Correlation of Early-Onset and Late-Onset Preeclampsia with Increased Lactic Dehydrogenase Serum Levels

Lois Tabitha Kezia Sitorus; Edy Priyanto; Zulvayanti Zulvayanti

doi:10.24198/obgynia.v7i3.711

Correlation of Early-Onset and Late-Onset Preeclampsia with Increased Lactic Dehydrogenase Serum Levels

Lois Tabitha Kezia Sitorus, Edy Priyanto, Zulvayanti Zulvayanti

Abstract

Introduction: Preeclampsia is a hypertensive disorder during pregnancy that is associated with 2-8% of pregnancy-related complications worldwide. Lactate Dehydrogenase (LDH) is a dominant intracellular cytoplasmic enzyme of anaerobic glycolysis and is released into the general circulation during cell death. This enzyme is increased in preeclampsia due to glycolysis and chronic anoxemia due to placental ischemia. The effect of LDH on pregnancy-related complications, such as preeclampsia, is now gaining attention. This study aims to assess the difference in LDH serum levels in early- and late-onset preeclampsia.
Methods: This is an analytical observational study with a retrospective approach and cross-sectional design. The sample consists of 106 patients with early- and late-onset preeclampsia at RSUD Prof Dr. Margono Soekarjo from July to December 2022. Data analyzed in this study was collected from medical records.
Results: This study found that 65.09% of the subjects were less than 35-years-old, 76.42% were multiparous, 64.15% had term birth, and 77.01% had a BMI >30. The mean LDH level in early-onset preeclampsia was 292.38 + 255.05 (141–1507), while the mean in late-onset preeclampsia was 181.60 + 43.13 (103–319). The cut-off value for LDH levels in preeclampsia patients was 185.5 U/L. A significant correlation was found between mean BMI and LDH levels (p=0.0001) and between mean maternal age and LDH levels (p=0.0001).
Conclusion: There was a significant relationship between the onset of preeclampsia, mean BMI, and mean maternal age and LDH levels.

Hubungan antara Kejadian Preeklamsia Awitan Dini dan Lanjut dengan Peningkatan Serum Laktat Dehidrogenase

Abstrak
Pendahuluan: Preeklamsia adalah kelainan hipertensi pada kehamilan yang berhubungan dengan 2 – 8% komplikasi terkait kehamilan di seluruh dunia. Laktat dehidrogenase (LDH) adalah enzim sitoplasma intraseluler dominan dari glikolisis anaerobik dan dilepaskan ke sirkulasi umum selama kematian sel. Enzim ini meningkat pada preeklamsia akibat glikolisis dan anoksemia kronis akibat iskemia plasenta. Pengaruh LDH terhadap komplikasi terkait kehamilan seperti preeklamsia kini mulai mendapat perhatian. Studi ini bertujuan untuk menilai perbedaan kadar serum LDH pada preeklamsia awitan dini dan lanjut.
Metode: Penelitian ini merupakan penelitian observasional analitik dengan pendekatan retrospektif dan desain potong lintang. Sampel terdiri atas 106 pasien dengan preeklamsia awitan dini dan lanjut di RSUD Prof Dr. Margono Soekarjo periode Juli-Desember 2022. Data diperoleh dari rekam medis.
Hasil: Ditemukan bahwa 65,09% subjek berusia kurang dari 35 tahun, sebanyak 76,42% subjek multipara, sebanyak 64,15% subjek mengalami kelahiran aterm, sebanyak 77,01% subjek memiliki IMT >30. Rerata kadar LDH pada preeklamsia awitan dini ditemukan 292,38 + 255,05 (141–1507), sedangkan rerata pada preeklamsia awitan lanjut adalah 181,60 + 43,13 (103–319). Nilai cut off kadar LDH pada pasien preeklamsia ditemukan 185,5 U/L. Hubungan signifikan ditemukan antara rerata IMT dengan kadar LDH (p=0,0001) dan rerata usia ibu dengan kadar LDH (p=0,0001).
Kesimpulan: Terdapat hubungan signifikan antara awitan preeklamsia, rerata IMT dan rerata usia ibu dengan kadar LDH.

Kata kunci: preeklamsia, lactic dehydrogenase, preeklamsia awitan dini, preeklamsia awitan lanjut

Keywords

preeclampsia, lactat dehydrogenase, early onset preeclampsia, late onset preeclampsia

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References

Karrar SA, Hong PL. Preeclampsia. StatPearls. 2022.

Vigil-De Gracia P. Maternal deaths due to eclampsia and HELLP syndrome. Int J Gynecol Obstet. 2009;104(2):90–4.

Sibai BM. Eclampsia: VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol. 1990;163(3):1049–54.

Sibai BM, Sarinoglu C, Mercer BM. Eclampsia: VII. Pregnancy outcome after eclampsia and long-term prognosis. Am J Obstet Gynecol. 1992;166(6):1757–63.

Nodler J, Moolamalla SR, Ledger EM, Nuwayhid BS, Mulla ZD. Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital dataset. BMC Pregnancy Childbirth. 2009;9(1):1–8.

Gynecology and Obstetrics preeclampsia. 2016.

Gynecologists AC of O and. Premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. ACOG practice bulletin no. 1. Int J Gynaecol Obs. 1998;63:75–84.

Homer CS, Brown MA, Mangos G, Davis GK. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens. 2008 Feb;26(2):295–302.

Sibai BM, El-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: Subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol. 1986 Nov;155(5):1011–6.

Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. 2019 May;15(5):275–89.

Makkonen M, Penttilä IM, Castrén O. Serum lactic acid dehydrogenase and isoenzymes during pregnancy and labor. Acta Obstet Gynecol Scand. 1980;59(2):97–101.

Mary VP, Chellatamizh M, Padmanaban S. Role of serum LDH in preeclampsia as a prognostic factor–a cross sectional case control study in tertiary care hospital. Int J Reprod Contracept Obs Gynecol. 2017;6(2):595–8.

Munde SM, Hazari NR, Thorat AP, Gaikwad SB, Hatolkar VS. Gamma glutamyl transferase and Lactate dehydrogenase as biochemical markers of severity of preeclampsia. Platelets. 2014.

Lavanya B, Ullagaddi R, Pavani M, Rao KS. Evaluation of serum lactate dehydrogenase as early diagnostic biomarker in pregnancy with preeclampsia and eclampsia. Indian J Obstet Gynecol Res [Internet]. 2022 Feb 28;9(1):83–7.

Jaiswar SP, Gupta A, Sachan R, Natu SN, Shaili M. Lactic dehydrogenase: a biochemical marker for preeclampsia–eclampsia. J Obstet Gynecol India. 2011;61:645–8.

Sonagra AD, Dattatreya K, Murthy JDS. Serum LDH, ALP and uric acid in hypertensive disorders of pregnancy. Int J Pharm Bio Sci. 2012;2(3):201–9.

Sarkar PD, Sogani S. Evaluation of serum lactate dehydrogenase and gamma glutamyl transferase in preeclamptic pregnancy and its comparison with normal pregnancy in third trimester. 2013.

Sreelatha S, Bharathi A, Ramya S, Sharau S. Estimation of serum LDH and uric acid in preeclampsia and its correlation with maternal and perinatal outcome. Int’l J Adv Comput Res. 2015;2:447–9.

Kozic JR, Benton SJ, Hutcheon JA, Payne BA, Magee LA, von Dadelszen P. Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia. J Obstet Gynaecol Canada. 2011;33(10):995–1004.

Gandhi M, Chavda R, Saini HB. Comparative study of serum LDH and uric acid in hypertensive versus normotensive pregnant woman. Int J Biomed Res. 2015;6(1):25–8.

Saleem FR, Chandru S, Biswas M. Evaluation of total LDH and its isoenzymes as markers in preeclampsia. J Med Biochem. 2020 Sep 2;39(3):392-398. doi: 10.2478/jomb-2019-0045. PMID: 33269027; PMCID: PMC7682784.

Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol. 2017;28(5):1340–9.

Bhave N V, Shah PK. A correlation of lactate dehydrogenase enzyme levels in pregnancy induced hypertensive disorders with severity of disease, maternal and perinatal outcomes. Int J Reprod Contracept Obs Gynecol. 2017;6(10):4302–8.

Bhandari N, Gupta A, Kharb S, Chauhan M. Lactate dehydrogenase levels in preeclampsia and its correlation with maternal and perinatal outcome. Int J Reprod Contraception, Obstet Gynecol. 2019 Mar 26;8(4):1505.

Umasatyasri Y, Van I, Shamita P. Role of LDH (Lactate dehydrogenase) in preeclampsia eclampsia as a prognostic marker: An observational study. 2015.

DOI: http://dx.doi.org/10.24198/obgynia.v7i3.711