Abstract 119: Lactate Dehydrogenase (LDH) as a Prognostic Biomarker in Patients with Ischemic Stroke: A Systematic Review and Meta‐Analysis

Abstract

Background

Ischemic stroke causes a significant worldwide health burden, with high morbidity and fatality rates. The absence of oxygen and glucose during an ischemia event triggers anaerobic metabolism, resulting in lactate accumulation and an increase in Lactate dehydrogenase (LDH) activity. Thus, in order to assess the LDH as a prognostic biomarker in IS, we conducted the first systematic review and meta‐analysis.

Methods

Through March 14, 2024, we conducted a thorough search of PubMed, Embase, Web of Science, and the Cochrane Library to find observational studies and clinical trials assessing the association between the LDH and IS in predicting functional outcome measured by Modified Rankin Scale (mRS) or mortality or intracranial hemorrhage We did the statistical analysis plan using Review Manager Software version 5.4.

Results

Fourteen studies with a total enrollment of 18,876 patients met our inclusion criteria. Four of the 14 studies with a total of 11,227 patients were considered valid for the meta‐analysis. The pooled analysis of LDH as a continuous variable revealed that each 10 U/L increase in LDH was associated with a 3% higher likelihood of poor prognosis at 12 and 18 months (OR: 1.03, 95% CI: [1.01, 1.05], P = 0.001), with homogenous data (I²; = 0%, P = 0.56). In contrast, when LDH was analyzed as a categorical variable, comparing high versus low levels at three months, no statistically significant difference was observed (OR: 2.19, 95% CI: [0.93, 5.15], P = 0.07), with heterogeneous data (I²; = 76%, P = 0.04). Additionally, LDH as a continuous variable was significantly associated with increased mortality risk, with each 10 U/L increase correlating with a 6% higher risk of mortality (OR: 1.06, 95% CI: [1.02, 1.1], P = 0.005), and data showed homogeneity (I²; = 0%, P = 0.65). These findings suggest that elevated LDH levels may be a significant predictor of poor prognosis and mortality, although the predictive value may vary depending on how LDH is categorized and the timing of follow‐up.

Conclusion

Elevate levels are significantly associated with unfavorable functional outcome and increased mortality in IS patients. This meta‐analysis highlights the potential of LDH as a prognostic biomarker, warranting further research to refine its clinical application.

Disclosure

A. Arafa: None. A. Abbas: None. A. Bayoumi: None. A. Samir: None. H. Sabet: None. M. Badawy: None. A. Hussein: None. N. Omar: None. M. Elfil: None.