S41 Serum Lactate Dehydrogenase Levels: The Grim Reaper Sign in Acute Pancreatitis?

Abstract

Introduction: Acute pancreatitis (AP) is one of the most common gastrointestinal presentations to the emergency department. Current scoring systems in place for predicting the severity and mortality of AP include Ranson criteria, the Acute Physiology And Chronic Health Evaluation II (APACHE II), and the Bedside Index of Severity in Acute Pancreatitis (BISAP) score. However, these scoring systems have their limitations and variable utility. Lactate dehydrogenase (LDH) is an enzyme found in almost all body tissues that is released during tissue damage and can be used as a marker of an organ injury. The purpose of this study was to investigate whether specific LDH values can predict mortality risk in patients with AP and it’s correlation with hospital length of stay. Methods: We conducted a retrospective cohort study of patients who had presented to HCA Healthcare facilities with the diagnosis of AP in the period of January 2011 - January 2021. A Total 514 patients that presented with AP and had a serum LDH data obtained on admission were identified and divided into three groups based on LDH cutoff levels. Length of hospital stay, length of intensive care unit stay (ICU), and mortality rate were compared among groups. Other variables included age, gender, race, BMI, and prior medical history of heart disease or cerebrovascular accident. The study was conducted using a Logistic Regression approach that used statistical analysis to predict the odds of a desired association. Results: Total 514 eligible patients were identified and divided into three groups. Group 1 consisted of 301 patients with LDH level < 300 IU/L, Group 2 consisted of 158 patients with LDH level between 300-600 IU/L, and Group 3 consisted of 55 patients with LDH level >600. AP patients with an initial LDH value of more than 600 IU/L on admission were likely to have longer hospital length of stay, by 4.5 days on average, 3.2 times more likely to be admitted to ICU, and 12.1 time more likely to expire than patients with an initial LDH value of less than 300 IU/L. Conclusion: This study has demonstrated that serum LDH is a cheap and a convenient test that can be obtained in AP patients to predict the length of hospital stay, ICU needs, and mortality rates. However, given our study is retrospective, additional randomized controlled studies are necessary to corroborate the beneficial effects of obtaining LDH in patients presenting with AP on admission (Table). Table 1. - The average length of hospital stay, percentage of patients required ICU care, and percentage of patients who has expired in each group along with the median and mode Groups Average Length of Hospital Stay Percentage of Patients required ICU care Percentage of Patients who has expired Group 1 8.09 22.92% 3.32% Group 2 10.03 33.54% 10.76% Group 3 15.63 54.55% 23.64%