Lactate dehydrogenase to albumin ratio as a convenient parameter for predicting the severity of Behçet disease: a cross-sectional study.

BackgroundNecrotizing soft tissue infections (NSTI) are rapidly progressing and life-threatening conditions that require prompt diagnosis. However, differentiating NSTI from other non-necrotizing skin and soft tissue infections (SSTIs) remains challenging. We aimed to evaluate the diagnostic value of the biochemical analysis of soft tissue infectious fluid in distinguishing NSTIs from non-necrotizing SSTIs.MethodsThis cohort study prospectively enrolled adult patients between May 2023 and April 2024, and retrospectively included patients from April 2019 to April 2023. Patients with a clinical suspicion of NSTI in the limbs who underwent successful ultrasound-guided aspiration to obtain soft tissue infectious fluid for biochemical analysis were evaluated and classified into the NSTI and non-necrotizing SSTI groups based on their final discharge diagnosis. Common extravascular body fluid (EBF) criteria were applied.ResultsOf the 72 patients who met the inclusion criteria, 10 patients with abscesses identified via ultrasound-guided aspiration were excluded. Based on discharge diagnoses, 39 and 23 patients were classified into the NSTI and non-necrotizing SSTI groups, respectively. Biochemical analysis revealed significantly higher albumin, lactate, lactate dehydrogenase (LDH), and total protein levels in the NSTI group than in the non-necrotizing SSTI group, and the NSTI group had significantly lower glucose levels and pH in soft tissue fluids.In the biochemical analysis, LDH demonstrated outstanding discrimination (area under the curve (AUC) = 0.955; p < 0.001) among the biochemical markers. Albumin (AUC = 0.884; p < 0.001), lactate (AUC = 0.891; p < 0.001), and total protein (AUC = 0.883; p < 0.001) levels also showed excellent discrimination. Glucose level (AUC = 0.774; p < 0.001) and pH (AUC = 0.780; p < 0.001) showed acceptable discrimination. When the EBF criteria were evaluated, the total scores of Light’s criteria (AUC = 0.925; p < 0.001), fluid-to-serum LDH ratio (AUC = 0.929; p < 0.001), and fluid-to-serum total protein ratio (AUC = 0.927; p < 0.001) demonstrated outstanding discrimination.ConclusionBiochemical analysis and EBF criteria demonstrated diagnostic performances ranging from acceptable to outstanding for NSTI when analyzing soft tissue infectious fluid. These findings provide valuable diagnostic insights into the recognition of NSTI. Further research is required to validate these findings.

Coronavirus disease 2019 (COVID-19) can be fatal in severe cases. Accordingly, predicting the severity and prognosis of the disease is valuable. This study examined the role of electrolyte imbalances in predicting the severity of COVID-19. In this cross-sectional study, 169 hospitalized patients with COVID-19 were included and categorized into three groups based on the severity of the disease (moderate, severe, and critical). Serum levels of electrolytes (calcium [Ca], phosphorus [P], sodium [Na], potassium [k], and magnesium [Mg]), inflammatory markers (D-dimer, C-reactive protein [CRP], ferritin, and lactate dehydrogenase [LDH]), and 25OHVitamin D were measured. The mean age of patients was 53 years, and 54% were male. They had moderate, severe, and critical illnesses in 22%, 47%, and 31%, respectively. CRP, D-dimer, and ferritin increased with the severity of the disease. The lower median values of Mg, Na, 25OHVitamin D, Ca, LDH, and higher median lymphocyte counts were observed in the moderate vs. the severe group (P < 0.05). These parameters have acceptable sensitivity and specificity at the suggested cut-off level to discriminate the moderate and critical cases. Serum parameters introduced in this study are appropriate for differentiating between critical and moderate cases. The electrolyte imbalance can predict critical patients.

BackgroundSerum lactate dehydrogenase (LDH) and total bilirubin (TB) have been shown to increase during acute myocardial infarction (AMI). However, how they associate with the prognosis of these patients is still...

"SARS-CoV-2 is a new virus that affects the human population, about which not all the details are known, and for which the research is ongoing. Several common in vitro diagnostic tests have been implicated in the unfavorable progression of COVID-19, providing potentially important prognostic information. According to some synthesis studies, the progressively low values of the lymphocyte / leukocyte ratio, and progressively increased of the neutrophil / lymphocyte and neutrophil / platelets ratios, correlate with the more severe evolution of COVID-19. The existence of a number of lymphocytes &lt;20% on day 10-12 indicates a pre-severe condition, and a number of &lt;5% on days 17-19 indicates a critical one. D-dimers are the most important prognostic element in monitoring patients with severe forms of COVID-19. Elevated levels of D-dimers compared to the reference biological interval observed at hospitalization of patients with COVID-19 and their marked increase, up to 3-4 times the initial value, were associated with increased mortality, which probably reflects the activation of coagulation in infection / sepsis, cytokine storm and imminent organ failure. Increasing ALT values by more than 5 times the reference biological interval increased the risk of mortality of patients with COVID-19 by seven times. High levels of AST compared to the biological reference range were observed in both patients with non-severe COVID-19 disease as well as in a double the number of patients with severe disease. The value of serum creatinine at hospitalization is a predictor of the death of hospitalized patients for COVID-19. More frequent measurements of serum creatinine are recommended in the management of COVID-19 to improve the early detection of renal lesions in patients with COVID-19. At patients confirmed with COVID19, elevated levels of highly sensitive troponin I (hs-cTnI) were observed during hospitalization, and more than 50% of those who died had a significantly higher concentration of hs-cTnI compared to the biological interval of reference. Hyperferritinemia has been associated with an increased severity of COVID-19 disease, because of elevated ferritin levels compared to the reference biological range, the so-called ""cytokine storm"" is developed which can be fatal for half of COVID-19 patients, especially for the elderly. Lactate dehydrogenase (LDH) has been associated with altered outcomes in patients with viral infections. In an American study (n = 1532 COVID-19 patients), the association between elevated LDH levels (that were measured as soon as possible after hospitalization ) and the severity of the disease in patients with COVID-19 was assessed. Elevated LDH levels were associated with a 6 fold increase in the chance of developing severe symptoms and a 16 fold increase in mortality in patients with COVID-19. C-reactive protein (CRP) is part of the acute phase plasma proteins. COVID-19 increases CRP. This seems to correlate the severity and prognosis of the disease. Studies have found low levels of PCR in patients who do not require oxygen therapy (mean 11 mg / L,) compared to patients who have become hypoxemic (mean 66 mg / L)."

BackgroundEarly identification of patients at high risk of poor clinical outcomes is the key to success in saving the lives of patients with coronavirus disease 2019 (COVID-19). Neutrophil to Lymphocyte Ratio (NLR) is an easily available and cheap surrogate inflammatory marker, its baseline NLR role in African COVID-19 patients remains to be investigated. The objective of the study aimed to evaluate the role of NLR as a predictor of severity and mortality of COVID-19 patients admitted at the Millennium COVID 19 care center in Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted on patients with COVID-19 admitted to the Millennium COVID-19 care center from August 1 to October 30, 2021. Receiver Operating Characteristic curve analysis was used to calculate the area under the curve to assess the predictive capacity of NLR on mortality and severity. Multivariable logistic regression analysis was done to identify the association between independent variables and disease outcomes with an Adjusted Odds Ratio (AOR), P-value, and 95% CI for AOR were used for testing significance.ResultsThe NLR of 9.47 was identified as the optimal cut-off value for predicting mortality with a sensitivity of 88.7% and a specificity of 95.4% (Area Under the Curve (AUC):0.95, 95% CI 0.92–98; P<0.001) and the NLR of 5.86 was an effective threshold value in predicting the severity of disease with a sensitivity of 92.2% and a specificity of 75% (AUC:0.85, 95% CI 0.800–0.905; P<0.001). In multivariable logistic regression analysis, after adjusting for confounding factors, NLR of more than 9.47 and 5.86 was significantly associated with all‐cause of in‐hospital mortality (AOR=4.73, 95% CI, 1.19–33.68; P<0.02), and severity of disease (AOR=12.98, 95% CI 3.85–43.80; P=0.001), respectively.ConclusionNLR greater than 9.47 and 5.86 effectively predict mortality and severity of the disease, respectively. It provides an objective input for early decision-making in inpatient management especially in resources limited area.

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Dengue hemorrhagic fever (DHF) is characterized by fever, bleeding, and pleural effusion which may be caused by increased vascular permeability. Based on these findings it is assumed that endothelial dysfunction plays a role in the pathogenesis of DHF. The aims of this study was to know whether endothelial dysfunction occurs in DHF by measuring sVCAM-1, vWF, and D dimer. The relationship between endothelial dysfunction and severity of the disease would also be analyzed. This was a cross sectional study which involved 31 DHF patients and 30 non DHF fever patients as control group. The level of sVCAM-1 was determined by ELISA method, vWF by enzyme linked fluorescent assay , and D dimer by sandwich enzyme immunoassay. The results indicated that mean of sVCAM-1 level in DHF group and control group were 1323 ng/mL and 1003 ng/mL, while standard deviation (SD) were 545 ng/mL and 576 ng/mL respectively. The mean of vWF level in DHF group and control group were 284% and 327%, with SD 130% and 141% respectively. The level of sVCAM-1 did not correlate with platelet count, albumin level, D dimer level and severity of disease. There was a weak correlation between vWF level with D dimer and severity of disease ( r = 0,472 and r = -0,450 ). Conclusion: The results of this study indicate that endothelial dysfunction occurs in DHF, but there is no correlation between sVCAM-1 with severity of disease, only a weak correlation between vWF with D dimer and severity of disease is found.

Objective To investigate the levels of matrix metalloproteinases-3 (MMP-3), adenosine deaminase (ADA) and lactate dehydrogenase (LDH) in the hydrothorax and ascites, and to approach the diagnostic value of three combined indexes in benign and malignant hydrothorax and ascites. Methods Case-control study. A total of 278 patients with hydrothorax and ascites were enrolled in this study who were hospitalized in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from August 2018 to July 2019 to detect the levels of MMP-3, ADA and LDH in the hydrothorax and ascites. The benign group (208 patients) and malignant group (70 patients) were compared with MMP-3, ADA, LDH, receiver operating characteristic (ROC) curve, sensitivity and specificity in the hydrothorax and ascites, and the results were compared comprehensively. Results (1)The MMP-3 level in the benign hydrothorax group was 89.21±61.93 ng/mL, the ADA level was (9.08±8.89) U/L, the LDH level was (143.34±68.63) U/L, and the MMP-3 level in the malignant hydrothorax group was (205.63±98.16) ng/mL, he ADA level was (10.96±5.04) U/L, the LDH level was (243.44±131.20) U/L. The MMP-3 level in the benign ascites group was (84.91±73.48) ng/mL, the ADA level was (3.48±2.80) U/L, the LDH level was (99.48±69.53) U/L, and the MMP-3 level in the malignant ascites group was (174.89±82.48) ng/mL, the ADA level was (6.31±4.42) U/L, the LDH level was (191.86±94.52) U/L. The levels of MMP-3, ADA and LDH in the hydrothorax and ascites of the malignant group were higher than those in the benign group, and the difference was statistically significant (Z1 values were 5.215, 2.549, 3.212, respectively, and Z2 values were 6.188, 4.524, 6.38, respectively, P1 and P2 were <0.05). (2)The area under the curve (AUC) of MMP-3 for diagnosis of hydrothorax, liver cancer ascites and gastric cancer ascites was 0.853, 0.826, and 0.763, respectively. The sensitivity was 76%, 96.9%, and 92.3%, respectively, and the specificity was 80%, 64.5%, 61.6%. The diagnostic efficacy of MMP-3 in lung cancer hydrothorax and liver cancer ascites was higher than ADA (AUC were 0.672, 0.691,respectively) and LDH (AUC were 0.717, 0.804, respectively), and the diagnostic efficacy of gastric cancer ascites was lower than ADA (AUC is 0.808) and LDH (AUC is 0.849), and LDH was the best. (3)The AUC of MMP-3, ADA and LDH combined diagnosis of lung cancer hydrothorax, liver cancer ascites and gastric cancer ascites were 0.861, 0.842, and 0.879, respectively. The sensitivities were 64%, 96.9%, and 84.6%, respectively, and the specificities were 92.9%, 63.8%, and 80.4%, respectively. In the lung cancer hydrothorax, liver cancer ascites and gastric cancer ascites, the combined efficacy of the three combined tests was better than the combined detection of MMP-3 and LDH (AUC were 0.86, 0.839, 0.872, respectively), combined detection of MMP-3 and ADA (AUC were 0.845, 0.831, 0.855, respectively), LDH and ADA combined detection (AUC were 0.713, 0.791, 0.846, respectively). Conclusions MMP-3 is important for the differential diagnosis of benign and malignant hydrothorax and ascites, and may be one of the important indicators for the differential diagnosis of benign and malignant hydrothorax and ascites. The diagnostic efficacy of MMP-3 combined with ADA and LDH and three combined detection is better than single index, which has certain clinical value for differential diagnosis of benign and malignant hydrothorax and ascites. Key words: Matrix metalloproteinase 3; Adenosine deaminase; Lactate dehydrogenases; Hydrothorax; Ascites; Diagnosis, differential

COVID-19 pandemic demanded upgrading of laboratory medicine to limit morbidity, disability and mortality from moderate and severe SARS-COV-2 infections. To assess among moderate and severe COVID-19 patients, C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, interleukin 6 (IL-6), lactate dehydrogenase (LDH), total and differential leucocyte count (TLC and DLC), neutrophil-to-lymphocyte ratio (NLR), absolute platelet count (APC), prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) to find their interdependence and role in prognosis. This open label analytical cross-sectional noninterventional study evaluated array of independent biochemical, haematological and coagulopathy markers, viz. CRP, PCT, ferritin, D-dimer, IL-6, LDH, TLC, DLC, NLR, absolute platelet count, PT, APTT and INR on consecutive 100 patients with diagnosis of moderate and severe COVID-19 from July to August 2021. In our study, on consecutive designated 100 cases (55 cases moderate and 45 cases severe), more severity were reported as the age progressed; gender difference was not noted. Among independent markers, CRP, PCT, ferritin, D-dimer, IL-6 and LDH had statistically significant relation in comparison with severity of the disease as Chi-square calculated value (P < 0.05). TLC, DLC and APC showed no significant relation in comparison with severity of the disease; NLR had highly significant relation. PT showed significant relation in comparison with severity, though APTT and INR did not show significant relation. Our research group felt that CRP, PCT, ferritin, D-dimer, IL-6, LDH and NLR should be in included in clinical practice guidelines to prognosticate COVID-19 cases. Furthermore, translational researches are needed at all levels of healthcare to improve validity for practices of primary care physicians.

BackgroundHuman adenoviruses (HAdVs) are prevalent pathogens responsible for respiratory infections. In this study, we examined the relationship between adenovirus viral loads in bronchoalveolar lavage fluid (BALF) and the severity of adenovirus pneumonia in children.MethodsThe medical records of patients admitted to Guangzhou Women and Children’s Medical Center with confirmed adenovirus pneumonia were analyzed in a prospective manner. We evaluated the potential link between the severity of the disease and the viral load, which was measured using real-time polymerase chain reaction (PCR) on the BALF of pediatric patients. Furthermore, the study investigated the connection between viral loads in BALF and the progression of the illness.ResultsIn hospitalized pediatric patients with adenovirus pneumonia, the viral loads found in BALF were positively associated with the severity of the disease during the acute phase (P<0.05). In addition, lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels were positively associated with viral loads in BALF, whereas albumin (ALB) levels showed a negative relationship (P<0.05). In addition, In addition, The receiver operating characteristic (ROC) analysis indicated that viral loads in BALF displayed great potential for predicting severe adenovirus pneumonia, with a cut-off value of >187,500 copies/mL, which achieved a sensitivity of approximately 77.27% and a specificity of 80.65%.Moreover, viral loads in BALF from patients at the acute stage of the disease were positively correlated with fever duration and length of stay (LOS) at the hospital, and viral loads declined quickly during the recovery stage (P<0.05).ConclusionsOur findings indicated a significant correlation between viral loads in BALF from patients with adenovirus pneumonia and the severity of the disease. We suggested that viral loads can serve as potential biomarkers for identifying severe cases and predicting the progression of illness.

The present study aimed to assess the symptoms of anxiety and depression, quality of life (QoL), and sleep quality in patients with allergic rhinitis (AR). Additionally, the study sought to analyze the relationship between these parameters and the severity of the disease, duration of symptoms, seasonality, predominant symptoms, and the coexistence of asthma. A total of 88 patients with AR without any systemic comorbidity and 78 healthy controls were enrolled. Patients with AR were grouped as mild or moderate-severe, seasonal or perennial, intermittent or persistent, and sneezers-runners or blockers. The Hospital Anxiety Depression Scale (HADS), Short Form-36 (SF-36), and Single-item Sleep Quality Scale (SQS) were assessed. HADS depression and anxiety scores were elevated in patients with AR compared to healthy controls (p=0.006 and p=0.025, respectively), and SF-36 physical role functionality and general health perception domains and SQS scores were lower (p&lt;0.001, p&lt;0.001, and p=0.004, sequentially). HADS anxiety scores were more elevated in individuals with AR and concomitant asthma (p=0.037). Higher depression and anxiety scores and lower sleep quality were observed in the moderate-severe group relative to the mild group (p=0.038, p=0.028, and p&lt;0.001, respectively), and in the persistent group relative to the intermittent group (p=0.010, p=0.030, and p&lt;0.001 sequentially). Blockers had higher HADS scores (p=0.010 and p=0.015, respectively) and lower sleep quality and social role functioning than sneezers-runners (p=0.040 and p=0.034, in sequence). Our study showed that AR downgraded patients' well-being. The severity, persistence, perennialism, nasal obstruction, and asthma comorbidity of the disease in question had a deleterious effect on the QoL and sleep, as well as mood.

Today world is trying to cope with the biggest pandemic caused by Coronavirus disease 2019 (COVID-19). The disease is graded as mild, moderate, serious and critical illness. Very few studies are done with methemoglobin along with other parameters for the assessment of the severity of COVID-19 disease. The objectives of the study were to estimate methemoglobin (Met-Hb), hemoglobin (Hb), ferritin and lactate dehydrogenase (LDH) levels in patients with COVID-19 disease and to investigate the interaction between these parameters and the severity of the disease. This observational study was conducted in three groups of COVID-19 patients- moderate, severe and critical, each group containing 30 patients, between June 2021 and September 2021 in the biochemistry department of a tertiary care hospital. For all patients, Met-Hb, Hb, ferritin, and LDH levels were estimated on the 2nd-3rd day of hospital admission. Patients in the critical group were older and had significantly high values of Met-Hb, ferritin and LDH and significantly low values of Hb (P&lt;0.05). In multivariate ordinal regression analysis, older age (OR-3.08; 95%CI:1.19-7.19;P-0.019), higher values of LDH (OR-8.66; 95%CI:2.53-29.5; P-0.001) and ferritin (OR-3.08; 95%CI:1.09-8.7;P-0.033) were independently associated with severity of the disease. A cut-off value of 410.50 U/L for LDH predicted the severity of the disease with 90% sensitivity and 88.3% specificity. In conclusion, higher levels of LDH and ferritin were related to the severity of the disease in COVID-19 cases. Although Met-Hb showed a minimal increase without any association with severity, it may be an underlying cause of hypoxia that may go unnoticed. So, monitoring of all these parameters should be done at intervals.

BackgroundRheumatoid arthritis (RA) is intrinsically associated with an increased incidence of lymphoproliferative disorders (LPDs). Furthermore, treatment with immunosuppressing agents, such as methotrexate (MTX) sometimes leads to the development of immunosuppressing...

Introduction. Necrotizing enterocolitis (NEC) is characterized by loss of gut wall integrity. Fatty acid binding protein (I-FABP) in blood serum allows to isolate infants in the early stages of the NEC and correlates with the severity of the disease. This protein is involved in the transport of polar lipids, such as fatty acids from the lumen of the small intestine.Aim of work: to determine diagnostic value of fatty acid binding protein (I-FABP) in blood serum in preterm children with necrotizing enterocolitis.Materials and methods. Under supervision there were 67 preterm children with NEC. The children were divided into groups depending on the severity of the NEC. Prior to the first group were involved 20 preterm infants with the NEC of IA and IB stage, and to the second group were involved 30 premature infants from the NEC of IIA and IIB stage and to the third group were involved 7 preterm infants with NEC of IIIA stage. The control group comprised 10 preterm infants without NEC. The content of the protein bound to fatty acids, the intestinal form (I-FABP) in serum was determined by the immunoassay method of the Human I-FABP (Hycult Biotech, Netherlands) kit according to the manufacturer's instructions.Results and discussion. Children of the III group had significantly lower body mass (p&lt;0.05) and gestational period at birth than children of the control group.All children with NEC involved in the study had an increase in the serum I-FABP content. Thus, in the I group, the I-FABP content was 796,0 [579-961] pg/ml, in group II - 1031,0 [873-1630] pg/ml, in group IІІ - 1698,0 [1598-2953] pg/ml, which significantly exceeded the value of I-FABP in control group children - 269,5 [252-289] pg/ml (p&lt;0.05). Also, there was a significant difference in I-FABP content in preterm infants with NEC, depending on the severity of the disease, the higher the stage, the higher the I-FABP content (p&lt;0.05). Diagnostic value of I-FABP in blood serum of prematurely born children with necrotizing enterocolitis, depending on severity, determined by ROC analysis. The most diagnostic value of I-FABP is for the diagnosis of NEC grade III. I-FABP ≥ 1484.0 pg/ml allows to identify NEC of III stage in preterm children with a sensitivity of 85.7% and a specificity of 82.0%. The area under the curve (AUC) is 0.880 [95% CI 0.784-0.976], which indicates a high diagnostic value of the model.Conclusions. The heavier course of NEC is associated with lower body weight (p&lt;0.05) and lower gestational age. In all children who were born prematurely with necrotizing enterocolitis, the content of intestinal fatty acid-binding protein (I-FABP) in serum was elevated. The highest level of I-FABP (1698,0 [1598-2953] pg/ml) was observed in preterm infants with necrotizing enterocolitis of the third stage (p&lt;0.05). The I-FABP index ≥1484.0 pg/ml allows to identify preterm infants with necrotizing enterocolitis of III stage with a sensitivity of 85.7% and a specificity of 82.0%, the area under the curve 0.880 [95% CI 0.784-0.976], which confirms the results of the ROC analysis.

To explore the feasibility of difference between hematocrit and albumin (HCT-ALB) to evaluate the severity in patients with severe scrub typhus (Tsutsugamushi disease). The clinical data of 408 patients with scrub typhus in 37 hospitals located in 15 prefectures of Yunnan Province from January 1st, 2017 to December 31st, 2018 were retrospectively collected. The patients were divided into the non-severe scrub typhus disease group (n = 265) and the severe scrub typhus disease group (n = 143) according to the diagnostic criteria. Volunteers attending Kunming City Medical Center in Yunnan Province for routine physical examination were enrolled as healthy control group (n = 230). HCT, ALB, lactate dehydrogenase (LDH), uric acid (UA), and acute physiology and chronic health evaluations II (APACHE II) and sequential organ failure assessment (SOFA) within 24 hours after admission were collected. HCT-ALB difference was calculated. Pearson method was used to analyze the correlation between HCT-ALB difference and LDH, UA, APACHE II and SOFA scores in patients with severe scrub typhus disease; the receiver operating characteristic (ROC) curve was used to analyze the value of HCT-ALB difference in the diagnosis of severe scrub typhus disease. (1) There was no significant difference in gender composition between patients with non-severe scrub typhus disease group and severe scrub typhus disease group, but the age of the severe scrub typhus disease group was significantly higher than that of the non-severe scrub typhus disease group (years old: 53.57±15.23 vs. 35.03±23.47, P < 0.01). (2) Compared with the healthy control group, the HCT, ALB of the non-severe scrub typhus disease group and severe scrub typhus disease group were significantly decreased [HCT: (36.54±6.82)%, (38.13±7.60)% vs. (46.20±4.42)%; ALB (g/L): 35.53±5.87, 26.90±6.10 vs. 47.75±4.28, all P < 0.01], and the HCT-ALB difference was significantly increased (5.28±3.90, 11.26±6.62 vs. 1.55±5.32, both P < 0.01). Compared with the non-severe scrub typhus disease group, the HCT of the severe scrub typhus disease group was significantly increased [(38.13±7.60)% vs. (36.54±6.82)%, P < 0.01], the ALB was significantly decreased (g/L: 26.90±6.10 vs. 35.53±5.87, P < 0.01), and the HCT-ALB difference was significantly increased (11.26±6.62 vs. 5.28±3.90, P < 0.01). (3) Pearson correlation analysis showed that HCT-ALB difference was positively correlated with LDH and UA in patients with severe scrub typhus disease (r values were 0.316 and 0.284, respectively, both P < 0.01), and negatively correlated with APACHE II score and SOFA score (r values were -0.229 and -0.198, respectively, both P < 0.05). (4) ROC curve analysis showed that the area under the curve (AUC) of HCT-ALB difference in the diagnosis of severe scrub typhus disease was 0.786, standard error was 0.024, P = 0.000, and 95% confidence interval (95%CI) was 0.739-0.832. When the best diagnostic value was 8.56, the sensitivity was 81.1%, the specificity was 60.8%, and the Youden index was 0.419. HCT-ALB difference is an indicator to evaluate the severe scrub typhus disease. When HCT-ALB difference is above 8.56, it can be used as an indicator to identify severe scrub typhus disease.

In recent years an increase has been seen in the number of patients with severe atopic dermatitis (AD) accompanied with generalized typical eruptions. Some markers indicating the severity of the disease and symptom changes are very useful, and therefore the purpose of the present study was to investigate serum lactate dehydrogenase (LDH) as such a marker. A total of 58 children with AD were enrolled. The severity of the disease was graded on the basis of the extent of eruptions and the severity of atopic symptoms. The fraction of serum LDH, number of eosinocytes in the peripheral blood, and serum IgE levels were also determined. There was a close correlation between the severity of cutaneous symptoms and serum LDH activity, and between severity and eosinocyte count, but no relationship was seen between serum IgE levels and severity of the disease. The aforementioned factors were determined in a time-related way. As the patients' condition improved, serum LDH activity tended to decline, but there were no consistent changes in eosinocyte count in the peripheral blood or serum IgE level. On LDH isozyme the levels of LDH4 and LDH5 were high. Tissue showed high LDH activity, especially in epidermides. These results suggest that serum LDH activity is a useful marker.