS). OBJECTIVE:To determine serum lactate and LDH levels in dengue patients to see whether they can be used as predictors of severe dengue cases. MATERIAL AND METHOD:A cross sectional study was conducted on suspected dengue patients admitted to the dengue ward, Queen Sirikit National Institute of Child Health (QSNICH), between May 2011 and February 2012. Laboratory tests were used to confirm dengue cases in the enrolled patients. Blood for serum lactate was drawn in patients every day after enrollment. Blood for LDH and liver function test (LFT) were drawn 3 times: enrollment day, day of leakage, and discharge day. Lactate and LDH levels are compared among dengue and non-dengue patients. Dengue fever (DF), DHF and DSS patients were classified according to the WHO 1997 dengue classification. RESULTS:253 patients were enrolled, comprising of 120 DF, 75 DH, 30 DSS, and 28 non-dengue patients. The majority of dengue patients had liver impairment, demonstrated by elevated aspartate aminotransferase (AST) (94.9%) and alanine aminotransferase (ALT) levels (68.6%) while non-dengue patients have minimal elevation. Serum lactate levels were not elevated in the early stages in dengue patients, but were elevated in non-dengue patients. The mean serum lactate levels in DSS patients increased towards the end of febrile phase and reached maximum values on Day 0 (2.2 U/L). On the other hand, serum lactate levels were found to be decreasing in the non-dengue group. The mean serum lactate levels on Day 0 was found to be different in DSS patients (2.26 U/L) compared to DF 1.63 U/L), DHF (1.79 U/L) and non-dengue patients (1.68 U/L) (p < 0.05). Mean serum LDH levels were elevated in the early stages of the disease in all groups of patients, but with different levels. Mean serum LDH levels was 709.2 in DF, 1,873 in DHF, 654.5 in DSS, and 434 IU in non-dengue patients. The mean LDH levels in dengue patients were > 500 IU, while it was < 500 IU in non-dengue patients. The increasing mean levels of LDH towards the end of febrile phase were only seen in DHF and DSS patients, but not in DF and non-dengue patients. The mean levels of LDH on Day 0 in DHF, DSS, DF and non-dengue patients are 1,060.7, 1,180.7, 787.2, and 423.8 IU, respectively. CONCLUSION:Serum lactate and LDH was found to be elevated in DHF and/or DSS patients. Lactate may be used as a predictor of DSS if the level is > 2 U/L on Day 0. LDH can be used to differentiate patients with or without dengue in the early febrile phase, if the level is > 500 IU. If the level of LDH is increased to approximately 1, 000 IU on Day 0, it may be a predictor of severe dengue infection or DHF and DSS with plasma leakage.

Lactate dehydrogenase is the key enzyme for pneumococcal pyruvate metabolism and pneumococcal survival in blood. Gaspar Paula,Al-Bayati Firas A Y,Andrew Peter W,Neves Ana Rute,Yesilkaya Hasan Infection and immunity Streptococcus pneumoniae is a fermentative microorganism and causes serious diseases in humans, including otitis media, bacteremia, meningitis, and pneumonia. However, the mechanisms enabling pneumococcal survival in the host and causing disease in different tissues are incompletely understood. The available evidence indicates a strong link between the central metabolism and pneumococcal virulence. To further our knowledge on pneumococcal virulence, we investigated the role of lactate dehydrogenase (LDH), which converts pyruvate to lactate and is an essential enzyme for redox balance, in the pneumococcal central metabolism and virulence using an isogenic ldh mutant. Loss of LDH led to a dramatic reduction of the growth rate, pinpointing the key role of this enzyme in fermentative metabolism. The pattern of end products was altered, and lactate production was totally blocked. The fermentation profile was confirmed by in vivo nuclear magnetic resonance (NMR) measurements of glucose metabolism in nongrowing cell suspensions of the ldh mutant. In this strain, a bottleneck in the fermentative steps is evident from the accumulation of pyruvate, revealing LDH as the most efficient enzyme in pyruvate conversion. An increase in ethanol production was also observed, indicating that in the absence of LDH the redox balance is maintained through alcohol dehydrogenase activity. We also found that the absence of LDH renders the pneumococci avirulent after intravenous infection and leads to a significant reduction in virulence in a model of pneumonia that develops after intranasal infection, likely due to a decrease in energy generation and virulence gene expression. 10.1128/IAI.02005-14

Procalcitonin, C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis, SIRS and systemic candidiasis. Miglietta Fabio,Faneschi Maria Letizia,Lobreglio Giambattista,Palumbo Claudio,Rizzo Adriana,Cucurachi Marco,Portaccio Gerolamo,Guerra Francesco,Pizzolante Maria Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive The aim of this study was to evaluate procalcitonin (PCT), C-reactive protein (CRP), platelet count (PLT) and serum lactate dehydrogenase (LDH) as early markers for diagnosis of SIRS, bacterial sepsis and systemic candidiasis in intensive care unit (ICU) patients. Based on blood culture results, the patients were divided into a sepsis group (70 patients), a SIRS group (42 patients) and a systemic candidiasis group (33 patients). PCT, CRP, LDH and PLT levels were measured on day 0 and on day 2 from the sepsis symptom onset. PCT levels were higher in Gram negative sepsis than those in Gram positive sepsis, although the P value between the two subgroups is not significant (P=0.095). Bacterial sepsis group had higher PCT and CRP levels compared with the systemic candidiasis group, whereas PLT and LDH levels showed similar levels in these two subgroups. The AUC for PCT (AUC: 0.892, P <0.001) was larger than for CRP (AUC: 0.738, P <0.001). The best cut-off values for PCT and CRP were 0.99 ng/mL and 76.2 mg/L, respectively. Diagnostic sensitivity and specificity for PCT were 84.3% and 81.8% whereas CRP showed a sensitivity of 77.2% and a specificity of 63.6%. However, PCT was unable to discriminate between SIRS and systemic candidiasis groups (P=0.093 N.S.). In conclusion, PCT can be used as a preliminary marker in the event of clinical suspicion of systemic candidiasis; however, low PCT levels (<0.99 ng/mL) necessarily require the use of other specific markers of candidaemia to confirm the diagnosis, due to great uniformity of PCT levels in systemic candidiasis and SIRS groups.

Prognostic value of neglected biomarker in sepsis patients with the old and new criteria: predictive role of lactate dehydrogenase. Duman Ali,Akoz Ayhan,Kapci Mucahit,Ture Mevlut,Orun Serhat,Karaman Kıvanc,Turkdogan Kenan Ahmet The American journal of emergency medicine OBJECTIVES:This study examined the pH, lactate dehydrogenase (LDH), and heart rate values on the first day of hospitalization in patients with a prediagnosis of sepsis and biomarkers that may predict mortality. METHODS:Patients hospitalized in an emergency intensive care unit with a diagnosis of systemic inflammatory response syndrome were classified as having sepsis (n = 28), septic shock (n = 8), or severe sepsis (n = 8) according to International Sepsis Guidelines (old criteria). Forty-four patients were classified as having sepsis (n = 4), septic shock (n = 30), or infection (n = 10) according to The Third International Consensus Definitions for Sepsis and Septic Shock (new criteria). The effects of these patients' laboratory values on survival between groups were compared. Significant values were evaluated by χ automatic interaction detection analysis. RESULTS:When the patients were categorized according to the new classification criteria, there was an increase in the number of septic shock patients and a decrease in the number of sepsis patients. In addition, 10 patients were removed from the sepsis category. There was a significant difference between ex and discharged patients in terms of heart rate, pH, sodium bicarbonate, lactate, and LDH (P= .007, P= .002, P= .034, P= .009, and P= .002, respectively). Based on a χ automatic interaction detection analysis of the significant values, pH, LDH, and heart rate were prominent predictors of prognosis. CONCLUSIONS:Systemic pH, LDH, and heart rate values may be used to determine the best time to discharge patients from intensive care to other, more affordable hospital units. 10.1016/j.ajem.2016.06.012

Lactate dehydrogenase is associated with 28-day mortality in patients with sepsis: a retrospective observational study. Lu Jun,Wei Zhonghong,Jiang Hua,Cheng Lu,Chen Qiuhua,Chen Mingqi,Yan Jing,Sun Zhiguang The Journal of surgical research BACKGROUND:Sepsis is a major health care problem, which affects millions of people around the world. Glucose metabolic reprogramming of immune cells plays a crucial role during advancement of sepsis. However, the association between glucose metabolic reprogramming and mortality in patients with sepsis is unclear. Lactate dehydrogenase (LDH) catalyzes the last step of glycolysis. Investigating the relationship between LDH and mortality is important to understand the effect of metabolic reprogramming on prognosis of patients with sepsis. METHODS:A total of 192 patients with sepsis were included in our study. Data on characteristics of patients, biochemical variables, and inflammatory mediator were collected. Association between the level of serum LDH and 28-day mortality was also analyzed. The correlations between serum LDH, interleukin-1β, creatinine, PaO/FiO, and lactate were also observed. The association between LDH and the risk of death was further analyzed. Moreover, receiver operating characteristic curve was depicted to compare the accuracy in prediction of LDH and other variables. RESULTS:There were statistic difference in 28-day mortality between elevated LDH group and normal LDH group (P = 0.021). Level of serum LDH was an independent risk factor for death of patients with sepsis (hazard ratio 1.005, 95% confidence interval 1.002-1.007, P = 0.001). There were significant correlations between LDH, interleukin-1β (r = 0.514, P = 0.000), creatinine (r = 0.368, P = 0.000), PaO/FiO (r = -0.304, P = 0.000), and lactate (r = 0.560, P = 0.000). The receiver operating characteristic curves showed that the area under the LDH curve for prediction for mortality was 0.783. CONCLUSIONS:Serum LDH is probably associated with 28-day mortality in patients with sepsis. 10.1016/j.jss.2018.03.035