key: cord-0694435-fp74i978
authors: Jin, Zhen-Mu; Shi, Ji-Chan; Zheng, Mo; Chen, Que-Lu; Zhou, Yue-Ying; Cheng, Fang; Cai, Jing; Jiang, Xian-Gao
title: Increased levels of lactate dehydrogenase and hypertension are associated with severe illness of COVID-19
date: 2022-01-07
journal: World J Clin Cases
DOI: 10.12998/wjcc.v10.i1.128
sha: 92e11fc870cda1a0c0721c68a0d09cb0dbfbcd1b
doc_id: 694435
cord_uid: fp74i978

BACKGROUND: Coronavirus disease 2019 (COVID-19) is amid an ongoing pandemic. It has been shown that patients with cardiovascular comorbidities are at higher risk of severe illness of COVID-19. AIM: To find out the relationship between cardiovascular comorbidities and severe illness of COVID-19. METHODS: The clinical data of 140 COVID-19 patients treated from January 22, 2020 to March 3, 2020 at our hospital were retrospectively collected. The clinical characteristics were compared between patients with mild illness and those with severe illness. RESULTS: There were 75 male patients and 65 female patients (53.6% vs 46.4%). The mean age was 45.4 ± 14.6 years (range, 2-85 years). Most of the patients had mild illness (n = 114, 81.4%) and 26 patients had severe illness (18.6%). The most common symptom was fever (n = 110, 78.6%), followed by cough (n = 82, 58.6%) and expectoration (n = 51, 36.4%). Eight patients were asymptomatic but were positive for severe acute respiratory syndrome coronavirus 2 RNA. Patients with severe illness were significantly more likely to be hypertensive than those with mild illness [(10/26, 38.4%) vs (22/114, 19.3%), P = 0.036]. The levels of lactate dehydrogenase were significantly higher in the severe illness group than in the mild illness group (299.35 ± 68.82 vs 202.94 ± 63.87, P < 0.001). No patient died in either the severe illness or the mild illness group. CONCLUSION: Hypertension and elevated levels of lactate dehydrogenase may be associated with severe illness of COVID-19.

Coronavirus disease 2019 (COVID-19) has rapidly evolved into a pandemic since its first outbreak in Wuhan, China in December 2019. However, there is still no effective drugs for this disease [1, 2] . In addition, the symptoms and signs and pathological mechanisms of COVID-19 are very complex, posing great challenges in treating patients. Our hospital is a dedicated hospital for treating patients with COVID-19 in Wenzhou, China, which is 680 km from Wuhan. There is strong economic connectivity and mass migrations between the two cities. The present study aimed to analyze the clinical characteristics of COVID-19 patients from a hospital in Wenzhou, China.

The clinical data of COVID-19 patients treated from January 22, 2020 to March 3, 2020 at our hospital were retrospectively collected. The diagnostic criteria for COVID-19 at our hospital were: (1) Potential exposure to COVID-19; (2) Had fever, respiratory symptoms, radiological abnormalities in the lungs, or leukocytopenia/lymphocytopenia; and (3) Presence of viral RNA in nasopharyngeal specimens. The inclusion criteria were: (1) With laboratory-confirmed COVID-19; (2) With specific outcomes of discharge or death; and (3) Had been examined by chest computed tomography (CT) during hospitalization. Our study was approved by the ethics committee of our hospital.

All data were retrospectively collected from electronic records of the patients, including sex, age, symptoms, radiological findings, laboratory test results, treatment methods, and patient outcomes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was tested using quantitative real-time polymerase chain reaction. Blood samples were collected at 7 am after fasting overnight. Disease severity was classified as mild illness (respiratory symptoms and/or radiological findings of pneumonia) and severe illness (respiratory distress and/or need of mechanical ventilation).

Continuous data are presented as the mean and standard deviation and were compared using the independent student's t-test. Categorical data are presented as counts or percentages and were compared using the Chi-square test. All statistical analyses were performed using SPSS 24.0 (IBM, United States). A P value less than 0.05 was considered statistical significance.

A total of 140 laboratory-confirmed COVID-19 patients were included in our study (Table 1 ). There were 75 male patients and 65 female patients (53.6% vs 46.4%). The mean age was 45.4 ± 14.6 years (range, 2-85 years). Most of the patients had potential exposure to COVID-19 (n = 92, 65.7%).

The most common symptom was fever (n = 110, 78.6%), followed by cough (n = 82, 58.6%), expectoration (n = 51, 36.4%), fatigue (n = 20, 14.3%), shortness of breath (n = 15, 10.7%), diarrhea (n = 14, 10%), and headache (n = 4.3%) ( Table 1 ). Eight patients (5.6%) were asymptomatic but were positive for SARS-CoV-2 RNA. These patients were family members or neighbors of other symptomatic patients and thus were tested for COVID-19.

The most common comorbidity was hypertension (n = 32, 22.9%). Other comorbidities included diabetes (n = 6), coronary heart disease (n = 3), and malignant tumor (n = 4). Most of the patients had mild illness (n = 114, 81.4%) and 26 had severe illness (18.6%) ( Table 1) . Patients with severe illness were significantly more likely to be hypertensive than those with mild illness [(10/26, 38.5%) vs (22/114, 19.3%), P = 0.036].

The results of laboratory tests are shown in Table 2 . The leukocyte count was lower than 3.5 × 10 9 /L in 26 patients (18.6%). The lymphocyte count was lower than 1.1 × 10 9 /L in 54 patients (38.6%). Low levels of hemoglobin were present in 16 patients (11.4%). Thrombocytopenia (< 100 × 10 9 /L) was present in three patients. Elevated serum levels of creatinine > 94 μmol/L were noticed in 18 patients. Elevated serum levels of creatine kinase > 200 U/L were noticed in 12 patients, and > 500 U/L in three patients. Elevated serum levels of lactate dehydrogenase were noticed in 37 patients. The level of lactate dehydrogenase was significantly higher in the severe illness group than in the mild illness group (299.35 ± 68.82 vs 202.94 ± 63.87, P < 0.001). There were significant differences in lymphocyte count, platelet count, levels of total serum protein, prealbumin, blood uric acid, lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate, arterial partial pressure of oxygen, and oxygenation index between patients with mild illness and those with severe illness (Table 2) .

Only 3 three patients showed no significant radiologic findings (3/140, 2.1%). The radiologic characteristics are shown in Table 3 . There was no significant difference in the frequency of affected lung sites between patients with mild illness and those with severe illness. However, significantly more patients with mild illness had ground-glass opacity than those with severe illness (78.9% vs 23.1%, P < 0.0001). On the contrary, there were significantly more patients with consolidation (100% vs 25.4, P < 0.0001) and pleural effusion (30.8% vs 2.6%, P < 0.0001) in the severe illness group than in the mild illness group.

High-flow nasal oxygen therapy was used in 22 patients with mild illness (22/114, 19.3%), while all the 26 patients with severe illness used this treatment. Non-invasive mechanical ventilation was used in 4/26 (15.4%) patients with severe illness, while 

Our study retrospectively analyzed 140 patients with laboratory-confirmed COVID-19 and found that patients with severe illness were more likely to have hypertension than those with mild illness. In addition, the level of lactate dehydrogenase was significantly higher in the severe illness group than in the mild illness group. Fever (78.6%) and cough (58.6%) were the most common symptoms in our patients. This finding is consistent with previous reports [3, 4] . However, these symptoms are not specific and many of the patients had early on-set symptoms of fatigue, diarrhea, and myalgia. In addition, eight patients (5.6%) were asymptomatic but were positive for SARS-CoV-2 RNA. Most recent research showed that the rate of asymptomatic infection in the general population may be as high as 80.9% [5, 6] . Due to the criteria for diagnosis and patient admission for COVID-19 at our hospital, asymptomatic patients were not tested for viral RNA and thus were not confirmed with the diagnosis of COVID-19.

The existence of comorbidities can increase the risk of more severe illness and mortality in COVID-19 patients [7, 8] . The most common comorbidity in our patients was hypertension (22.9%), and patients with severe illness were significantly more likely to be hypertensive than those with mild illness (38.4% vs 19.3%). A previous study with 1099 COVID-19 patients also found that hypertension was associated with severe disease [3] . In addition, we found that the levels of lactate dehydrogenase were significantly elevated in patients with severe illness compared to those with mild illness. Lactate dehydrogenase is a biomarker for myocardial injury [9, 10] . All these findings suggest that hypertension and the resulting myocardial injury may lead to a poor prognosis in COVID-19. There have been concerns and debates on the roles of the renin-angiotensin system, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in COVID-19 and poor prognosis [11] [12] [13] [14] [15] . However, there is no con-

Current Drugs with Potential for Treatment of COVID-19: A Literature Review

Treatment options for COVID-19: The reality and challenges

Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths

Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures

He JX; China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Comparison of cardiac troponin I and lactate dehydrogenase isoenzymes for the late diagnosis of myocardial injury

Comparative sensitivity of cardiac troponin I and lactate dehydrogenase isoenzymes for diagnosing acute myocardial infarction

Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China

Hypertension and COVID-19

COVID-19, ACE2, and the cardiovascular consequences

COVID-19 and the cardiovascular system

Management of hypertension in COVID-19

Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial

Effects of angiotensin receptor blockers and angiotensinconverting enzyme inhibitors on COVID-19

Chest CT Findings in 2019 Novel Coronavirus (2019-nCoV) Infections from Wuhan, China: Key Points for the Radiologist

Evolution of CT Manifestations in a Patient Recovered from 2019 Novel Coronavirus (2019-nCoV) Pneumonia in Wuhan, China