An Interplay between Oxidative Stress (Lactate Dehydrogenase) and Inflammation (Anisocytosis) Mediates COVID-19 Severity Defined by Routine Clinical Markers
Marta Alonso-Bernáldez,
Amanda Cuevas-Sierra,
Víctor Micó,
Andrea Higuera-Gómez,
Omar Ramos-Lopez,
Lidia Daimiel,
Alberto Dávalos,
María Martínez-Urbistondo,
Víctor Moreno-Torres,
Ana Ramirez de Molina,
Juan Antonio Vargas,
J. Alfredo Martinez
Affiliations
Marta Alonso-Bernáldez
Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
Amanda Cuevas-Sierra
Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
Víctor Micó
Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
Andrea Higuera-Gómez
Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
Omar Ramos-Lopez
Medicine and Psychology School, Autonomous University of Baja California, Tijuana 22390, Mexico
Lidia Daimiel
Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28049 Madrid, Spain
Alberto Dávalos
Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28049 Madrid, Spain
María Martínez-Urbistondo
Puerta de Hierro Research Institute, University Hospital, Majadahonda, 28222 Madrid, Spain
Víctor Moreno-Torres
Puerta de Hierro Research Institute, University Hospital, Majadahonda, 28222 Madrid, Spain
Ana Ramirez de Molina
Molecular Oncology and Nutritional Genomics of Cancer Group, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
Juan Antonio Vargas
Puerta de Hierro Research Institute, University Hospital, Majadahonda, 28222 Madrid, Spain
J. Alfredo Martinez
Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
Viral infections activate the innate immune response and the secretion of inflammatory cytokines. They also alter oxidative stress markers, which potentially can have an involvement in the pathogenesis of the disease. The aim of this research was to study the role of the oxidative stress process assessed through lactate dehydrogenase (LDH) on the severity of COVID-19 measured by oxygen saturation (SaO2) and the putative interaction with inflammation. The investigation enrolled 1808 patients (mean age of 68 and 60% male) with COVID-19 from the HM Hospitals database. To explore interactions, a regression model and mediation analyses were performed. The patients with lower SaO2 presented lymphopenia and higher values of neutrophils-to-lymphocytes ratio and on the anisocytosis coefficient. The regression model showed an interaction between LDH and anisocytosis, suggesting that high levels of LDH (>544 U/L) and an anisocytosis coefficient higher than 10% can impact SaO2 in COVID-19 patients. Moreover, analysis revealed that LDH mediated 41% (p value = 0.001) of the effect of anisocytosis on SaO2 in this cohort. This investigation revealed that the oxidative stress marker LDH and the interaction with anisocytosis have an important role in the severity of COVID-19 infection and should be considered for the management and treatment of the oxidative phenomena concerning this within a precision medicine strategy.