Association of LDH-derived biochemical ratios with severe pre-eclampsia: a multicenter retrospective cohort study

Objective Pre-eclampsia (PE) is a major pregnancy-related hypertensive disorder associated with increased maternal and perinatal morbidity, particularly in severe cases. Early identification of patients at risk for severe disease remains clinically important, especially using simple and widely accessible laboratory markers. This study aimed to evaluate the association between Lactate dehydrogenase (LDH) derived biochemical ratios and severe pre-eclampsia in a multicenter obstetric cohort.Methods This multicenter retrospective cohort study included 326 pregnant women diagnosed with pre-eclampsia between January 2020 and July 2024 at two tertiary referral centers in Türkiye. Patients were classified as having non-severe pre-eclampsia (n = 116) or severe pre-eclampsia (n = 210) according to established clinical criteria. LDH-derived biochemical ratios, including LDH/albumin, LDH/creatinine, LDH/uric acid, and uric acid/creatinine, were calculated using routinely obtained laboratory parameters. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of these biomarkers for severe disease, while multivariate logistic regression analysis was used to determine independent predictors associated with severe pre-eclampsia.Results LDH/albumin, LDH/creatinine, and LDH/uric acid ratios were significantly higher in women with severe pre-eclampsia compared with those with non-severe disease (all p < 0.05). Among the evaluated biomarkers, the LDH/albumin ratio demonstrated the best predictive performance for severe pre-eclampsia, with an Area under the curve (AUC) of 0.639 (95% Confidence interval (CI) 0.579–0.702, p < 0.001). An LDH/albumin cutoff value of 11.38 yielded a sensitivity of 36.8% and a specificity of 86.2%. In multivariate logistic regression analysis, the LDH/albumin ratio remained independently associated with severe pre-eclampsia (Odds ratio (OR): 1.19, 95% CI: 1.08–1.31, p < 0.001).Conclusion LDH-derived biochemical ratios, particularly the LDH/albumin ratio, may represent simple and readily available biomarkers for identifying patients at increased risk for severe pre-eclampsia. Because these parameters are inexpensive and routinely obtained in obstetric practice, they may provide additional support for early risk stratification and clinical assessment. Further prospective multicenter studies are needed to validate these findings.