LDH elevations: a key indicator of progression in presymptomatic COVID-19

  • Tabata S & al
  • Lancet Infect Dis
  • 13 Jun 2020

  • curated by Liz Scherer
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

Why this matters

  • High LDH levels may signal risk of transitioning to symptomatic status.
  • Age is a risk factor for transitioning to becoming symptomatic.

Study design

  • Lancet Infectious Disease: retrospective analysis, 104 cruise passengers testing positive for SARS-CoV-2 and hospitalized for observation in Japan.
  • NEJM letter: analysis of 96 passengers who were asymptomatic when testing positive for SARS-CoV-2, also hospitalized for observation.
  • Funding: None.

Key results

  • Lancet Infectious Disease study:
    • 104 participants; median age, 68 (interquartile range [IQR], 47-75) years; 52% (54) male.
    • At admission, 41% (43) were asymptomatic, and 39% (41) had mild COVID-19.
    • 23% (10/43) asymptomatic patients developed symptomatic COVID-19.
    • Increased LDH concentrations were more common in those who transitioned to being symptomatic: OR, 7.25 (P=.020).
    • Overall, 10% (8/84) with asymptomatic or mild COVID-19 progressed to severe illness.
  • NJEM report:
    • 11/96 asymptomatic patients developed symptoms at a median of 4 (IQR, 3-5) days after a positive SARS-CoV-2 test, and thus were really presymptomatic.
    • Age was associated with being presymptomatic: 
      • OR per year increase in age: 1.08 (95% CI, 1.01-1.16).

Limitations

  • Selection bias.
  • Small samples.