Prognostic Value of a Clinical Biochemistry-Based Nomogram for Coronavirus Disease 2019

Abstract

Background: This study aimed to explore the predictive value of a clinical biochemistry-based nomogram in COVID-19.Methods: The plasma or serum concentrations/levels of carcinoembryonic antigen (CEA) and other biomarkers, e.g., C-reactive protein (CRP), white blood cell (WBC), interleukin-6 (IL-6), ferritin (Fer), procalcitonin (PCT), lymphocyte percentage (L%), D-dimer (D2), and neutrophils percentage (Neu%), were assessed in 314 hospitalized patients with confirmed COVID-19. The area under the curve was used to estimate the diagnostic and prognostic value for COVID-19. Cox and logistic regression analyses were used to estimate the independent prognostic risk factors for the survival of patients with COVID-19.Results: Receiver operating characteristic (ROC) curves were used to determine the area under the curve (AUC) values for CEA, IL-6, CRP, PCT, Fer, D-dimer levels and L%, Neu%, and WBC to assess disease classification. The critical values for these markers to predict severe disease type were then determined. The hazard ratio of prognosis for risk of COVID-19 identified CEA, WBC, CRP, PCT, Fer, D-dimer, Neu%, and L% as independent prognostic factors. For the nomogram of overall survival (OS), the C-index was 0.84, demonstrating a good discriminative performance.Conclusions: An OS nomogram for the clinical diagnosis and treatment of COVID-19 was constructed using biomarkers. These data will be useful for the diagnosis, management, and therapy of COVID-19.

D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

“…A threshold >1000 ng/mL upon admission was associated with a 18-fold higher in-hospital mortality [ 43 , 45 ]. An increase of neutrophils count was also associated with higher mortality [ 46 , 47 ] and is also usually associated with high D-dimer level with a pro-coagulant state [ 48 , 49 ]. This may support the utility of combining these variables in the assessment of thromboembolic risk.…”

Tumor marker response to SARS‐CoV‐2 infection among patients with cancer

“…In cohort studies of patients without cancer, clinical data shows that up to a quarter of patients with COVID‐19 have elevated CEA values and that the intensity of increase is correlated with severity of COVID‐19. 15 , 16 , 17 , 19 , 20 Among patients hospitalized with COVID‐19, the average CEA value was 8.23 ng/ml, which increased to 14.8 ng/ml among those who died and decreased to 3.8 ng/ml among those who were discharged. 17 Moreover, Chen et al report serial measurement of CEA in 13 patients while they were hospitalized with COVID‐19 and found that levels began to decrease at a median interval of 24 days following infection.…”

“…Finally, this work supplements prior research, which identifies a significant increase in tumor markers among non‐cancer patients infected with COVID‐19. 15 , 16 , 17 , 18 , 19 , 20 Despite these clinical observations, the mechanism of benign elevations in tumor markers, like those following COVID‐19 infection, is not known and are hypothesized to stem from the molecular roles of the markers within the pulmonary inflammatory response. 11 , 14 , 17 , 22…”

“…Clinical data suggest that CEA, CA 19–9, and CA 125 levels might rise in patients with COVID‐19. 15 , 16 , 17 In patients without malignancy, preliminary data show that CEA is elevated above 5.0 ng/ml in approximately one‐fifth (18.7%) to one‐quarter (23.1%) of patients with COVID‐19. 18 , 19 Moreover, the magnitude of increase in CEA, CA 19–9, and CA 125 is associated with severity of COVID‐19 infection.…”

“…The severe acute respiratory coronavirus 2 (SARS‐CoV‐2) induces a distinct viral inflammatory response, resulting in coronavirus disease 2019 (COVID‐19). Clinical data suggest that CEA, CA 19–9, and CA 125 levels might rise in patients with COVID‐19 15–17 . In patients without malignancy, preliminary data show that CEA is elevated above 5.0 ng/ml in approximately one‐fifth (18.7%) to one‐quarter (23.1%) of patients with COVID‐19 18,19 .…”