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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 149-152

Correlation of lactate dehydrogenase levels with outcome in patients with pre-eclampsia


Department of Obstetrics and Gynaecology, Government Medical College, Pali, Rajasthan, India

Date of Submission24-May-2020
Date of Decision30-May-2020
Date of Acceptance05-Jun-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Balgopal Singh Bhati
Department of Obstetrics and Gynaecology, Government Medical College, Pali, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_46_20

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  Abstract 


Background: Pregnancy causes profound anatomical, physiological and metabolic changes in maternal tissues. Lactate dehydrogenase (LDH) is an intracellular enzyme. Hence, the present study was undertaken for assessing and correlating LDH levels with outcome in patients with preeclampsia. Materials and Methods: A total of 60 pregnant women with pre-eclampsia (PE) were included in the present study. Among these 60 patients, 30 patients were mild PE while the remaining 30 patients were of severe PE. Another set of 30 subjects of normotensive pregnancy were included as controlled group. Blood samples were obtained from all the subjects and were sent to laboratory where auto-analyser was used for the evaluation of serum LDH levels. Follow-up was done and outcome was recorded in all the patients. All the results were recorded into Microsoft excel sheet and were analysed by SPSS software. Results: Mean LDH levels amongst subjects of normotensive group, mild PE group and severe PE group was found to be 169.2 IU/L, 338.4 IU/L and 629.7 IU/L, respectively. Non-significant results were obtained while comparing the mean gestational age of the patients divided on the basis of mean LDH levels. Significant results were obtained while comparing the neonatal complications and neonatal mortality amongst patients divided on the basis of LDH levels. Conclusion: Significant alteration of LDH levels occurs in PE patients. In addition, higher levels of LDH levels are significantly associated with worse outcome in PE patients.

Keywords: Lactate dehydrogenase, outcome, pre-eclampsia


How to cite this article:
Bhati BS, Mirza N, Choudhary PK. Correlation of lactate dehydrogenase levels with outcome in patients with pre-eclampsia. Adv Hum Biol 2020;10:149-52

How to cite this URL:
Bhati BS, Mirza N, Choudhary PK. Correlation of lactate dehydrogenase levels with outcome in patients with pre-eclampsia. Adv Hum Biol [serial online] 2020 [cited 2020 Nov 27];10:149-52. Available from: https://www.aihbonline.com/text.asp?2020/10/3/149/295832




  Introduction Top


A plethora of anatomical, physiological and metabolic transitions can be observed in the maternal organs during the pregnancy. A large number of fetomaternal complications can result from certain unexpected alterations in the maternal tissues. Pre-eclampsia (PE)/gestational hypertension is one of the most frequently encountered and feared complications which has the capability to further progress into eclampsia (E). It is still claimed to be the biggest risk in the under developed nations.[1],[2],[3] The primary source of vitality in placenta is derived through the process of glycolysis. Chronic hypoxia induces morphological, molecular and functional changes in the placenta that closely resemble those observed in placentae from women suffering from preeclampsia. Hypoxia in turn stimulates the process of glycolysis which results in over-activity of Lactate dehydrogenase (LDH). A greater genomic expression and the over-activity of LDH have been observed in the placenta of preeclampsia cases as compared with uneventful cases of pregnancy. End result is a greater amount of lactate synthesis due to over-activity of LDH iso-enzyme triggered by hypoxia.[4],[5],[6] Various life-endangering side effects such as placental abruption, hepatic failure, acute renal failure and cardiovascular collapse may be elicited because of pre-eclampsia. A proper assessment of certain pertinent biomarkers in relation to vascular dysfunction like LDH may empower the medical field to avoid the unwanted occurrence of pre-eclampsia in the times to come.[5],[6],[7] The purpose of this study was to assess and correlate LDH levels with outcome in patients with PE.


  Materials and Methods Top


The present study was conducted in the Department of Gynaecology in Government Medical College, Pali, Rajasthan, and it included correlation of LDH levels with outcome in patients with PE. A total of 60 pregnant women with PE were included in the present study. Among these 60 patients, 30 patients were mild PE while the remaining 30 patients were of severe PE. Another set of 30 subjects of normotensive pregnancy were included as controlled group. Exclusion criteria included:

  • Diabetic patients,
  • Subjects with any known drug allergy,
  • Subjects with history of haemolytic anaemias, stroke or coronary artery disease.


After meeting the exclusion criteria, complete demographic details of all the patients were recorded. Blood samples were obtained from all the subjects and were sent to laboratory where auto-analyser was used for the evaluation of serum LDH levels. The follow-up was done and outcome was recorded in all the patients. All the results were recorded into Microsoft excel sheet and were analysed by SPSS version 16 software. Student t-test and Chi-square test were used for the evaluation of level of significance.


  Results Top


In the present study, a total of 30 patients were mild PE while the remaining 30 patients were of severe PE. Thirty subjects of normotensive pregnancy were included as control group. Mean LDH levels among subjects of normotensive group, mild PE group and severe PE group was found to be 169.2 IU/L, 338.4 IU/L and 629.7 IU/L, respectively. Significant results were obtained while comparing the mean LDH levels amongst normotensive patients, patients with mild PE and severe PE (P < 0.05). In the present study, mean gestation age of the patients with LDH levels <800 IU/L and of patients with LDH levels of more than 800 IU/L was found to be 37.12 weeks and 36.56 weeks, respectively. Non-significant results were obtained while comparing the mean gestational age of the patients divided on the basis of mean LDH levels.

In the present study, mean APGAR score at 1 min and 5 min was significantly lower among patients with LDH levels of more than 800 IU/L. Amongst the 60 patients with PE, 18.33% of the patients (11 patients) with LDH levels <800 IU/L and 31.67% of the patients (19 patients) with LDH levels of more than 800 IU/L had neonatal complications. Neonatal mortality was seen in 10% of the patients (16.67 patients) with LDH levels <800 IU/L and 30% of the patients (18 patients) with LDH levels of more than 800 IU/L. Significant results were obtained while comparing the neonatal complications and neonatal mortality amongst patients divided on the basis of LDH levels.


  Discussion Top


Preeclampsia, a hypertensive disorder of pregnancy is estimated to complicate 2%–8% of pregnancies and remains a principal cause of maternal and fetal morbidity and mortality. This idiopathic multisystem disorder classically presents with non-uniform and heterogeneous clinical and laboratory findings which form the basis of its clinical diagnosis. Despite being known and studied for a long-time PE and E are responsible for half the number of such global cases due to inadequate knowledge of the disease. Various studies have been carried out to find a correlation between PE and various variables such as mean arterial blood pressure, uterine vessels ultrasound and LDH to indicate the severity of pre-eclampsia. LDH being an intracellular cytoplasmic enzyme is universally seen in all the primary organ systems, for example, heart, kidney, muscle, leucocytes and erythrocytes.[7],[8],[9] Hence, the present study was undertaken to assess and correlate LDH levels with outcome in patients with PE.

In the present study, mean LDH levels amongst subjects of normotensive group, mild PE group and severe PE group was found to be 169.2 IU/L, 338.4 IU/L and 629.7 IU/L, respectively. Significant results were obtained while comparing the mean LDH levels among normotensive patients, patients with mild PE and severe PE (P < 0.05). The mean gestation age of the patients with LDH levels <800 IU/L and of patients with LDH levels of more than 800 IU/L was found to be 37.12 weeks and 36.56 weeks, respectively. Non-significant results were obtained while comparing the mean gestational age of the patients divided on the basis of mean LDH levels. In a study conducted by Jaiswar et al., the mean gestational age was similar in both the groups.[10] Gangwar and Dahiya et al. assessed serum LDH in eclampsia patients. This study included a group of 50 patients with emergency admissions into labour room and 50 control group patients [Table 1]. A record of all the haematological parameters was obtained from the patients of eclampsia group by keeping them in the lateral recurrent position [Table 2]. LDH levels of all the patients were obtained from the results of serum samples sent to the central laboratory. 1548.11 IU/L was found to be the mean LDH levels of the subjects of the eclampsia group whereas the control group had mean LDH levels of 269.8 IU/L. A significantly higher concentration of mean serum LDH was observed in the eclampsia group in comparison with the control group making it obvious that the serum LDH levels are deranged in the eclampsia patients.[11]
Table 1: Mean lactate dehydrogenase levels

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Table 2: Comparison of mean lactate dehydrogenase levels amongst different study groups

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In the present study, mean APGAR score at 1 min and 5 min was significantly lower among patients with LDH levels of more than 800 IU/L. Amongst the 60 patients with PE, 18.33% of the patients (11 patients) with LDH levels <800 IU/L and 31.67% of the patients (19 patients) with LDH levels of more than 800 IU/L had neonatal complications. Dave et al. analysed the role of serum LDH in judging the adverse outcomes of PE and E. Their study included 200 patients. Of these, 100 were controls [Table 3]. Thirty-two belonged to severe PE and 68 were eclampsia patients. Patients of PE and eclampsia showed grossly elevated systolic and diastolic pressure, liver enzymes, uric acid, urine albumin and LDH levels. Values of serum urea and creatinine were more or less within normal parameters. A prominent increase in the chances of perinatal mortality was observed in cases where serum LDH levels were in excess of 800 IU/l. Apart from perinatal mortality a range of other complications such as retinopathy, Acute renal failure, abruption, disseminated intravenous coagulation, cerebrovascular accident, multiple organ dysfunction syndrome and even shock was seen in cases where the serum LDH level was in excess of 800 IU/L. One of the first markers to be seen in the blood during hypoxia and oxidative stress happens to be LDH.[12]
Table 3: Correlation of perinatal outcome with lactate dehydrogenase levels

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In the present study, neonatal mortality was seen in 10% of the patients (16.67 patients) with LDH levels <800 IU/L and 30% of the patients (18 patients) with LDH levels of more than 800 IU/L. Significant results were obtained while comparing the neonatal complications and neonatal mortality among patients divided on the basis of LDH levels. Kasraeian et al. assessed the levels of serum biomarkers in an attempt to detect the severity of preeclampsia in pregnant women. Four hundred and fifty pregnant women were selected for this study. These patients had varying degree of PE severity. The serum biomarkers which were analysed and compared included aspartate aminotransferase, alanine aminotransferase (ALT), LDH, haemoglobin, platelet count, uric acid, direct bilirubin, total bilirubin, creatinine and alkaline phosphatase. 30.63 ± 6.43 years was the mean age of women and their mean gestational age was 34.69 ± 3.97 weeks. Significantly greater levels of mean LDH, ALT, uric acid and creatinine were recorded in patients with severe PE when compared with those of mild eclampsia.[13] Gupta et al. carried out a study to compare the serum LDH levels in women with uneventful pregnancy and with those with preeclampsia. Of 200 patients, half had normal pregnancy and the other half had preeclampsia. Maximum amount of maternal complications were witnessed in patients who had serum LDH levels in excess of 800 IU/l. The most common of all the complication was an abruption. It was concluded that high levels of LDH seem to have a direct correlation with perinatal mortality and neonatal deaths.[14]


  Conclusion Top


From the above results, the authors concluded that significant alteration of LDH levels occur in PE patients. Also, higher levels of LDH levels are significantly associated with worse outcome in PE patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cunningham FC, Leveno KJ, Bloom SL, Hauth, Rouse, Spong. Williams Obstetrics. 23rd ed. New York: McGrawHill; 2010. P. 706.  Back to cited text no. 1
    
2.
Craici I, Wagner S, Garovic VD. Preeclampsia and future cardiovascular risk: Formal risk factor or failed stress test? Ther Adv Cardiovasc Dis 2008;2:249-59.  Back to cited text no. 2
    
3.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Look PF. WHO analysis of causes of maternal death: A systematic review. Lancet 2006;367:1066-74.  Back to cited text no. 3
    
4.
Alavi A, Jahanshahi K, Karimia S, Arabzadea N, Fallahi S. Comparison of serum calcium, total protein and uric acid levels between hypertensive and healthy pregnant women in an Iranian population. Life Sci J 2012;9:485-8.  Back to cited text no. 4
    
5.
S C Tsoi, J Zheng, F Xu, H H Kay. Differential expression of lactate dehydrogenase isozymes(LDH) in human placenta with high expression of LDHA4 isozyme in the endothelial cells of preeclampsia villi. Placenta 2001;22:317-22.  Back to cited text no. 5
    
6.
Kozic JR, Benton SJ, Hutcheon JA, Payne BA, Magee LA, von Dadelszen P, et al. Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia. J Obstet Gynaecol Can 2011;33:995-1004.  Back to cited text no. 6
    
7.
Baschat AA, Magder LS, Doyle LE, Atlas RO, Jenkins CB, Blitzer MG. Prediction of preeclampsia utilizing the first trimester screening examination. Am J Obstet Gynecol 2014;211:514.e1-7.  Back to cited text no. 7
    
8.
Roberts JM, Bodnar LM, Lain KY, Hubel CA, Markovic N, Ness RB, et al. Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. Hypertension 2005;46:1263-9.  Back to cited text no. 8
    
9.
Thangaratinam S, Ismail KM, Sharp S, Coomarasamy A, Khan KS. Tests in prediction of pre-eclampsia severity review g. accuracy of serum uric acid in predicting complications of pre-eclampsia: A systematic review. BJOG 2006;113:369-78.  Back to cited text no. 9
    
10.
Jaiswar SP, Gupta A, Sachan R, Natu SN, Shaili M. Lactic dehydrogenase: A biochemical marker for preeclampsia-eclampsia. J Obstet Gynaecol India 2011;61:645-8.  Back to cited text no. 10
    
11.
Gangwar V, Dahiya P. Estimation of serum lactate dehydrogenase in eclampsia patients: An institutional based study. Int J Med Res Prof 2019; 5: 262-4.  Back to cited text no. 11
    
12.
Dave A, Maru L, Jain A. LDH (lactate dehydrogenase): A biochemical marker for the prediction of adverse outcomes in pre-eclampsia and eclampsia. J Obstet Gynaecol India 2016;66:23-9.  Back to cited text no. 12
    
13.
Kasraeian M, Asadi N, Vafaei H, Zamanpour T, Shahraki HR, Bazrafshan K. Evaluation of serum biomarkers for detection of preeclampsia severity in pregnant women. Pak J Med Sci 2018;34:869-73.  Back to cited text no. 13
    
14.
Gupta A, Bhandari N, Kharb S, Chauhan M. Lactate dehydrogenase levels in preeclampsia and its correlation with maternal and perinatal outcome. Int J Reprod Contracept Obstet Gynecol 2019;8:1505-10.  Back to cited text no. 14
    



 
 
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