Prognostic value of carcinoembryonic antigen on outcome in patients with coronavirus disease 2019

Assessment of Thyroid Status and Six Months of Follow-Up in COVID-19 Patients: A Prospective, Observational Study

Background Globally, the COVID-19 pandemic inflicted considerable morbidity and mortality. It has become a systemic illness that affects several body organs. The primary pathway for the SARS-CoV-2 virus to enter cells is the angiotensin-converting enzyme 2 (ACE2) receptor, and it uses transmembrane serine protease 2 (TMPRSS2) for S protein priming. Thyroid follicular cells have been found to express ACE2 and TMPRSS2 at even higher levels than those found in the lungs. The objective of the study was to assess and determine the six-month clinical outcome of thyroid dysfunction in COVID-19 patients. Methods This prospective, observational study was carried out in the COVID-19 unit of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Forty-eight hospital-admitted COVID-19 reverse transcription-polymerase chain reaction (RT-PCR)-positive patients were included as per inclusion and exclusion criteria, and there was no control group. All admitted patients were classified into non-severe (mild, moderate) and severe (severe and critical) disease as per national guidelines. Baseline laboratory tests for thyroid-stimulating hormone (TSH), free T3, and free T4 were done on admission. The patients were again categorized according to their thyroid status. Further evaluation was done by performing autoantibody tests (TSH receptor Ab, anti-thyroid peroxidase Ab, anti-thyroglobulin Ab). The patients were followed up in the first month and sixth month to see disease progression and outcomes. Results Age and comorbidities were associated with an increased risk of severe disease. A total of 35 (73%) patients had comorbidities, 23 (49%) had multiple comorbidities, and 12 (24%) had single comorbidities. All patients (n=48) presented with fever and cough; 45 (94%) patients had fatigue, palpitations were present in 35 (73%) patients, and dyspnea in 32 (67%) patients. The difference in mean values of TSH, FT4, and FT3 among severe and non-severe groups was found to be significant. Most of the patients (n=36; 75%) were in a euthyroid state at baseline. Among the rest, 25% had thyroid dysfunction, including one (2.08%) who had subacute thyroiditis and eight (16.67%) who had euthyroid sick syndrome, which was higher in the severe group (14.59%). Three (6.24%) patients were autoantibody-positive and were diagnosed as having Hashimoto's thyroiditis in the form of primary hypothyroidism (2.08%; n=1) and subclinical hypothyroidism (4.16%; n=2). The Spearman correlation coefficient showed a strong negative correlation between severity and TSH (rs = -0.71) and moderate positive correlations between severity and free T3 (rs = 0.63) and free T4 levels (rs = 0.53). Follow-up at the first month showed that 44 (91.96%) returned to a euthyroid state, and at six months, 45 (93.7%) returned to a euthyroid state. Conclusion Thyroid hormone levels appear to change and recover gradually and spontaneously. Most patients have normal thyroid function status during COVID-19 infections, but a considerable number of patients can develop euthyroid sick syndrome in severe COVID-19 infections, from which they recover spontaneously.

Role of Carcinoembryonic Antigen in Severity Assessment and Mortality Prediction in COVID-19 Patients

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.

Unexplained increases in serum carcinoembryonic antigen levels in colorectal cancer patients during the postoperative follow-up period: an analysis of its incidence and longitudinal pattern

BACKGROUND

Carcinoembryonic antigen (CEA) monitoring facilitates the detection of recurrence in patients with colorectal cancer (CRC) after resection. False-positive CEA has been reported in CRC patients with certain comorbidities or smokers. However, limited information is currently available on the frequency of and changes in falsely elevated CEA levels in patients without these conditions.

MATERIALS AND METHODS

We retrospectively examined CRC patients who underwent surgical resection at our hospital between 2001 and 2017, had no recurrence for at least five years, and were free of known factors that may increase CEA. Postoperative CEA levels were retrieved until 2 years before the last contact. For comparison, we similarly selected patients who developed recurrence after resection of CRC during the same period, and CEA levels at initial presentation, at nadir, and at the time of recurrence were reviewed. The patterns of elevated CEA (>5 ng/ml) were classified as transient, repeated, or persistent based on longitudinal changes. The relationships between CEA and carbohydrate antigen 19-9, transaminases, creatinine, and C-reactive protein were examined.

RESULTS

CEA elevation occurred in 90 (20%) out of 446 eligible patients without recurrence at least once during the mean postoperative period of 50.5 months, whereas CEA was >5 ng/ml in 117 (53%) of 221 patients when they developed recurrence. Twenty-seven patients without recurrence showed a transient elevation in CEA, 45 repeated elevations, and 18 a persistent elevation; the frequency of a high preoperative CEA level increased in this order. The majority (98%) of false elevations ranged between 5 and 15 ng/ml. CEA was not associated with other laboratory data.

CONCLUSIONS

Unexplained CEA elevations were observed in 20% of recurrence-free CRC patients after surgery, and were classified into three patterns based on longitudinal changes. A more detailed understanding of patient-specific fluctuations in CEA will prevent unnecessary imaging studies and reduce medical costs.

Tumor biomarkers CEA, CA19.9, CA15.3 and AFP levels in the serum of patients with COVID-19

Early diagnosis is very important to reduce morbidity and mortality in COVID-19 infected patients. The aim of this study was to detect of tumor antigens CEA, CA19.9, CA15.3, and AFP and to compare their levels in the serum of 69 COVID-19 patients and 69 healthy individuals who did not have COVID-19. The levels of CEA, CA19.9, CA15.3, and AFP in the serum were measured using ELISA. The levels of the tumor biomarkers in the serum of COVID-19 patients were found to be 7.74 ± 4.65 ng/ml for CEA, 29.33 ± 16.35 U/ml for CA19.9, 23.24 ± 13.48 U/ml for CA15.3 and 7.46 ± 5.57 ng/ml for AFP, while in the serum of healthy control patients 9.73 ± 43.58 ng/ml for CEA, 20.66 ± 11.1 for CA19.9, 19.64 ± 10.99 U/ml for CA15.3, and 3.83 ± 9.20 ng/ml for AFP, indicating no differences in the levels of the studied tumor biomarkers in the two experimental groups. It is concluded that tumor biomarkers CEA, CA19.9, CA15.3, and AFP cannot be used as effective screening tools for patients with COVID-19.

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

Background

Inflammatory responses from benign conditions can cause non‐cancer‐related elevations in tumor markers. 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 carcinoembryonic antigen (CEA), carbohydrate antigen 19–9 (CA 19–9), and cancer antigen 125 (CA 125) levels might rise in patients with COVID‐19. However, available data excludes cancer patients, so little is known about the effect of COVID‐19 on tumor markers among cancer patients.

Methods

We conducted a case series and identified patients with a positive SARS‐CoV‐2 PCR test, diagnosis of a solid tumor malignancy, and a CEA, CA 19–9, CA 125, or CA 27–29 laboratory test. Cancer patients with documented COVID‐19 infection and at least one pre‐ and two post‐infection tumor marker measurements were included. We abstracted the electronic health record for demographics, cancer diagnosis, treatment, evidence of cancer progression, date and severity of COVID‐19 infection, and tumor marker values.

Results

Seven patients were identified with a temporary elevation of tumor marker values during the post‐COVID‐19 period. Elevation in tumor marker occurred within 56 days of COVID‐19 infection for all patients. Tumor markers subsequently decreased at the second time point in the post‐infectious period among all patients.

Conclusion

We report temporary elevations of cancer tumor markers in the period surrounding COVID‐19 infection. To our knowledge this is the first report of this phenomenon in cancer patients and has implications for clinical management and future research.

Effect of the coronavirus pandemic on tumor markers

The new type of coronavirus could cause severe acute respiratory syndrome and injuries in other systems as well. Multiple organ damage can occur rapidly in patients infected with coronavirus disease 2019 (COVID‐19). Previous studies have shown that many laboratory biomarkers were not within the normal ranges in COVID‐19 patients. We aimed to summarize laboratory parameters and the tumor markers in COVID‐19 patients. This is a retrospective cohort study conducted on 53 women between the ages of 19–85 years infected with COVID‐19 at a training and research hospital between May 2020 and August 2020. Of the 53 women, 16 (30.2%) had leukopenia. The mean C‐reactive protein level was 18.42 ± 59.33 mg/L. The mean procalcitonin level was 0.1 ± 0.21 µg/L. The liver function tests were within normal limits. The mean creatinine level was 0.58 ± 0.37 mg/dl. Elevated levels of α‐fetoprotein (AFP) in 1 patient, elevated levels of carcinoembryonic antigen (CEA) in 2 patients, elevated levels of cancer antigen 125 (CA125) in 4 patients, elevated levels of CA19‐9 in 2 patients, and elevated levels of CA15‐3 in 2 patients were detected. One of 4 patients who were taken to the intensive care unit had elevated levels of AFP. In addition, 2 of 4 patients who were taken to the intensive care unit had elevated levels of CA125 and CA15‐3. Except for AFP, levels of all tumor markers of the patient who died were high. We found that COVID‐19 had no effect on tumor markers (CA125, CA19‐9, CA15‐3, AFP, and CEA).

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

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic continues to affect millions of people and impact health-care delivery worldwide. New data and insights into the diagnosis and treatment of SARS-CoV-2 are emerging rapidly. Several prognostic biomarkers have been studied in patients with SARS-CoV-2. Among those biomarkers is the carcinoembryonic antigen (CEA). We report the case of a 46-year-old male with a history of colon cancer who was found to have an elevated CEA level during routine surveillance. Further workup confirmed a diagnosis of SARS-CoV-2 infection. The CEA level normalized with the resolution of the infection.

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

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.