Carcinoembryonic Antigen: A Potential Biomarker to Evaluate the Severity and Prognosis of COVID-19

Abstract

Background and Objectives: Corona Virus Disease 2019 (COVID-19) has become a serious pandemic disease worldwide. Identification of biomarkers to predict severity and prognosis is urgently needed for early medical intervention due to high mortality of critical cases with COVID-19. This retrospective study aimed to indicate the values of carcinoembryonic antigen (CEA) in evaluating the severity and prognosis of COVID-19. Methods: We included 46 death cases from intensive care unit and 68 discharged cases from ordinary units with confirmed COVID-19 of Wuhan Jin Yin-tan Hospital from January 1 to March 22, 2020. Laboratory and radiologic data were analyzed retrospectively. All patients were followed up until April 10, 2020. Results: COVID-19 patients in the death group had significantly higher CEA levels (ng/ml) than discharged group (14.80 ± 14.20 vs. 3.80 ± 2.43, P < 0.001). The risk of COVID-19 death increased 1.317 times for each additional 1 ng/ml CEA level (OR = 1.317, 95% CI: 1.099–1.579). The standardized and weighted receiver operating characteristic curve (ROC) analysis adjusted to age, sex, and ferritin levels suggested that the area under the curve (AUC) of the serum CEA levels was 0.808 in discrimination between death cases and discharged cases with COVID-19 ( P < 0.001). We found mortality of COVID-19 is associated with elevated CEA levels increased (HR = 1.023, 95% CI: 1.005–1.042), as well as age (HR = 1.050, 95% CI: 1.016–1.086) and ferritin levels (HR = 1.001, 95% CI: 1.001–1.002) by survival analysis of Cox regression model. Among discharged patients, CEA levels were significant lower in moderate cases compared to the severe and critical cases ( P = 0.005; OR = 0.488, 95% CI: 0.294–0.808) from binary logistic regression analysis. The AUC of CEA levels was 0.79 in distinguishing moderate cases from discharged COVID-19 patients by standardized and weighted ROC analysis ( P < 0.001). A positive correlation between CEA levels and CT scores existed in discharged patients (Correlation Coefficient: 0.687; P < 0.001). Conclusions: Elevated CEA levels increased the risk of death from COVID-19 and CEA levels were related to CT scores of the discharged patients positively.

Serum amyloid A, ferritin and carcinoembryonic antigen as biomarkers of severity in patients with COVID‑19

“…Of the 124 cases, 98 (79%) were men and 26 were women (21%). The median male age was 48.5 years (IQR, [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] and the median female age was 44.5 years (IQR, . Data were collected from hospitalized patients between September 2020 and February 2021.…”

Carcinoembryonic Antigen Elevation in a Patient with SARS-CoV-2 and a History of Colon Cancer

“…The human angiotensin-converting enzyme 2 receptor is a known entry point for the SARS-CoV-2 virus and is abundantly expressed on the cell surface of pulmonary epithelial cells, allowing an entry point to pneumocytes with subsequent destruction of these cells. This is followed by regeneration of pneumocytes with a concordant increase in serum CEA levels [3].…”

“…A potential explanation for an elevated CEA in cases of SARS-CoV-2 is the fact that CEA is coded by the CEACAM5 gene, which is exclusively expressed by epithelial cells, including pneumocytes [5]. Increased CEA expression in pneumocytes has been detected in nonneoplastic pulmonary diseases [3,6]. The human angiotensin-converting enzyme 2 receptor is a known entry point for the SARS-CoV-2 virus and is abundantly expressed on the cell surface of pulmonary epithelial cells, allowing an entry point to pneumocytes with subsequent destruction of these cells.…”

“…The investigators found that higher levels of CEA were associated with a worse prognosis [4]. In another study that excluded patients with a known history of cancer, Chen et al [3] evaluated the CEA level as a prognostic marker in patients with SARS-CoV-2. The study included 46 patients who died and 68 patients who were discharged from the hospital.…”

“…Since its emergence, several biomarkers have been described as having prognostic and therapeutic implications in SARS-CoV-2 infections [2]. Recent studies have evaluated the carcinoembryonic antigen (CEA) as a prognostic biomarker in patients with SARS-CoV-2 [3,4]. An elevated CEA level was associated with inferior outcomes.…”