ORIGINAL RESEARCH article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Serum lactate dehydrogenase and rapidly progressive interstitial lung disease are associated with increased mortality in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis
Provisionally accepted
- Second Affiliated Hospital of Soochow University, Suzhou, China
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Abstract Objective This study aims to evaluate the clinical characteristics and prognostic significance of serum lactate dehydrogenase (LDH) in patients with anti-MDA5+ dermatomyositis (anti-MDA5+ DM). Methods We assessed 246 consecutive patients with anti-MDA5+ DM. The patients were divided into two groups based on LDH levels: the LDH ≤338 U/L group and the LDH > 338 U/L group. We compared the clinical characteristics, laboratory findings, and long-term prognosis between the two groups. Results Overall, the one-year mortality rate in patients with anti-MDA5+ DM was high, at 24.39% (60/246). LDH levels exhibited a nonlinear, inverted S-shaped relationship with the overall mortality risk in anti-MDA5+ DM patients (nonlinear P = 0.001). Patients in the LDH > 338 U/L group had significantly higher levels of ALT [64.0 (32.0, 121.0) vs 40.0 (23.0, 66.5), P<0.001], AST [75.0 (47.5, 134.0) vs 40.0 (26.0, 60.6), P<0.001], CK [107.0 (42.0, 208.8) vs 50.0 (35.5, 100.5), P<0.001], CRP [8.5 (3.5, 17.6) vs 4.7 (2.7, 10.2), P<0.001], and serum ferritin levels [1307.6 (679.8, 1565.5) vs 1001.0 (391.2, 1307.6), P<0.001] compared to the LDH ≤338 U/L group. Additionally, the positivity rate of Anti-Ro52 antibodies (70.7% vs 57.7%, P=0.033), the incidence of rapidly progressive interstitial lung disease (RPILD) (42.3% vs 29.3%, P=0.033), and the mortality rate (35.0% vs 13.8%, P<0.001) were significantly higher in the LDH > 338 U/L group than in the LDH ≤338 U/L group. Multivariable regression analysis revealed that LDH > 338 U/L and the presence of RPILD were associated with poor prognosis [hazard ratios of 2.253 (95% CI 1.258, 4.035, P = 0.006) and 10.293 (95% CI 4.683, 22.623, P < 0.001), respectively]. Conclusion Patients with different LDH levels exhibit distinct clinical characteristics, laboratory findings, and long-term prognosis. Elevated LDH levels (> 338 U/L) and the presence of RPILD are associated with poor prognosis.
Keywords: Lactate dehydrogenase, Dermatomyositis, Anti-MDA5 positive dermatomyositis, Rapidly progressive interstitial lung disease, anti-MDA5 antibody, Clinical Characteristics, prognosis
Received: 07 Jun 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Wang, Yan, Zhang, Liu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhichun Liu, zcliurheu@suda.edu.cn
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