Serum Lactate Dehydrogenase Dynamics in Acute Ischemic and Hemorrhagic Stroke: A Marker of Prognosis but Not Diagnosis

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KEHAYA S., KORKMAZ S.

NAMIK KEMAL MEDICAL JOURNAL, cilt.14, sa.3, ss.278-288, 2026 (ESCI, TRDizin)

Özet

Aim: Lactate dehydrogenase (LDH) is a marker of cellular damage, increasingly recognized for its prognostic value in stroke. However, its role in differentiating stroke types and in predicting outcomes remains incompletely defined. Materials and Methods: In this retrospective, single-center study, 1,299 patients [1,185 acute ischemic stroke (AIS), 114 intracerebral hemorrhages (ICHs)] between 2018 and 2023 were analyzed. Admission and first-week LDH levels were compared across stroke types, etiologies, and outcomes. Functional status was assessed using the 3-month modified Rankin Scale (mRS). Multivariate stepwise linear regression was applied to determine factors independently associated with admission LDH. Results: Mean admission LDH was 329.3 +/- 176.1 U/L in AIS and 342.4 +/- 174.9 U/L in ICH (p=0.45). First-week LDH levels were 276.2 +/- 148.1 U/L in AIS and 300.1 +/- 123 U/L in ICH (p=0.19). In AIS, higher admission LDH levels were associated with unfavorable outcomes (mRS 3-6; p=0.002) and were significantly elevated in total anterior circulation infarcts (total anterior circulation infarction: 354.1 +/- 165 U/L) compared to lacunar infarcts (lacunar infarction: 312.1 +/- 141 U/L; p=0.077). First-week LDH levels were significantly higher in cardioembolic strokes compared with large-artery atherosclerosis (cholesteryl ester: 302 U/L vs. LAA: 248 U/L; p=0.006). In ICH, higher first-week LDH levels were associated with unfavorable outcomes, particularly in deep hematomas. In multivariate analysis, chronic kidney disease (B=63.1, p=0.017), female sex (B=47.9, p=0.004), and unfavorable outcome (B=58.4, p=0.008) were independently associated with elevated admission LDH. Conclusion: LDH levels alone do not distinguish between AIS and ICH, but higher admission values and sustained elevation are associated with poorer 3-month functional outcome, especially in ischemic stroke subtypes with larger infarcts or cardioembolic origin, and in deep ICH. LDH may be a marker that contributes to early risk stratification, yet the retrospective single-center design, small hemorrhagic subgroup, and exploratory multiple comparisons mean that these findings should be interpreted with caution and confirmed in prospective studies.