Anjan Md Ashraful Hassan, Ahmed Quazi Mamtaz U, Masum Abdullah Al, Sami Chowdhury Adnan, Matin Md Abdul, Islam Mohammad Syedul, Chowdhury Fazle R, Arafat Shohael Mahmud, Rahman Mahbubur, Hasan Md Nazmul
Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
Internal Medicine, Nilphamari Sadar Hospital, Nilphamari, BGD.
Cureus. 2024 Sep 22;16(9):e69894. doi: 10.7759/cureus.69894. eCollection 2024 Sep.
Background Early risk stratification of COVID-19 may yield a better prognosis by tailoring effective treatment strategies. Recent studies have identified that elevated carcinoembryonic antigen (CEA) has prognostic value in terms of disease severity and mortality in patients with pneumonia. This study aims to explore the potential of CEA as a marker for both severity assessment and mortality prediction in COVID-19 patients. Methods From August 2020 to October 2021, we conducted this observational study in which patients who tested positive for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) or had high-resolution computed tomography (HRCT) chest suggestive of COVID-19 were included on day 0 of their admission to the COVID unit. Patients were classified into mild, moderate, severe, and critical according to the World Health Organization (WHO) guidelines. Blood samples were collected for complete blood count (CBC), C-reactive protein (CRP), ferritin, and CEA on days 0, 3, 7, and 14 of admission. The patient's profile was used to obtain lactate dehydrogenase (LDH), D-dimer, and HRCT scores [based on COVID-19 reporting and data system (CO-RADS) grade]. We used receiver operating characteristic (ROC) curves with Youden's index to find the initial (day 0) critical values of CEA for each of mild, moderate, severe, and critical COVID-19. The Kaplan-Meier survival curve was used to predict mortality with the best initial (day 0) cut-off value of CEA. Results Among 75 patients in this study, 15, 20, 19, and 21 were in the mild, moderate, severe, and critical groups, respectively; most were male (68%), and mortality was 18 (24%). Spearman's rank correlation test demonstrates a strong correlation between COVID-19 severity and changes in CEA. In the ROC curves, the area under the curve (AUC) value of CEA was higher among markers in all classifications except for mild to moderate disease. The AUC and critical values of CEA were as follows: for mild to moderate (0.948), 2.5 ng/ml; moderate to severe (1.000), 6.02 ng/ml; and severe to critical (0.769), 11.75 ng/ml. The survival curve shows the best initial cut-off values for mortality outcomes: CEA ≥7.15, CRP ≥81.52, ferritin ≥680.68, lymphocyte percentage ≤7.5, and neutrophil lymphocyte ratio ≥12.7. Conclusions The initial levels of CEA can serve as markers for severity assessment and mortality outcome prediction of COVID-19.
对新型冠状病毒肺炎（COVID-19）进行早期风险分层，通过制定有效的治疗策略可能会带来更好的预后。最近的研究表明，癌胚抗原（CEA）升高对肺炎患者的疾病严重程度和死亡率具有预后价值。本研究旨在探讨CEA作为COVID-19患者严重程度评估和死亡率预测标志物的潜力。方法：2020年8月至2021年10月，我们开展了这项观察性研究，将入院第0天通过逆转录聚合酶链反应（RT-PCR）检测COVID-19呈阳性或胸部高分辨率计算机断层扫描（HRCT）提示COVID-19的患者纳入研究。根据世界卫生组织（WHO）指南，将患者分为轻症、中症、重症和危重症。在入院第0天、第3天、第7天和第14天采集血样进行全血细胞计数（CBC）、C反应蛋白（CRP）、铁蛋白和CEA检测。利用患者资料获取乳酸脱氢酶（LDH）、D-二聚体和HRCT评分[基于COVID-19报告和数据系统（CO-RADS）分级]。我们使用受试者工作特征（ROC）曲线和尤登指数来确定轻症、中症、重症和危重症COVID-19患者CEA的初始（第0天）临界值。采用Kaplan-Meier生存曲线，以CEA的最佳初始（第0天）临界值预测死亡率。结果：本研究中的75例患者中，轻症、中症、重症和危重症组分别有15例、20例、19例和21例；大多数为男性（68%），死亡率为18例（24%）。Spearman等级相关检验显示COVID-19严重程度与CEA变化之间存在强相关性。在ROC曲线中，除轻症到中症外，CEA在所有分类标志物中的曲线下面积（AUC）值均较高。CEA的AUC和临界值如下：轻症到中症（0.948），2.5 ng/ml；中症到重症（1.000），6.02 ng/ml；重症到危重症（0.769），11.75 ng/ml。生存曲线显示死亡率结局的最佳初始临界值：CEA≥7.15、CRP≥81.52、铁蛋白≥680.68、淋巴细胞百分比≤7.5、中性粒细胞淋巴细胞比值≥12.7。结论：CEA的初始水平可作为COVID-19严重程度评估和死亡率结局预测的标志物。
