High LDH Levels Research Articles

The Incidence of Acute Pulmonary Embolism with COVID-19 Pneumonia in Saudi Arabia: A Retrospective Single-Center Study.

Acute pulmonary embolism (APE) is a common and prognostically significant complication of COVID-19 infection. We investigated the clinical characteristics and chest CT findings of COVID-19 positive patients complicated with APE. A retrospective, record-based, case-series study was performed examining 483 patients admitted to King Saud Medical City during the pandemic, from April 2020 to June 2020. Of these, 92 patients who underwent chest CT scans were included in the final analysis. The incidence of APE, clinical presentations, radiological patterns, and patient outcomes were assessed and compared against those for patients without PE. The incidence of APE was 22% [95% confidence interval (95% CI): 19%–39%], detected by chest CT. Men constituted 85.0% of patients, with a mean age of 48.9 ± 16.7 years. For most patients with APE, risk factors for thromboembolism were established but did not differ significantly from those without PE. The mean D-dimer level of 9.1 (range 7.0–10.2) was significantly higher among patients diagnosed with APE (OR: 1.021; 95% CI: 1.012–1.028; P = 0.001) compared with that in patients without PE. Moreover, the mean levels of lactate dehydrogenase (LDH, 628.5; range: 494.0–928.3; OR: 1.002; 95% CI: 1.000–1.003; P = 0.02), C-reactive protein (CRP; 158.5; range: 105.3–204.5; OR: 1.025; 95% CI: 1.015–1.035; P = 0.001), and cardiac troponin (3.5; range; 2.6–3.8; OR: 1.016; 95% CI: 0.971–1.067; P = 0.01) were also significantly higher in patients with APE than those in patients with PE. The chest CT presentations of APE included massive, segmental, and sub-segmental APE. The need for Intensive Care Unit admission was higher among patients diagnosed with APE, who presented a fatality rate of 10%.. Our study pointed to the incidence and predictors of APE in COVID-19 patients. High levels of D-dimer, CRP, cardiac troponin, and LDH should alert the clinician to the possibility of APE in COVID-19 patients..

Clinical characteristics and outcomes of adult patients with acquired thrombotic thrombocytopenic purpura: a single center retrospective study.

Thrombotic thrombocytopenic purpura (TTP) is a rare disease and a potentially life-threatening thrombotic microangiopathy. Although the diagnostic and therapeutic techniques have improved, it is still difficult for clinicians to identify early due to different initial clinical manifestations and the incidence and survival rate are reported inconsistently. This study investigated the clinical characteristics, treatment strategies, and treatment outcomes of adult patients with acquired TTP. A retrospective analysis of 55 patients (35 females and 20 males) treated for acquired TTP from January 1, 2013 to December 31, 2017 was conducted. The analysis included clinical manifestations at onset, treatment efficacy measures, survival, cause of death, and the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (sequential organ failure assessment) scores. At onset, in addition to thrombocytopenia and hemolysis, 50 patients (90.91%) presented with neurological abnormalities, but only 19 (34.55%) showed the classic TTP pentad of symptoms. The overall mortality rate was 34.55%. Plasma exchange (PEX) was performed in 49 patients. The most effective treatment was PEX with a normal dose of corticosteroid and rituximab which showed a response rate of 81.25%. The main cause of death was cerebral hemorrhage. The APACHE II and SOFA scores were higher in non-survivors compared to survivors (APACHE II: 20.12±7.83 vs. 11.50±4.49, P<0.05; SOFA: 12.06±3.27 vs. 7.74±2.10, P<0.05). Non-survivors had higher levels of lactic dehydrogenase (LDH; 1,646.94±1,269.48 vs. 942.76±740.58 IU/L, P=0.015), and higher numbers of schistocytes (6.18%±4.69% vs. 3.44%±3.13%, P=0.035) compared to survivors. TTP progressed rapidly, and its clinical manifestations varied between patients. The diagnosis depended on the clinical features and laboratory tests. Combination therapy with PEX, immunosuppressive therapy, and rituximab may be useful. Higher APACHE II and SOFA scores, higher LDH levels, and a greater degree of schistocytosis were associated with the severity and outcome of TTP.

Circulating Exosomal MiR-107 Restrains Tumorigenesis in Diffuse Large B-Cell Lymphoma by Targeting 14-3-3η.

Exosomes, nanometer-sized membranous vesicles in body fluids, have emerged as promising non-invasive biomarkers for cancer diagnosis. However, the function of exosomes in diffuse large B-cell lymphoma (DLBCL) remains elusive. This study aimed to investigate the role of exosomal miR-107 in lymphomagenesis and explore its clinical significance. In this study, decreased exosomal miR-107, miR-375-3p, and upregulated exosomal miR-485-3p were detected in the plasma of DLBCL patients and showed potential diagnostic value. Downregulated miR-107 expression was associated with advanced Ann Arbor stage, high IPI score, LDH, and β2-MG level in DLBCL patients. Overexpression of miR-107 by miR-107 Agomir significantly abrogated cell proliferation, induced apoptosis, and inhibited cell invasion in vitro, and repressed tumor growth in vivo. Moreover, the downregulation of miR-107 went in the opposite direction. The target genes of miR-107 were mainly enriched in the PI3K-Akt, Hippo, and AMPK signaling pathways. Notably, upregulated 14-3-3η (YWHAH) was suppressed by miR-107 in DLBCL, suggesting that miR-107 may restrain tumorigenesis by targeting 14-3-3η. In summary, this study unveils the function of miR-107 in lymphomagenesis, highlighting its potential as a diagnostic and prognostic indicator and as a new therapeutic target in the management of DLBCL.

Precision medicine: preliminary results from the Initiative for Molecular Profiling and Advanced Cancer Therapy 2 (IMPACT2) study

Precision medicine is associated with favorable outcomes in selected patients with cancer. Herein, we report an interim analysis of IMPACT2, an ongoing randomized study evaluating genomic profiling and targeted agents in metastatic cancer. Patients with metastatic cancer underwent tumor genomic profiling (ClinialTrials.gov: NCT02152254), and 69 patients met the criteria for randomization. Tumor board and multidisciplinary review of molecular alterations optimized treatment selection. From 5/2014 to 4/2017, 320 patients (median age, 63 years; men, 47%) had tumor molecular aberrations, and 213 (66.56%) received anticancer therapy. The most frequently mutated genes were TP53 (42%), KRAS (16%), PIK3CA (12%), and CDKN2A (11%). The median OS was 10.9 months (95% CI, 8.8–12.9). OS was shorter in patients with higher tumor mutational burden. Independent factors associated with shorter OS were age ≥60 years, liver metastases, low albumin levels, high LDH levels, and KRAS and TP53 mutations. Outcomes for randomized patients will be reported after completion of the study.

A case report of greater saphenous vein thrombosis in a patient with coronavirus (COVID-19) infection

In December 2019, the World Health Organization (WHO) announced a series of pneumonia cases caused by an unknown origin, discovered in Wuhan, China. A dangerous virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a disease named acute respiratory syndrome, which was later popularly called coronavirus infection (COVID-19). Patients with acute COVID-19 are at high risk of thrombosis in various blood vessels due to hypercoagulability, blood stasis, and endothelial damage. In this study, we present a case report of a patient with COVID-19, who was hospitalized in one of the hospitals in Sanandaj, Iran. There were symptoms of fever, chills, muscle aches, cough, and tachycardia. Laboratory tests showed high levels of CRP, ESR, Ferritin CLIA, LDH and D-Dimer in this patient. Doppler ultrasound of the patient also revealed an abnormal finding, thrombosis in the right greater saphenous vein. This suggests that COVID-19 may lead to other negative effects through damage to blood vessels.

P52.06 “High Tumor Burden” in Metastatic Non-Small Cell Lung Cancer: Defining the Concept

IntroductionIdentifying patient characteristics that define a worse prognosis for the disease or a “high tumor burden” (HTB) status is essential for clinical decision-making and treatment selection in metastatic non-small cell lung cancer (mNSCLC). This study aimed to define this concept based on the oncologist’s experience in clinical practice.MethodsA representative sample of Spanish experts was selected and asked to complete an online survey regarding the definition of “high tumor burden” according to their personal experience.ResultsView Large Image Figure ViewerDownload Hi-res image Download (PPT)ConclusionIn the real-world setting, HTB is defined by the number of metastatic lesions, location of metastases, size of tumors and by high LDH levels according to experts’ opinion. Given the relevance of this concept, efforts should be made to unify its definition, and to further explore its potential as a prognostic factor for mNSCLC patients.Keywordsnon-small cell lung cancer; “high tumor burden” IntroductionIdentifying patient characteristics that define a worse prognosis for the disease or a “high tumor burden” (HTB) status is essential for clinical decision-making and treatment selection in metastatic non-small cell lung cancer (mNSCLC). This study aimed to define this concept based on the oncologist’s experience in clinical practice. Identifying patient characteristics that define a worse prognosis for the disease or a “high tumor burden” (HTB) status is essential for clinical decision-making and treatment selection in metastatic non-small cell lung cancer (mNSCLC). This study aimed to define this concept based on the oncologist’s experience in clinical practice. MethodsA representative sample of Spanish experts was selected and asked to complete an online survey regarding the definition of “high tumor burden” according to their personal experience. A representative sample of Spanish experts was selected and asked to complete an online survey regarding the definition of “high tumor burden” according to their personal experience. Results ConclusionIn the real-world setting, HTB is defined by the number of metastatic lesions, location of metastases, size of tumors and by high LDH levels according to experts’ opinion. Given the relevance of this concept, efforts should be made to unify its definition, and to further explore its potential as a prognostic factor for mNSCLC patients. In the real-world setting, HTB is defined by the number of metastatic lesions, location of metastases, size of tumors and by high LDH levels according to experts’ opinion. Given the relevance of this concept, efforts should be made to unify its definition, and to further explore its potential as a prognostic factor for mNSCLC patients.

Different Features of Interleukin-37 and Interleukin-18 as Disase Activity Markers of Adult-Onset Still's Disease.

The aim of this study was to evaluate the usefulness of serum interleukin (IL)-37 and IL-18 as disease activity markers of adult-onset Still’s disease (AOSD) and to compare their related clinical features. Forty-five patients with a set of high and subsequent low disease activity status of AOSD were enrolled. Modified Pouchot (mPouchot) score and serologic disease activity markers including levels of IL-37 and IL-18 were compared between high and low disease activity status. The relationships between disease activity parameters and differences in levels of cytokines according to each disease manifestation were evaluated in high disease activity status. mPouchot score and all disease activity markers including IL-37 and IL-18 significantly declined after treatment. Though both cytokines positively correlated with mPouchot score, the two did not correlate with each other in high disease activity status. IL-18 positively correlated with ferritin, AST, and LDH while IL-37 correlated better with CRP. The expression level of IL-37 was related to leukocytosis while IL-18 was related to pleuritis, pneumonitis, abnormal LFT, and hyperferritinemia. In addition, patients in the IL-18 dominant group presented with higher LDH levels and required a higher mean corticosteroid dose. In conclusion, IL-37 and IL-18 are disease activity markers reflecting different aspects of AOSD that can complement each other.

Study to identify incidence and risk factors associated Residual pleural opacity in tubercular pleural effusion

IntroductionResidual pleural opacity (RPO) is a common radiographic sequela in patients with tubercular pleural effusion at the end of the treatment. This study was designed to find out the risk factors associated with residual pleural opacity (RPO). Materials & methodsThis was a prospective longitudinal study performed to analyse data of 56 patients (46 males & 10 females) who were diagnosed as tubercular pleural effusion and treated for the same between 1st Jan 2019 to 30th March 2020. Chest X-ray posteroanterior & Lateral view was done (performed) at 0 and 6 months of treatment to quantify the amount of pleural effusion and measured the residual pleural opacity at the end of the treatment. RPO included both non resolving pleural effusion as well as residual pleural thickening (RPT). All statistical analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Multivariate logistic regression was performed to explore the association of risk factors and Residual pleural opacity. The statistical significance level was set at 0.05 (two-tailed). ResultsThe incidence of Residual pleural opacity (RPO) at the end of 6 months of antituberculosis treatment was 53.57% (30/56)). The study patients were divided into RPO and non- RPO group. Male gender had significantly higher incidence of RPO (93.3% vs 69.2% P = 0.01)). Patients with RPO group had significantly more cough and weight loss as compared to non RPO group (96.6% vs 65.3% P = 0.002 and 60% vs 23% P = 0.005). The proportion of patients who underwent therapeutic aspiration and gained weight of more than 5kg during treatment (19.5% vs 7.6% P = 0.02 & 46.6% vs 7.6% P = 0.001) was significantly higher in RPO group. A significantly lower protein, glucose and higher LDH level in pleural fluid was observed in the RPO group compared to non-RPO group (P = 0.006, P = 0.01, P = 0.001)). No significant difference was found in the pleural fluid ADA, lymphocyte, neutrophil levels between the two groups (p > 0.05). Logistic regression analysis showed that the male gender, low pleural fluid glucose, presence of cough and weight loss were associated with significantly increased risk of residual pleural opacity and thickening (p < 0.05). ConclusionTubercular pleural effusion is associated with residual pleural opacity in more than half of the patients. Male gender and low glucose levels in pleural fluid was associated with increased risk of residual pleural opacity.

Diseminovana intravaskularna koagulopatija u akutnoj nepromijelocitnoj mijeloidnoj leukemiji - učestalost, kliničko-laboratorijske karakteristike i prognostički značaj

Introduction: Acute promyelocytic leukemia (APL) has the highest risk for overt disseminated intravascular coagulopathy (DIC), with reported incidence of DIC of up to 90%, as compared to 10-40% in other AML types. The influence of DIC on early death in non-APL AML patients has not been evaluated so far. Aim: The aim of our study was to analyze the incidence of DIC, its clinical and laboratory characteristics, and the impact on the survival and early death of patients with non-APL AML. Materials and methods: A total of 176 patients with non-APL AML, diagnosed and treated at the Clinic for Hematology of the Clinical Center of Serbia, between 2015 and 2020, were evaluated retrospectively. The diagnosis of DIC was made on the basis of ISTH (International Society on Thrombosis and Haemostasias) criteria. Results: The mean age of our patients was 53.8 ± 14.6 years, with 99/176 patients being men (56.2%). DIC was present in 74/176 patients (42.05%), who had a significant prevalence of the hemorrhagic syndrome (p = 0.01). The risk factors for overt DIC were the following: older age (p &lt;0.01), comorbidities (p = 0.01), leukocytosis (p &lt;0.001) and a high level of LDH (p &lt;0.001). The FAB (French, American and British) type of non-APL AML, the cytogenetic risk group, and CD56 (cluster of differentiation) had no influence on overt DIC (p &gt; 0.05). No difference was found in early mortality, outcome, and the survival of non-APL AML patients, with and without DIC (p &gt; 0.05). Conclusion: Older age at diagnosis, comorbidities, leukocytosis, and high LDH concentrations are found to be adverse risk factors for overt DIC in non-APL AML patients. If treated promptly, with immediate, adequate and intensive use of blood derivates and components, DIC has no negative impact on early mortality, outcome, and survival.

Transmissible venereal tumours (TVT) in bitches: A haematological, biochemical and histopathological study

The dogs affected with transmissible venereal tumours were investigated for haematolgical, biochemical, cytological and histopathological study. The prevalence of canine venereal tumour was found to be 25.46 per cent with respect to all reproductive diseases and 34.15 per cent of all types of tumours in dogs in and around Bhubaneswar, Odisha. The incidence was more in young female dogs of age group 2 to 11 years (46.34%) with a mean age of 5.17 years. Non-descript/ indigenous breeds (73.17%) were more affected as compared to pure breeds of dogs. Haematological examination of suspected cases revealed normocytic –hypochromic anaemia, neutrophilic leucocytosis with thrombocytopenia and lymphopenia. Serum biochemical examination of affected cases revealed hypoproteinemia, hypoalbuminemia, hypoglobulinemia, hypoglycemia, decreased triglyceride and higher levels of LDH, blood urea nitrogen, creatinine, calcium, increased levels of alanine aminotransferase and alkaline phosphatase. Gross examination revealed presence of tumour masses around the genital organs with pinkish or hyperemic cauliflower like appearance with ulcerations and bleeding. Cytological and histopathological examinations of suspected cases revealed typical pleomorphic neoplastic round cells with marked anisocytosis, anisokaryosis, vacuolated cytoplasm, large central to eccentric nuclei, increased mitoses, hyperchromsia which are suggestive of Transmissible venereal tumours. Cytological, histopathological along with haematological and biochemical studies can be profitably utilized for early diagnosis and prognosis of canine transmissible venereal tumours.

Predictors of Mortality in Patients with COVID-19 Infection-associated Acute Kidney Injury.

To determine clinical characteristics, renal replacement therapy (RRT) requirements, and predictors of mortality in critically ill patients with COVID-19 associated AKI. Descriptive study. Sakarya University Education and Training Hospital, Sakarya, Turkey, between April 1 and 30, 2020. The study included 55 patients who were admitted with diagnosis of COVID-19, and whose illnesses showed a critical course that leads to AKI. The variables were studied as per objective. During the follow-up, 43 out of 55 patients (78.2%) died and 12 (21.8%) were discharged with recovery. The mortality was higher in patients at stage 3 (88.9% mortality) compared to stage 2 (53.8% mortality) (p=0.014). In the nonsurvivor group, RDW (red cell distribution width) and albumin levels were lower at admission; whereas, the LDH levels and CRP/albumin ratios were higher. On regression analysis, low albumin level (OR: 12.793, p = 0.010), high LDH level (OR: 8.454, p = 0.026), and presence of stage 3 AKI (OR: 10.268, p = 0.020) were found as independent risk factors for mortality in COVID-19 patients, who developed AKI. In critically ill patients with COVID-19 pneumonia, who developed AKI, it was seen that the presence of low albumin, high LDH, and stage 3 AKI at the time of admission could be used as predictors of mortality. Moreover,, it was shown for the first time that in these patients, the high CRP/albumin ratio and low RDW could be associated with mortality. Key Words: Acute kidney injury, Mortality, COVID-19.

Assessment of FVIII, D-dimer, S. ferritin, and lactate dehydrogenase in hospitalized patients with 2019 coronavirus disease

BACKGROUND: Corona virus disease 2019 (COVID-19) is a coronavirus that can produce a variety of symptoms, ranging from asymptomatic carrier status to severe respiratory failure, multiple organ dysfunction, and death, it might be associated with hypercoagulability as increase in coagulation factor 8 (FVIII).OBJECTIVES: This study was carried out to investigate markers of hypercoaguablility (factor VIII activity, D-Dimer) in hospitalized adult patients with COVID-19, evaluation of certain markers of inflammation (S. ferritin, lactate dehydrogenase [LDH], C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]) and correlate those markers with each other.PATIENTS AND METHODS: This cross-sectional study included 70 adult hospitalized patients with COVID-19. Blood samples were obtained for FVIII, D. dimer, and ESR. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23 and Microsoft Office Excel 2010.RESULTS: The mean age of enrolled 70 patients was 60.22 ± 14.43 years. 44 (62.9%) of patients had neutrophilia and lymphopenia was seen in 41 (58.6%). High ratio of N/L was seen in 66 (94.3%). Low count of eosinophil was seen in 44 (62.9%), high LDH level was seen at 57 (81.4%). Regarding serum ferritin, high level was seen 64 (91.4%) and high level of CRP was seen in 56 (80%). High level of ESR was seen in 64 (91.4%) and high level of D. dimer was seen in 55 (78.6%), while the high level of FVIII was seen in 30 (42.9%) and low FVIII level was seen in 4 (5.7%).CONCLUSIONS: The majority of patients had neutrophilia, lymphopenia, high N/L ratio, and eosinopenia. Markers of inflammation (S. ferritin, LDH, CRP, and ESR), which were elevated. FVIII level and D. dimer were elevated in the majority of patients with COVID-19. Few of the patients were had a low level of FVIII, which might be related to abnormal function of the liver or might be attributed to autoantibodies directed against FVIII.

Predictors of Mortality in Patients with COVID-19 Infection-associated Acute Kidney Injury.

To determine clinical characteristics, renal replacement therapy (RRT) requirements, and predictors of mortality in critically ill patients with COVID-19 associated AKI. Descriptive study. Sakarya University Education and Training Hospital, Sakarya, Turkey, between April 1 and 30, 2020. The study included 55 patients who were admitted with diagnosis of COVID-19, and whose illnesses showed a critical course that leads to AKI. The variables were studied as per objective. During the follow-up, 43 out of 55 patients (78.2%) died and 12 (21.8%) were discharged with recovery. The mortality was higher in patients at stage 3 (88.9% mortality) compared to stage 2 (53.8% mortality) (p=0.014). In the nonsurvivor group, RDW (red cell distribution width) and albumin levels were lower at admission; whereas, the LDH levels and CRP/albumin ratios were higher. On regression analysis, low albumin level (OR: 12.793, p = 0.010), high LDH level (OR: 8.454, p = 0.026), and presence of stage 3 AKI (OR: 10.268, p = 0.020) were found as independent risk factors for mortality in COVID-19 patients, who developed AKI. In critically ill patients with COVID-19 pneumonia, who developed AKI, it was seen that the presence of low albumin, high LDH, and stage 3 AKI at the time of admission could be used as predictors of mortality. Moreover,, it was shown for the first time that in these patients, the high CRP/albumin ratio and low RDW could be associated with mortality. Key Words: Acute kidney injury, Mortality, COVID-19.

Original Article: Clinical Research.

Aim:In this study, we aimed to investigate the possible role of endotrophin, a profibrotic byproduct of collagen VI, in the complex process of fibrosis development in the disease group with pulmonary fibrosis among interstitial lung diseases.Material and Method:When the patients’ participation in the study were completed, smoking or alcohol drinking conditions, and family history were recorded. Their weights and heights were recorded and body mass index (BMI) was calculated. In every patient, Spirometry with bronchodilator testing, determination of single-breath DLCO, and plethysmographic measurement of thoracic gas volume and airway resistance were performed. Blood samples were obtained for the inflammation markers such as sedimentation rate, C-reactive protein (CRP), complete blood count, liver and renal function tests, and lactate dehydrogenase levels. Serum endotrophin levels were measured in all patients.Results:Thirty-five patients with interstitial lung disease who were having pulmonary fibrosis, 35 patients with interstitial lung disease without pulmonary fibrosis, and 20 control patients without any signs or symptoms of interstitial lung disease were included in the study. Age distribution was similar between groups. The fibrotic ILD group was more commonly smoker or ex-smoker compared with the non-fibrotic ILD patients or control cases. Fibrotic ILD patients were leaner, having significantly decreased total lung capacity, diffusion capacity, and higher LDH levels. In the comparison of the 3 study groups regarding the endotrophin levels, there was a significant difference between groups. The fibrotic and non-fibrotic patient groups were compared for the Endotrophin levels and the difference was also significant. However, there was not any significant difference regarding the endotrophin levels between control cases and non-fibrotic ILD patients. Smoked cigarette pocket x year showed a significant positive correlation and DLCO % and KCO % showed a significant negative correlation with the endotrophin levels.Conclusion:Serum endotrophin levels significantly increase in fibrotic ILD patients compared with the non-fibrotic ILD patients and control cases. Endotrophin may be suggested as a diagnostic marker in fibrotic interstitial lung diseases.

Study of maternal and perinatal outcomes among women with pregnancy induced hypertension with normal and high serum LDH levels

Study of maternal and perinatal outcomes among women with pregnancy induced hypertension with normal and high serum LDH levels

Association of lactate dehydrogenase with mortality in incident hemodialysis patients.

Lactate dehydrogenase (LDH) plays a role in the glucose metabolism of the human body. Higher LDH levels have been linked to mortality in various cancer types; however, the relationship between LDH and survival in incident hemodialysis (HD) patients has not yet been examined. We hypothesized that higher LDH level is associated with higher death risk in these patients. We examined the association of baseline and time-varying serum LDH with all-cause, cardiovascular and infection-related mortality among 109 632 adult incident HD patients receiving care from a large dialysis organization in the USA during January 2007 to December 2011. Baseline and time-varying survival models were adjusted for demographic variables and available clinical and laboratory surrogates of malnutrition-inflammation complex syndrome. There was a linear association between baseline serum LDH levels and all-cause, cardiovascular and infection-related mortality in both baseline and time-varying models, except for time-varying infection-related mortality. Adjustment for markers of inflammation and malnutrition attenuated the association in all models. In fully adjusted models, baseline LDH levels ≥360 U/L were associated with the highest risk of all-cause mortality (hazard ratios = 1.19, 95% confidence interval 1.14-1.25). In time-varying models, LDH >280 U/L was associated with higher death risk in all three hierarchical models for all-cause and cardiovascular mortality. Higher LDH level >280 U/L was incrementally associated with higher all-cause and cardiovascular mortality in incident dialysis patients, whereas LDH <240 U/L was associated with better survival. These findings suggest that the assessment of metabolic functions and monitoring for comorbidities may confer survival benefit to dialysis patients.

Serum Lactate Dehydrogenase as a prognostic marker in preeclampsia and eclampsia

Introduction: Hypertensive disorders of pregnancy are major contributor of maternal and perinatal mortality and morbidity. Several laboratory paramerters like AST, ALT, uric acid, LDH are evaluated to study the seriousness of the disease. Aim of this study was to evaluate the effectiveness of serum lactate dehydrogenase as a prognostic marker in pre eclampsia and eclampsia. Materials and Methods: This study was undertaken in Dept of OBG KIMS Hubli for a period of six months from November 2016 to April 2017. It was a prospective comparative case control study. A total of 130 women were enroled for the study. Out of 130 women, 30 women were considered as controls and they were normotensives. Out of remaining 100 who served as cases, 79 women were cases of preeclampsia and 21 women were cases of eclampsia. Results: Preeclampsia and eclampsia were associated with higher levels of LDH .Adverse maternal and foetal outcome were noted in women with higher LDH values. Conclusion: Increased levels of LDH are associated with severity of the disease and adverse maternal and foetal outcome. So LDH levels can act as a prognostic marker in preeclampsia and eclampsia. Keywords: Eclampsia, Outcome, Pre eclampsia, Prediction, Prognosis, Serum Lactate Dehydrogenase.

Severe COVID-19 pneumonia in Piacenza, Italy — A cohort study of the first pandemic wave

BackgroundPiacenza is the closest city to the first coronavirus disease 2019 (COVID-19) cluster in Italy and has the highest national COVID-19 death rates per population. The objective of this study is to present characteristics and outcomes of patients admitted to medical departments of the Hospital of Piacenza during the first wave of the epidemic. MethodsA total of 218 patients with confirmed or suspect COVID-19 and severe pneumonia were included from February 21st to May 15th, 2020. Routinely-collected clinical and laboratory data were retrospectively retrieved from electronic medical files. A Cox proportional-hazards model was fit to assess the association of treatment and other variables with death. ResultsMedian age of patients was 68 years; 150 patients (69%) had comorbidities, mainly hypertension (107, 49%). Overall, 185 (85%) patients had acute respiratory distress syndrome (ARDS) on admission, including 103 (47%) with moderate or severe ARDS. Chest computed tomography scan showed bilateral disease in 201 (98%) and extensive lung involvement in 79 (50%) patients. Most patients received antiviral treatment (187, 86%) and corticosteroids (134, 61%). All patients received respiratory support and 64 (29%) were admitted to intensive care unit. As of June 30th, 100 patients (46%) died, 109 patients (50%) were discharged, and 9 patients (4%) were still hospitalized. In multivariable Cox analysis, age above 65 years, having more than one comorbidity, severe ARDS, low platelet counts, and high LDH levels at admission were associated with mortality, while having diarrhea at admission was associated with survival. The use of antivirals or corticosteroids was not associated with survival. ConclusionsOverall case fatality rates were high and associated with comorbidities, extensive lung involvement, ARDS at admission, and advanced age. The use of antivirals was not associated with increased survival.

Clinical Value of Serum Amyloid A and Misfolded Transthyretin for Relapsed/Refractory Diffuse Large B-Cell Lymphoma Patients

To evaluate the clinical value of serum amyloid A (SAA1/2) and misfolded transthyretin (TTR) for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) patients. 30 R/R DLBCL patients were enrolled as observation group, 20 remission/stabilization DLBCL and 10 chronic lymphadenitis patients were enrolled as control group. SELDI technique, Tris-Tricine sodium dodecyl sulfate-polyacrylamide gel electro-phoresis, the shotgun-LTQ-MS method, and bioinformatics technique were used to detected and analyzed SAA and TTR in R/R DLBCL patients. SPSS 21.0 software was used to analyze the relationship between the high expression of SAA, misfolded TTR in serum and the clinicopathological features, survival time of R/R DLBCL. patients Chi-square test was used to analyze clinical count data, Kaplan-Meier curve was used for survival analysis, and Log-Rank test was used to compare single-factor survival differences. The high expression of SAA and TTR (SAA+TTR+) was significantly associated with extranodal lesion, high level of LDH, and NCCN-IPI scores, and also correlated with non-GCB type. TTR+ was correlated with C-MYC in pathological tissue, while SAA+ was also associated with B-symptoms. The survival time of patients in SAA+, TTR+, and SAA+TTR+ group were shorter than that in control group. Both SAA and misfolded TTR are poor prognosis factors of R/R DLBCL patients.

Comparison of Clinical Characteristics of Hospitalized Patients with and without Covid-19 in Mashhad, Iran: A Retrospective, Single-Center Experiences

Background: Covid-19 is known to be diagnosed with clinical manifestations such as dry mouth, fever, respiratory distress, fatigue and tiredness, decreased leukocyte, and pneumonia evidence on CT- scan. We aimed to investigate the clinical symptoms of hospitalized patients with and without Covid-19 to develop the required clinical information. Materials and Methods: A retrospective descriptive study was conducted in 200 patients suspected of having Covid-19 infection hospitalized in Imam Reza hospital, one of the Referral Hospitals for Covid-19 patients, Mashhad, Iran. Patients’ records were reviewed for demographics and clinical symptoms, and the results of laboratory tests over January and February 2020 were reviewed. The admission criterion was definitive Corona virus infection diagnosis, and the exclusion criteria were suffering from viral hepatitis, chronic liver disease, and liver malignancies. Data were analyzed using SPSS version 16.0. Results: The prevalence of Covid-19 was revealed to be 75% among the suspected patients (71.1% in women and 77.4% in men). The average age of Covid-19 patients was 55.06± 17.23, and the average hospitalization period of Covid-19 patients was 8.22± 5.81 days. The most prevalent symptom among Covid-19 patients was fever and cold symptoms (65%), respiratory complications (17.5%), and fever (6%). The most significant laboratory findings regarding Covid-19 patients were their high NET, LDH, and CRP levels. Conclusion: The prevalence of Covid-19 was revealed to be 77.4% among the suspected patients. The average age of Covid-19 patients was 55.06± 17.23 years. Based on the results, laboratory parameters are not sufficient for Covid-19 diagnosis due to their low sensitivity and indication, but can improve the value and diagnostic aspects of the disease if used accompanied by CT- scan.