Elevated α‐hydroxybutyrate dehydrogenase as an independent prognostic factor for mortality in hospitalized patients with COVID‐19

AIMS: Many studies have explored the clinical characteristics of patients with coronavirus disease (COVID‐19), especially patients with cardiovascular disease. However, associated mechanisms and markers remain to be further investigated. This study aimed to investigate the effect of α‐hydroxybutyrate dehydrogenase (α‐HBDH) levels on disease progression and prognosis of patients with COVID‐19. METHODS AND RESULTS: One thousand seven hundred and fifty‐one patients from the Leishenshan hospital in Wuhan were divided into elevated and normal groups by α‐HBDH level, and the clinical information between the two groups was compared retrospectively. The main outcome evaluation criteria included in‐hospital death and disease severity. Univariate and multivariate regression analyses, survival curves, logistic regression, and receiver operating characteristic curve models were performed to explore the relationship between elevated α‐HBDH and the two outcomes. Besides, curve fitting analyses were conducted to analyse the relationship between computed tomography score and survival. Among 1751 patients with confirmed COVID‐19, 15 patients (0.87%) died. The mean (SD) age of patients was 58 years in normal α‐HBDH group and 66 years in elevated α‐HBDH group (P < 0.001). The mortality during hospitalization was 0.26% (4 of 1559) for patients with normal α‐HBDH levels and 5.73% (11 of 192) for those with elevated α‐HBDH levels (P < 0.001). Multivariate Cox analysis confirmed an association between elevated α‐HBDH levels and higher risk of in‐hospital mortality [hazard ratio: 4.411, 95% confidence interval (95% CI), 1.127–17.260; P = 0.033]. Multivariate logistic regression for disease severity and α‐HBDH levels showed significant difference between both groups (odds ratio = 3.759; 95% CI, 1.895–7.455; P < 0.001). Kaplan–Meier curves also illustrated the survival difference between normal and elevated α‐HBDH patients (P < 0.001). CONCLUSIONS: Our study found that serum α‐HBDH is an independent risk factor for in‐hospital mortality and disease severity among COVID‐19 patients. α‐HBDH assessment may aid clinicians in identifying high‐risk individuals among COVID‐19 patients.