Management of Elevated Serum Lactate Dehydrogenase (LDH)

Clinical Significance and Diagnostic Approach

Liver disease, myocardial infarction, kidney disease, hemolysis, and pneumonia can cause elevated LDH levels 1
The National Comprehensive Cancer Network recommends determining if LDH elevation is isolated or accompanied by other abnormal laboratory values, and assessing the magnitude of elevation, as part of the initial assessment 2
A focused evaluation based on clinical context is recommended, including assessing for known or suspected malignancy, and using LDH for prognostic purposes in testicular cancer, but not alone for staging or risk stratification 3
In melanoma, elevated LDH is an independent predictor of poor outcome in stage IV disease, and has been incorporated into the AJCC staging system 5
The National Comprehensive Cancer Network recommends complete blood count, comprehensive metabolic panel, and imaging studies based on clinical suspicion, such as PET/CT for suspected malignancy with unknown primary 5
The American Academy of Dermatology recommends considering bone marrow examination for suspected hematologic malignancy 7
In osteosarcoma, elevated LDH is associated with metastatic disease at presentation 6

The National Comprehensive Cancer Network recommends identifying and treating the underlying cause of non-malignant LDH elevation, and monitoring LDH levels to assess response to treatment 5
Patients should not be treated based solely on an elevated LDH without identifying the underlying cause, as recommended by the National Comprehensive Cancer Network 4