Implications for current clinical practice and future
research
The findings of this meta-analysis suggest that serum LDH differences
are minimal among the various forms of hypertensive disorders of
pregnancy. The only potential group that might benefit from the addition
of serum LDH in standard preclinical evaluation is that of patients with
severe preeclampsia. Maternal morbidity outcomes as well as perinatal
mortality of the fetus/neonate were found increased among patients with
an increased LDH value and particularly among those with LDH that
exceeded 800 IU/L. However, the observed confidence intervals as well as
prediction intervals indicated a wide range of the effect size; thus,
indicating that the actual power of this biomarker was low in
determining these adverse outcomes. Given this information we believe
that it is difficult to determine the actual levels that may help
discriminate patients at risk of experiencing adverse maternal or
neonatal outcomes as current evidence is scarce and reports particularly
heterogeneous optimal cut-off values.
Taking this into consideration, we believe that future research should
focus in patients with severe preeclampsia and incorporate a predictive
accuracy analysis that will help discriminate patients at risk of severe
morbidity at specific cut-off points. Taking in mind that the increase
of LDH might precede more severe adverse effects, such as acute
hemolysis, kidney injury, pulmonary oedema, admission to the ICU and
NICU it would be prudent to evaluate the optimal interval to delivery of
patients with unaffected blood parameters (including platelets,
creatinine, liver enzymes) that firstly develop an increase in serum
LDH. In order to do so, future research should firstly establish an
ideal cut-off value that is associated with increased specificity (and
if possible, sensitivity) for developing severe morbidity. Following
that, evaluation of the optimal interval to deliver will become
possible.