Lactate Dehydrogenase/Albumin To-Urea Ratio: A Novel Prognostic Maker for Fatal Clinical Complications in Patients with COVID-19 Infection

Objective: To investigate lactate dehydrogenase/Albumin to-urea (LAU) ratio as a potential predictor for COVID-19-induced fatal clinical complications in hospitalized patients. Methods: This is a retrospective study involving blood analyses from 1139 hospitalised COVID-19 infection survivors and 349 deceased cases post-COVID-19 infection. Laboratory tests included complete blood picture, inflammatory markers, and routine organ function tests. Results: The non-survivor group showed lower haemoglobin (p < 0.001), platelet (p < 0.0001) and higher mean corpuscular volume, neutrophil count, neutrophil/lymphocytes ratio (NLR), and LAU (p < 0.001, p < 0.0013, p < 0.001, p < 0.0126) than the patients who survived the infection. The non-survivors also exhibited higher markers for infection-related clinical complications, such as international normalized ratio (INR), D-dimer, urea, total bilirubin, alkaline phosphatase (ALK), creatinine, c-reactive protein (CRP), and serum ferritin levels (all p < 0.05). In addition, LAU ratio was positively correlated with infection prognostic parameters including INR (r = 0.171), D-dimer (r = 0.176), serum urea (r = 0.424), total bilirubin (r = 0.107), ALK (r = 0.115), creatinine (r = 0.365), CRP (r = 0.268), ferritin (r = 0.385) and negatively correlated with serum albumin (r = -0.114) (p <= 0.05). LAU ratio had an area under receiver operating characteristic of 0.67 compared to 0.60 with NLR. Conclusion: Patients with a high LAU ratio are at increased risk of mortality due to COVID-19 infection. Therefore, early assessment of this parameter, intensive intervention and close monitoring could improve their prognosis.