Early Prediction of Mortality risk in Neonatal Sepsis Using Combined Assessment of Lactate Dehydrogenase and Malondialdehyde

Background:  Neonatal sepsis continues to be a leading contributor to illness and death among newborns, especially in low and middle - income countries (LMICs). Early risk stratification is critical for initiating life-saving interventions; however, conventional biomarkers often lack sufficient prognostic accuracy. Aim: The study aimed to assess and compare the prognostic accuracy of serum lactate dehydrogenase (LDH) and malondialdehyde (MDA), as biomarkers of cellular injury and oxidative stress, with CRP in predicting mortality in neonates with sepsis. Methods:
A prospective cross-sectional study was carried out from November 2022 to April 2023 on 64 newborns diagnosed with sepsis and admitted to the Level III Neonatal Intensive Care Unit at Ain Shams Pediatrics Hospital in Cairo. Serum levels of LDH, MDA, and CRP were measured on Day 1 (baseline) and Day 7 (follow-up). Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of each biomarker by comparing levels between surviving and non-surviving infants.
Results: revealed that elevated baseline levels of both LDH and MDA were significantly related with increased mortality (p < 0.05). MDA demonstrated the highest prognostic accuracy (AUC: 0.948) with 100% sensitivity and 89.3% specificity. LDH also showed strong predictive value (AUC: 0.854) with slightly lower specificity (78.6%). CRP displayed high specificity (87.8%) at baseline but lower sensitivity (58.3%) that declined by Day 7.
Conclusion: MDA and LDH are valuable prognostic biomarkers in neonatal sepsis, with MDA showing superior performance.